Community News

Toolkit for Children with Special Healthcare Needs
As our project enters its fourth and final year we would like to redirect our emphasis to training parents and professionals to effectively access all of the resources to which they are entitled. We have developed a “toolkit” to assist our partners. This “toolkit” will include a resource directory database, templates for letters of medical necessity and descriptions of and directions for obtaining subsidized health insurance, Medicaid and Medicaid Waiver programs. The materials will be posted on this website as they become available. Later in the year we will be conducting training sessions to further explain the various programs and provide assistance to our community partners and families.

MEDICAID TRANSPORTATION

Medicaid provides transportation to medical appointments for eligible clients

Requirements: Client must have Medicaid
Client does not have adequate transportation for medical appointments

Process: Physician completes transportation form
Physician provides prescription, including what type of transportation is necessary and why. (i.e. cab, ambulette or ambulance)
Completed forms are faxed to the Medicaid Transportation Office in the county in which the client resides.

Phone Numbers/ Fax Numbers:
Suffolk County: Fax: 631-854-5822
Phone:631-854-5801
Or mail to: Dept of Social Services
PO Box 18100
Hauppauge, NY 11788
Att: Medical Transportation

Nassau County: Fax:516-931-0853
Phone: 516-433-1660

New York City:Phone:800-343-9000

Special requests are required for facilities outside of client’s local area or for upgrades in mode of transport.
Medicaid Transport will send a letter of approval to the clients’ home with the coverage dates(usually coverage is granted in 6 month increments) and any special provisions (out of area or upgrades in mode of transport, ie. ambulette, ambulance)

Client must call in advance for each appointment. Appointments require 24 hours notice (unless emergency) and may be booked one month in advance.


DIAPERS FOR ELIGIBLE MEDICAID CLIENTS
Diapers, chux (disposable underpads) and diaper liners will be delivered to the client’s home each month. Three reusable chux will be provided each year.

Requirements:
1. Client must have Medicaid.
2. Client must be >3 years old.
3. Client must have special needs.

Process:
1.Physician must provide prescription every 6 months.
2.Fax prescription and client information, including size of diapers, to participating supply companies.

Supply Companies:

NuTech-631-234-4443
RRT Group, Inc.-888-455-4855
Centereach Pharmacy- 631-588-7935
Home Care Supply- 516-349-4500
Home Care Concepts- 631-752-0555



WIC PROGRAM

WIC is a nutrition education and supplemental food program for low income pregnant, postpartum and breastfeeding women, infants and children up to 5 years of age.

Requirements:
1. The WIC Program is designed to serve certain categories of women, infants, and children. Therefore, the following individuals are considered categorically eligible for WIC:
Women -- pregnant (during pregnancy and up to 6 weeks after the birth of an infant or the end of the pregnancy)-- postpartum (up to six months after the birth of the infant or the end of the pregnancy)-- breastfeeding (up to the infant's first birthday)
Infants (up to the infant's first birthday)
Children (up to the child's fifth birthday)

2. Participants must live in the state in which they apply.
3. To be eligible for WIC, applicants must have income at or below an income level or standard set by the State agency or be determined automatically income-eligible based on participation in certain programs.
WIC Income Eligibility Guidelines
(Effective from July 1, 2007 to June 30, 2008)
48 Contiguous States, D.C., Guam and Territories
Annual**** Monthly**** Weekly
1 18,889**** 1,575**** 364
2 25,327**** 2,111**** 488
3 31,765**** 2,648**** 611
4 38,203**** 3,184**** 735
5 44,641**** 3,721**** 859
6 51,079**** 4,257**** 983
7 57,517**** 4,794**** 1,107
8 63,955**** 5,330**** 1,230

Process: Contact the WIC office nearest you for an appointment.

Stony Brook WIC- 631-444-5239
181 Belle Meade, Road Suite 2
East Setauket, NY 11733
Family Service League-same # for appt. 1444 Fifth Ave
Bay Shore, NY 11706


CARE AT HOME WAIVER FOR DEVELOPMENTALLY DISABLED CHILDREN (III, IV AND VI)
FUNDED BY OMRDD

CRITERIA:
· Under the age of 18
· Developmentally disabled and has a true medical diagnosis making the child medically fragile
· Ineligible for Medicaid due to parent(s) income/eligible when parent(s) income is not counted
· Needs home care that will continue for at least 12 months
· Eligible for ICF (intensive care facility) level of care but living at home
· Not currently hospitalized
· Home assessment required

BENEFITS:
· Medicaid coverage
· Case Management
· Home Modifications ($16,200 per year)
*The first requirement for waiver programs is to apply for Medicaid and receive a denial.


Contact information: LIDDSO

Stephanie Earl
Marjorie Ziemann 631-493-1711



CARE AT HOME WAIVER FOR PHYSICALLY DISABLED CHILDREN I & II
Funded by OMRDD & DOH (Office of Mental Retardation and Developmental Disabilities & Department of Health)

CRITERIA:

· 30 days in the hospital within a 90 day period any time in child’s life.
· Under the age of 18
· Ineligible for Medicaid due to parent(s) income/eligible when parent(s) income is not counted
· Has a skilled need that requires placement in home of private duty nursing
· Eligible for ICF (intensive care facility) level of care but living at home
· Level two requires that child is technologically dependent

There will be a Home Health Assessment performed by DSS nurse to determine the extent of needs the family and child require. This is part of the eligibility process.


BENEFITS:

· Medicaid coverage
· Case management
· Home modifications ($20,000 a lifetime)
· Nursing coverage

* The first requirement for waiver programs is to apply for Medicaid and receive a denial.

Contact Information:

Tom Meade 631-854-5863


CHILDREN WITH SPECIAL HEALTH CARE NEEDS PROGRAM
FUNDED BY NEW YORK STATE DEPARTMENT OF HEALTH
AND SUFFOLK COUNTY
ADMINISTERED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES
DIVISION OF SERVICES FOR CHILDREN WITH SPECIAL NEEDS

Criteria:
· Under the age of 21
· Physically Disabled or Chronic Health Condition
· Meet financial eligibility standards
· Medicaid Pending or ineligible for Medicaid
· Private insurance does not meet all the child’s needs

Process:
Contact the Suffolk County Office for information:
631-853-8350
The Medical Director will determine medical eligibility.
Financial eligibility will be determined by Suffolk County based upon family income and assets.
Child’s specialist physician must be a Medicaid provider, sign documentation and provide information regarding child’s status, and agree to accept Medicaid fees.
Complete the financial portion of the application. This will determine the amount of the monthly premium you will be required to pay.
Example: Based of a Family of 4:
Earnings of $42,000 or less – no parent payment
$50,000 premium is $37 per month
$56,000 premium is $60 per month

Benefits:
NO COPAYMENTS FOR ELIGIBLE CONDITIONS
Program pays for items that private insurance does not (i.e. diapers, formula), as approved by Medical Director
Assists with payment for durable medical equipment
Does NOT pay for nursing services or therapies

*Your primary (private insurance) must be utilized first. This program will pay for the uncovered portion in many cases, up to the Medicaid rate.



LOMBARDI PROGRAM
Long Term Home Health Care Program (LTHHCP)
Funded by The Department of Health
Administered by
Suffolk County Department of Social Services

Criteria:

· Must be eligible for Medicaid
· Chronically ill or disabled, children and adults, & medically eligible for a Skilled Nursing Facility
· Not currently in a Nursing Home or Hospital
· Necessary Home Care services can not exceed 75% of the monthly cost of a Skilled Nursing Facility
· Must have at least 2 areas of unmet skilled needs, ie: therapy, skilled nursing visits, social services

Provisions:

Program is meant to keep patient out of the hospital and/or nursing home
Patient remains at home with all medical & physical needs appropriately maintained
Comprehensive services are available to assist caretaker in maintaining at home
(Nursing, Home Health Aide, Medical Supplies and Equipment, Therapies, Home Adaptations, Home Maintenance, Social Services)



Contact: Loretta Savino 631-854-9834
Department of Social Services


CRITERIA FOR MEDICAID ELIGIBILITY
Low Income Families (LIF)

-Strictest guidelines for acceptance
-Based on income of the parent(s)
Counted income is earned (employment) and unearned (child support, SSI)

Resource allowance $3000
Leased cars are not considered an asset
Allowance for value of 1st car $4650
A 2nd car is only allowed if needed for work or medical appointments
Allowance for burial/funeral arrangements $1500


Medically Needy Families

-Allows for the deduction of all medical costs for every member of the family (this is subtracted from countable income thus lowering the amount of earned/unearned income) it is called a Spendown.
-If the income requirements are not met the family can pay an out of pocket premium in the amount of the surplus income this is call an Overage.


Child Health Plus

-under age of 19
-NY State resident
-not enrolled in Medicaid
-not have health insurance equal to Child Health Plus
-not have access to coverage by a state health plan*
*a child who has a parent with access to family coverage by a State benefits plan where the public agency pays all or part of the cost of medical benefits
Cost is based on family income and number of people in the family
Child Health Plus may be FREE or have a small monthly cost
-you must select a managed care plan
1-800-522-5006


Supplementary Security Income (SSI)
www.ssa.gov or 1-800-772-1213

-Automatic Medicaid coverage
-Based on parent income for a child under 18
No limit on car value
Burial/Funeral allowance $1500
Resource Allowance $4000
After age 18 SSI is based on income of recipient
All assets of children over 18 in excess of $2000 are countable
Assets in excess of the allowance need to be protected in a Special Needs Trust


*See chart for Medicaid Assistance Only Income and Resource Standard. The income allowance is measured by family size and ages of the children in the household.
http://www.nyc.gov/html/hra/html/medical_insurance/medicaid.shtml

*Medicaid recipients with eligible disabilities are exempt from mandatory enrollment into managed care programs.


DISENROLLMENT FROM MEDICAID MANAGED CARE
· Medicaid recipients with physical or developmental disabilities are not mandated to participate in a Managed Care Program because they can be too restrictive to meet all of the individual’s needs. (I.e. some clinics only accept straight Medicaid)
· They are often assigned a Managed Care agency but have the option of disenrolling.

If you or your child are disabled and have been enrolled in a Managed Care program you can contact the specific program and request a disenrollment form. (See attached contact numbers)
State that you are exempt from the mandatory Managed Care assignment. * See attached exemption list
Ask how soon you/your child will be disenrolled.

Please call 888-566-9799 to request disenrollment form


Medicaid Managed Care Exclusions and Exemptions
EXEMPTIONS

The following persons may voluntarily enroll but are not required to enroll in Medicaid managed care.

· Individuals who are HIV positive
· Individuals who are seriously & persistently ill or seriously emotionally disturbed
· Individuals for whom a managed care provider is not geographically accessible
· Pregnant women receiving prenatal care from a provider not participating in any Medicaid managed care plan
· Individuals with chronic medical conditions who have been under active treatment for at least six months with a sub-specialist who is not a network provider for any Medicaid managed care plan in the service area or whose request has been approved by the SDOH medical director because of unusually severe chronic care needs
· Individuals with end stage renal disease
· Residents of intermediate care facilities for the mentally retarded (ICF/MR)
· Individuals with characteristics and needs similar to those who are residents of an ICF/MR
· Individuals already scheduled for a major surgical procedure (within 30 days of scheduled enrollment) with a provider who is not a participant in the network of any Medicaid managed care plan in the service area
· Persons with developmental or physical disability receiving services through a Medicaid home and services waiver
· Individuals whose needs are similar to participants receiving services through a Medicaid home and community based service waiver
· Participants in the Medicaid model waiver (Care at Home) programs
· Individuals whose needs are similar to participants receiving services through the Medicaid model waiver (Care at Home) programs
· Residents of alcohol/substance abuse long term residential treatment programs
· Homeless
· Eligible Native Americans
· Individuals who can not be served by a managed care provider due to language barrier
· Residents with a “County of Fiscal Responsibility” code of 97 OMH in MMIS or 98 OMRDD in MMIS
· Individuals temporarily residing out of district





Medicaid Managed Care Exclusions and Exemptions
EXCLUSIONS

The following persons are excluded and can not join a managed care plan.

· Medicare/ Medicaid Dually Eligible
· Individuals who become eligible for Medicaid only after spending down a portion of their income
· Residents of state psychiatric facilities and residential treatment facilities for children and youth
· Residents of residential health care facilities at time of enrollment and persons who enter a residential health care facility subsequent to enrollment except for short-term rehabilitative stays anticipated to be less than 30 days
· Participants in capitated long term care demonstration projects, including beneficiaries with Medicare
· Medicaid eligible infants living with incarcerated mothers
· Infants weighing less than 1200 grams at birth and other infants less than 6 months old who meet the criteria for SSI related category
· Comprehensive private health insurance consumers if cost is lower to the state
· Certified blind or disabled children living or expected to live separate from their parents for 30 days or more
· Individuals expected to be Medicaid eligible for less than 6 months (except for pregnant women)
· Individuals receiving (at the time of enrollment) institutional long term care services through long term home health care programs, or child care facilities (except for ICF services for the developmentally disabled)
· Individuals eligible for medical assistance benefits only with respect to tuberculosis related services
· Mental health family care services recipients
· Individuals enrolled in the restricted recipient program
· Individuals with a “County of fiscal responsibility code 99 in MMIS”
· Individuals receiving hospice services
· Foster care




*This does not apply to children with Child Health+ B. They will be assigned a Managed Care Program and are not permitted to disenroll. It is important to select your in network providers accordingly.


Cody Center Spring 2008 Workshop Series
REGISTRATION: Call the Cody Center at (631) 632-3706, or email shirley.woodward@stonybrook.edu at least one week in advance to confirm location and insure admission.
SUGGESTED DONATION: $10 per workshop. Professionals seeking documentation of attendance are asked to pay a fee of $25
LOCATION : Room 120, Endeavour Hall, Stony Brook University (Unless otherwise noted)


Graduate Courses
The Cody Center has developed two tracks of graduate courses for professionals interested in learning more about autism spectrum disorders, effective intervention strategies, and lifetime issues for individuals with autism and related disorders. The two tracks include a five course series for students seeking board certification as a behavior analyst (BCBA), and a generalist track for teachers, social workers, guidance counselors, and other allied health professionals. All courses are offered through the School of Professional Development at Stony Brook University. For more information about specific courses and schedules, visit www.codycenter.org.


Social Skills and Parent Training Groups
The Cody Center offers Social Skills training for children ages 6 to 16 as well as Parent Training for all parents of children with autism spectrum and related disorders. For more information, please visit
www.codycenter.org for intake questionnaires or phone 631-632-3070, option 3.

Sexuality Education and Reproductive Health Services
The Cody Center is funded by a grant from the New York State Department of Health to provide sexuality education and counseling, and sexual health services to adolescents and adults with developmental disabilities. Education and short-term counseling services are available free-of-charge. Sexual health services may be paid for by insurance, Medicaid or Medicare, or may be paid by a government program. For an intake, please phone 631-632-3147, or visit www.codycenter.org for an intake questionnaire.






YOGA FOR KIDS
O’Connell, Selig & Associates of Hauppauge PRESENTS:

YOGA FOR KIDS!

Classes are taught by a
Registered Occupational Therapist and Yoga Instructor,
Kathleen Dormer Brady.

Join YOGA FOR KIDS to discover how Yoga can:

· promote healthy development for children of all ages and abilities
· improve overall strength and flexibility, motor planning skills and sensory awareness
· teach breathing techniques and proper alignment which can help enhance speech development
· improve focusing and concentration skills
· promote self-calming abilities





*All of our classes are grouped by age and are INCLUSIVE, involving children with special needs, as well as typically developing children.
*Class size is limited to 3-5 participants.
*Classes run for 8 weeks, 45 minute sessions and will begin in September.

If you are interested in signing your child up for YOGA FOR KIDS, please call O’Connell, Selig and Associates Hauppauge office at 631-582-0088.


PARENT TO PARENT WINTER 2008 CALENDAR OF EVENTS








ALL OF THE ABOVE EVENTS WILL BE HELD AT
PARENT TO PARENT, LOCATED AT THE LONG ISLAND DDSO,
415A OSER AVENUE, HAUPPAUGE, NY
SPACE IS LIMITED, PLEASE CALL (631) 434-6196 TO REGISTER.