Programs provide medical assistance

By DANIELLE LYNCH

Families with special-needs children face challenges in the area of health insurance coverage and often have to turn to programs that offer medical assistance, such as Medicaid agencies.
Children with special health care needs include those with a chronic physical, developmental, behavioral or emotional condition, according to an April 2007 report by Families USA and the Campaign for Children’s Health Care.
“One in five households with children in the United States includes at least one child with special health care needs,” states the report. “Nationwide, more than 13.5 million children – 18.5 percent of all children under the age of 18 – have special health care needs.”
The report notes that comprehensive, affordable health insurance coverage is vital for special needs children.
“Nearly two out of five children with special health care needs (38 percent) receive this coverage from Medicaid and the State Children’s Health Insurance Program (SCHIP),” states the report.
Medical assistance is based on income or if a person is disabled, according to Stacey Witalec, a spokeswoman for the Pennsylvania Department of Public Welfare. But a private insurance company has to pay all it’s willing to pay before a person can turn to medical assistance, she said.
“Medical assistance is considered the ‘payer of last resort,’” Witalec said.
Between Aug. 30, 2004 and Aug. 30, 2008, those eligible for medical assistance under 18 years of age increased both in Chester County and statewide. In Chester County there were 11,782 residents under 18 eligible for medical assistance; and in 2008 it increased to 14,156, according to the state’s Department of Public Welfare’s division of planning, evaluation and budget analysis.
Officials from the West Chester Area School District and the Downingtown Area School District, the two largest school districts in Chester County, commented on the increase in those under 18 eligible for medical assistance over the past five years.
“The West Chester Area School District relies upon student evaluations made on a case-by case basis,” said spokesman Robert Partridge on behalf of district officials. “In cases of identified and verified need, our school district does encourage families of children with Individualized Education Program eligible disabilities to enroll in the medical assistance program, thereby allowing the district to recoup a portion of the expenditures in order to cover district-provided, medically necessary services on IEP (physical therapy, speech therapy, as well as psychological and other services.)”
Partridge said that these services are provided to students based on their individual needs, and this program, known as Medical Access, was opened to allow public school districts to recoup some of the millions of dollars that are spent every year providing IDEA mandated services.
Medical Access was launched in the 1991-1992 school year in Pennsylvania and all school districts are allowed to enroll, according to Pennsylvania Department of Education spokeswoman Leah Harris. Across the state, 600 of the 726 local education agencies, which include intermediate units and charter schools, currently utilize Medical Access, according to Harris. And in Chester County, all 12 school districts and the intermediate unit use the program, she said.
“The federal government continually fails to provide the promised share of funding for the education of students with disabilities,” Partridge said. “Although the district has not become more aggressive in encouraging applications, better diagnostic regimens have allowed for more comprehensive identification of special needs children in recent years, possibly accounting for growth in student numbers in Chester County recently.”
Downingtown Area School District Assistant Superintendent Jake Lopez said his school district informs parents at IEP meetings of the Medical Access program that’s available to those who are eligible.
“It’s one way we can recoup a percentage of the special education costs,” Lopez said. “But it’s also always ultimately the parent’s decision whether they want to apply.”
Lopez said Medical Access is a helpful program for the district because it allows it to earn money back after completing a series of documentation and logs of services.
On the issue of an increase for those applying, he said that over the past five years DASD has increased its awareness of the services available and then informed parents, teachers and administrators of these options.
“I think we’ve become more educated on the process,” Lopez said.
Statewide, there were 783,738 residents under 18 eligible for medical assistance in 2004, according to the Department of Public Welfare. In 2008, the number of medical assistance eligibles raised to 824,368.

For more information about the Campaign for Children’s Health Care, visit http://www.childrenshealthcampaign.org.

To contact staff writer Danielle Lynch, send an e-mail to dlynch@dailylocal.com.