2. Overview of Presentation
Overview
Funding History
Timeline and Process for Services
Insurance Background
New Hampshire's Subsidized Insurance Plans
Affects on Child and Community
Policy Recommendations
Summary
Reference Page
3. Overview
Children and Families with medical diagnoses face many daily
challenges
We all want our children to be as successful as they can be
Why would Special Needs children be any different?
If they need extra supports in the home and at school- why
do some policies prevent this from happening in the
State of Vermont?
4. Funding of Services
Funding for services within the State of Vermont comes from federal grants, as well as disability
insurance
Howard Center, a large mental health agency, received 72.6% of its revenue through Medicaid in fiscal
year July 2008 to June 2009*
Public schools, some mental health agencies, and out of network providers are able to bill Medicaid
or other insurances for services
Families are asked soon after a diagnosis to fill out paperwork for Katie Beckett, disability insurance,
through the State of Vermont**
This allows for service agencies to be reimbursed for services if not paid through insurance
*Howard Center Annual Report, 2009
**Vermont Family Network, n.d.
5. Timeline for Services
Family becomes concerned about their child
Pediatrician and family discuss concerns
Referral is made to have assessment done OR a follow up visit will be made to revisit
concerns
Determination made regarding if the child will qualify for services based on
developmental assessments and diagnoses
Multiple meetings may be set up with service providers, legal guardian, and child if
appropriate
Service begins once Individual Education Plan, or Individualized Family Service Plan is in
place
Meetings will occur after plan has been in effect for 6 months, and will be reviewed every
year. Assessments will occur every three years or as needed
Vermont Family Network, n.d.
6. Katie Beckett Insurance
Disability based Medicaid insurance
Targeted to service children, ages birth to nineteen, who have a disability that
requires a high level of care
Eligibility is based on the child’s income and their medical history
The Eligibility office will collect medical history to determine if the child qualifies
Examples of Children who may qualify
A child may have a g tube or IV and require extra specialized care at home to remain
out of the hospital may qualify
A child who has a mental health diagnosis that may need to live at a residential
facility like Brattleboro Retreat
◦ Vermont Health Connect, n.d.
7. Green Mountain Care : Dr. Dinosaur
Provides insurance to Vermonters below poverty level and 100% above depending on
family size
Federally and State funded insurance
Subsidized medical, dental, and eye care insurance
◦ Monthly payments and doctor office copayments based on qualifying plan
◦ Some limitations on coverage including hearing aid and eye wear replacement, and other
specialty exams
Examples of Children who may qualify
◦ Eligibility based on family combined income
◦ Children in State of Vermont Department of Children and Families custody
Vermont Health Connect, n.d.
8. Similar Policies in New Hampshire
Children with Severe Disabilities (CSD)
◦ New Hampshire’s Katie Beckett insurance
◦ Based on child’s income
◦ Insurance up to 20 years old
◦ Coverage for home care for children with severe disabilities
◦ Must provide documentation and Doctor letter to verify medical condition
Children and Families
◦ Based on families income
◦ Insurance up to 19 years old
◦ Coverage for children, pregnant women, and family members
New Hampshire Department of Health, 2016
9. More than Child and Families Affected
Children and their Families
◦ Diagnosis may affect available services due to finances
◦ Lack of funding may leave parents with unexpected and large medical bills
Community Members
◦ Pay taxes towards Mental Health services
◦ Donate money and serve on boards of organizations like Vermont Family Network, Howard
Center, and Visiting Nurses Association
◦ Employees for the above organizations
Policy Makers
◦ Responsible for making decisions that affect families and children as well as making
financially responsible decisions
Howard Center, 2009
10. Social Workers are Advocates
Be able to refer to services available based on
Evidence Based Practice (EBP) as well as follow
up on how progress
Be able to advocate for and educate families
on the process of screenings and services to
enable their successful involvement in the
process
◦ The process of how a referral works and the
timeline
◦ How the Medicaid application process and
funding works
Social workers should be involved in public
policy as they work with families day in and
out
Advocate for public policy to benefit the
population serving by using knowledge
◦ Primarily the interest of the child
◦ Secondly the interest of the family
◦ Thirdly the interest of the community
Hardcastle, 2011
11. Policy #1
Create a new subsidized insurance to help
agencies be reimbursed for services provided.
Will provide reimbursement to organizations that covers services provided to children
who do not meet the criteria for Katie Beckett Medicaid Insurance
Children and Families should be able to receive the support they need to reduce the
risk for hospitalization or needing to move to a residential facility
Early intervention has proved to be a successful strategy used, yet there is little
funding for families to guarantee these services will be available for their child
Organizations and Agencies not currently contracted with State could become
approved and accept this insurance
12. Policy #2
Increase the income limits for children’s Medicaid
By providing insurance to families at a higher rate above poverty
◦ Families stress level will decrease
◦ Parents may be able to work less to provide basic needs of their family instead of working to
pay for insurance
◦ This will increase the amount of children who qualify for subsidized
◦ Additional supports would be available for families with children who are at risk
◦ By having supports for at risk families, early problems can be identified and intervention can
take place
◦ This would save money in the long run for families and our communities
13. Policy #3
Organizations able to receive reimbursement for services
from private insurances
Would open access of services to more children
Reduce the time consuming application and the stress of families to apply for
Katie Beckett Applications that are denied may be able to be approved by this
alternative insurance
Could be used as a step down from disability insurance with option to apply for Katie
Beckett if needs arise
Allow child to receive services before the child's symptoms need residential housing
14. Summary
Social workers should be engaged in both helping families and children directly and should effect
changes via policy changes to create greater support for families and children
Children and families should have access to the services they need without needing to convince
anyone their child's diagnosis qualifies for disability
Community organizations should be reimbursed for provided services
By supporting early interventions, social workers can refer clients to the appropriate programs for
support as there can be confusion regarding insurance requirements
15. References
6 Ways to Access Medicaid. (2009, July). Retrieved April 21, 2016, from http://www.vermontfamilynetwork.org/wp-content/uploads/2010/09/6WaysAccess.pdf
Annual Report 2009 Howard Center. (2009, August 1). Retrieved April 21, 2016, from http://www.howardcenter.org/documents/AnnualReport2009_004.pdf
Department for Children and Families - EARLY INTERVENTION PARENTAL RIGHTS. (n.d.). Retrieved April 21, 2016, from http://dcf.vermont.gov/child-
development/cis/IDEA_part_C/parental_rights#One_Plan
Eligibility - Children | Medical Assistance | Division of Family Assistance | New Hampshire Department of Health and Human Services. (2016). Retrieved April 22, 2016, from
http://www.dhhs.nh.gov/dfa/medical/children.htm
Inspirational Quotes Archives - Special Education Resource. (n.d.). Retrieved April 20, 2016, from http://specialeducationresource.whoknowsaguy.com/resource-
center/category/inspirational-quotes
Hardcastle, D. A., Wenocur, S., & Powers, P. R. (2011). Community practice: Theories and skills for social workers [Third Edition]. Retrieved April 22, 2016, from
https://books.google.com/books?id=GPpg3KK9o6EC&pg=PT479&lpg=PT479&dq=advocacy spectrum&source=bl&ots=WLmis075fa&sig=-uddHCaLcjnGa9ExLk-
F3P7vnG4&hl=en&sa=X&ved=0ahUKEwjxk8bRkaLMAhWIVz4KHQNKC4EQ6AEIMTAD#v=onepage&q=advocacy spectrum&f=false
Kilpatrick, C., & McCarthy, P. (2013, Spring). Initial VCDR Response to the First Challenges Progress Report. Retrieved April 21, 2016, from http://vcdr.org/position.html#CPCS
Vermont Family Network - Empowering and Supporting All Vermont Families of Children with Special Needs. (n.d.). Retrieved April 22, 2016, from
http://www.vermontfamilynetwork.org/
Vermont Health Connect. (n.d.). Retrieved April 22, 2016, from http://info.healthconnect.vermont.gov/Medicaid
