Medicaid is a federal medical assistance program, administered by each state, for qualifying low-income children who are citizens and, under certain special circumstances, for some immigrant and refugee children. There is a separate Medicaid program for adults aged 18 and above. Beyond the basic minimum required benefits, each state can choose to offer certain extra programs and services as part of Medicaid, as well as its own state programs with different eligiiblty critieria. Washington is one of several states that enroll children who have been hospitalized for 30 days in the state children’s Medicaid program, regardless of family income. Many WA children undergoing BMT at CHRMC will qualify for this benefit. This special coverage lasts for a year, at which time coverage will be reviewed. Medicaid also includes coverage for transportation and prescription drug costs, and additional services for children with special health needs.
If your child does qualify for this special Medicaid coverage, and is also covered by other insurance, a determination will be made as to which plan will be the first payor of claims. A plan–called coordination of benefits–will be made to designate which insurance is primary and which is secondary for paying the bills. Some private insurance plans will not coordinate benfits, and you may be responsible for submitting the claims to the company yourself. You will be given detailed information about Medicaid coverage, and coordination of benefits if appropriate, by the Financial Services staff at CHRMC. See also the sections of this site on Financial Assistance and If Your Child is Uninsured to learn more about the Medicaid. program.
Indian Health Service (IHS)
If your child is a beneficiary of the Indian Health Service, s/he may also be eligible for Medicaid, depending on your family income. Contact the BMT center’s financial services office or call Healthy Kids Now at 1-877-543-7669 for more information. The websites of the regional IHS office, as well as of the Centers for Medicare and Medicaid Services (CMS) may also offer some useful information.
Portland Area IHS Office (serving OR, WA, and ID
Although it may seem curious to mention Medicare on a website about BMT for chidlren and youth, some young people may qualify for this program if they are eligible disabled workers. Young people who have been employed part-time or full-time (including students who have worked during summers and school breaks) possibly may become eligible for coverage by the Medicare program. Medicare covers not only most senior citizens, but also certain workers under age 65 who have been enrolled in the Social Security Disability Insurance (SSDI) program for a 24 month period. Eligibility for SSDI is based both on the severity of an illness or disability and on having earned a certain number of work credits pro-rated by age. Workers must have been disabled for at least 6 months with a condition that is expected to last for at least a year or be fatal; BMT-treatable illnesses often fall into this category. Eligibility can sometimes be adjusted retroactively after approval. For more information you may need to speak with an oncology social worker who works with adults. Medicare may restrict coverage for BMT based on diagnosis and/or transplant type. For more information, visit the following websites.
1 -800- MEDICARE
ALERT: Hill-Burton Program
Families should note that although they may see this program listed elsewhere as a resource for financial help, the Hill-Burton program should NOT now be considered a source of aid for specialty care like cancer treatments or BMT. The Hill-Burton program was created by the federal government after WWII to address a serious shortage of hospitals nationwide, and ended in 1997. There are now very few facilities that have any remaining community service obligations. In WA, only two nursing homes for adults and one community health clinic are in this category. See our Financial Assistance page for more details, and visit the Hill-Burton program website for a nationwide listings of currently obligated facilities.