Things to Consider
- Keep an updated medical history of doctor's seen, tests performed, medications, etc.
- Develop a list of medical providers that are important in order to maintain the health of your young adult.
- Work with your young adult to identify what needs are critical and ensure the insurance they choose will meet those needs.
- Know that just because a provider accepts Kansas Medicaid for children, this does NOT mean they will also take Medicaid, even if they see adult patients.
- If your young adult will need to switch doctors because of insurance, begin the transfer of care process as early as possible to avoid a gap in care.
Where to go for Healthcare
Accessing healthcare can sometimes be a challenge, especially if you have public insurance or no insurance at all. There are many access or entry points into the health system that can help you. The option that is most effective and generally provides the highest quality care is through a primary care provider. This is someone who will help you manage your overall health and can help coordinate with other specialists or doctors. However, having a primary care provider is most challenging when you do not have insurance coverage or with Medicaid coverage.
Another option for health care access is a community health center. Community health centers are hospitals, health centers or clinics that provide free or low-cost health care. Typically you will find a wide range of services at a community health center, including (but not limited to): prenatal care, child immunizations, general primary care and some specialized care. Specialized care within a community health center will vary, but it commonly includes mental health, substance abuse and HIV/AIDS. You can access care at one of these centers if you have insurance as the cost of care at a community health center depends on income and insurance status.
Of course, urgent care walk-in clinics and emergency rooms are available for those urgent or emergency situations. However, urgent care centers or emergency rooms are not recommended for primary health care services. Not only is it nearly impossible to receive patient-centered care, but it is also much more costly for the patient and the overall health system.
State & Local Health Programs
Just as there are many options to access care, there are several options for paying for that care for young adults with disabilities or health care needs. Many times you can get insurance through an employer. However, if an employer does not offer insurance, or if the individual is not qualified for their insurance or is unemployed, there are options available.
The two main types of public insurance options include Medicaid and Medicare. Medicaid provides coverage for people with lower incomes, the elderly, people with disabilities and some families and children. Medicaid is a state-run program that receives funding from the federal government. You can view information regarding Medicaid on the state’s website at www.kdheks.gov/hcf.
Medicare is health insurance for people over the age of 65, certain people under 65, people with disabilities and anyone with end-stage renal disease. To be eligible for Medicare, you must also be getting Social Security Disability Insurance (SSDI) benefits. There is a 24-month waiting period after receiving SSDI benefits. However, your young adult may be eligible for Medicaid during this time.
Private insurance options include those you purchase on your own. Although private insurance options are generally more costly, the benefits will likely outweigh the added expense, especially if the individual has chronic conditions or high medical needs. The federal government has a tool that can help you identify possible options for you at their website www.HealthCare.gov.
Long-term care or personal assistance care can provide supports for people with disabilities for activities of daily living. Often, Medicare and many insurance companies will not pay for this type of care. However, Medicaid will cover these types of expenses for eligible individuals in assisted living, nursing care or independent living settings. Independent living settings generally can receive assistance through the Home and Community Based Service waivers. For more information on these waivers, review the Housing section of this website.
Another option is a pre-existing condition insurance plan (PCIP) or high-risk insurance pools, available for those who have a hard time getting insurance. A PCIP can make health coverage available to you if you have been denied insurance because of a pre-existing condition or you’ve been uninsured for at least six months. In Kansas, the PCIP is a state-run program that is administered by the Kansas Health Insurance Association (KHIA). The KS PCIP offers a PPO benefit plan that includes comprehensive coverage for hospital care, primary and specialty services, and prescription drugs for those who qualify. To be eligible for this program:
- You must be a resident of Kansas and a U.S. citizen or national, or person lawfully present in the United States; and
- You must have been uninsured for at least six months prior to applying; and
- You must have a qualifying pre-existing medical condition or a denial letter from an insurance company or a letter of acceptance with a reduction or exclusion of coverage for your pre-existing condition.
State & Local Health Programs
In addition to the coverage options, some state or local programs that may be able to provide assistance with certain medical needs if you meet eligibility criteria.
The Charitable Health Program provides medical care to those who do not have health insurance and have an annual income at or below 200% federal poverty level or are enrolled in programs funded by the state Medicaid agency or Indian Health Services. This program provides liability coverage to health care professionals in exchange for providing charitable care without fear of lawsuit for that care.