Wednesday, March 21, 2012

Paid In Full

When caring for a child with autism things can get expensive. There are many things that can begin to eat away at your bank account. Even if you find that some services are free to you through the school or other programs you may be lucky enough to have, it never hurts to have extra sources of money. If you are in Oklahoma I may have a way to help with these growing costs.

As I have mentioned in the past, Konner attends numerous therapies each week to help with different issues caused by his disorder. There is occupational therapy twice a week, speech therapy three times a week, and behavior therapy once a week. While the OT and two sessions of speech therapy are paid for through the school, the others are (or were) out of pocket expenses.

Even with insurance there are many types of services that are not covered. This is because autism, although actually a neurological disorder, is considered a mental disability. Many know that these are not covered with your average health insurance.

Oklahoma residents have a resource that many don’t even know about. Through the Oklahoma Department of Human Services families may be eligible through The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1992 which allows children with physical or mental disabilities, who would not ordinarily be eligible for State Supplemental Income benefits because of their parent's income or resources, to become eligible for SoonerCare (Medicaid)

We actually learned about this program through our first psychologist Dr. Lisa Fitzgibbons. She recommended that we apply to help with costs.

I’m not going to lie and tell you that it’s easy to apply for. In fact, it’s a pretty big ordeal. The first time we tried we didn’t have everything together in time and had to reapply. However, it’s well worth it. Hopefully I can give you some tips to help you out.

The first thing to do is to visit the OKDHS website at: This link will take you directly to the TEFRA information with links to help you gather everything you need and download the forms that you will have to fill out.

According to the website the following are the eligibility requirements:

  • Be under age 19;

  • Meet the Social Security definition of disability (which falls under the following criteria: you cannot do work that you did before; DHS decides that you cannot adjust to other work because of your medical condition(s); your disability has lasted or is expected to last for at least one year or to result in death).

  • Have qualifying income and resources;
  • Meet an institutional level of care. The three levels are: intermediate care for the mentally retarded, nursing facility, or hospital;
  • It must be appropriate to care for the child at home;
  • The estimated cost of caring for the child at home cannot exceed the estimated cost of caring for the child in the institution.

The benefits that will be covered if you are approved include:

  • child health/EPSDT
  • dental care
  • emergency and non-emergency transportation
  • inpatient and outpatient treatment
  • medical equipment
  • occupational therapy
  • pharmacy
  • physical therapy
  • vision

After you have read everything and get a good idea of what you need to do you will have to contact your local DHS and contact the person who processes their TEFRA forms. You will do a request for benefits, and you will have to have a doctor fill out the physician assessment form.

You will also be selected for an interview at the DHS office. Take whatever date they give you and don’t miss it.

As mentioned before there is a small window of opportunity when filling out these forms, so make sure that you have everything you can prepared ahead of time and make copies of everything. If they ask for information more than once give it to them. Remember that no matter how frustrating it can be they are trying to get you benefits (free money). If they give you a deadline to fill out paperwork, do it and turn it in early.

Don’t call and bug them to death, but I would recommend that you check in with them frequently to make sure they have everything.

You have to reapply each year, so make sure that you fill out the annual forms and turn them in on time.

Some people may feel like this would be asking for help or taking handouts from the government. If you have a problem with that then you can ask yourself if your pride is more important than helping your child. In our case we both work, have insurance, and already pay out of pocket as much as we can for services for Konner. This was just a way of helping to obtain additional services that we wouldn’t have been able to afford otherwise. Don’t feel like you’re taking handouts. You’re just providing the best care for your child.

Without this program Konner’s medicine would have been $100 per month with insurance alone. Now they are free, our insurance pays a portion, and the TEFRA pays the rest. This is the same for doctor’s visits as well.

When it comes to therapies, we were paying $75 or more per hour for certain therapies. After being accepted to TEFRA the therapies are paid in full.

TEFRA, a national program, is available in many states, but some have their own assistance plans. If you are in a different state I would recommend that you contact your local Department of Human Services and ask if they have a similar program.

Disclaimer: I am in no way claiming to be an expert. I’m just a father who is trying to learn as much about Autism as I can to help my child. I hope that you all can learn from me, and I from you. I ask anyone who has questions or comments about something I have written, or autism, please contact me at I will try to answer questions as I have time, and if I find it interesting enough I may touch on it in my column.

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