I learned much of this the hard way with Pumpkin. And I do need to specify that this process is only how it works for ME in my part of Texas. I'm sure it's different elsewhere.
The first thing I had to learn is that foster kids in Texas have a different kind of Medicaid. It's safe to say that every single medical professional accepts Medicaid in Deep South Texas. (The culture of poverty almost dictates its necessity.) However, not every professional takes Star Health - the division of Medicaid that foster children are moved to.
Every one of my foster kids has come to me already on Medicaid. I now know to make sure that I specify "Star Health" when I'm contacting a medical professional. Their actual Medicaid number doesn't change when they come in to Care, but the way the insurance is processed does change. So a professional might say that they can accept my child as a patient the first couple weeks. But if they aren't an approved Star Health provider, I'm up a creek as soon as Medicaid makes the paperwork switch. The process can take up to a month.
I knew that Pumpkin (and Miss Daisy) NEEDED private occupational, physical and speech therapies. Yes, you can receive services via Early Childhood Intervention (ECI). However, it is my experience that these therapies focus mainly on educational goals. The speech pathologist currently working with Miss Daisy goes much "deeper" with the therapy than an ECI professional typically would (this information is according to Daisy's therapist). For example, speech therapy currently helps Daisy with feeding - not something that ECI usually does. A lot of stimulation, stretching and other exercises are done all while feeding Daisy a jar of baby food or even a bottle. This therapist is thoroughly trained on feeding issues and concerns. She's able to ascertain whether or not there are aspiration concerns. I feel much better about Daisy's eating after watching what the therapist does with her.
Private therapies are what I wanted Daisy to have. It is my understanding that you cannot have both ECI and private therapies at the same time. So, this is what I did:
- The first thing that had to happen was that Daisy needed to be evaluated by a therapy professional for each discipline. (In Daisy's case this happened when she was in the first foster home.) Generally the child's Primary Care Physician (PCP) will give you a referral to a company that provides therapies. I'm pretty sure it is also possible to call therapy companies in your area and ask for an evaluation without the referral as well. It is my preference to make sure I find a company that does in-home health care. These therapies, in and of themselves, are quite minor when it comes to overall healing. I personally need to watch and put in to practice all the things the therapists are doing with Daisy.
- Each discipline will do an evaluation separately. They go over as much medical history as you can provide. They also work with the child to see what the delays are and they set the goals that the child needs to master based on their development. The evaluator then draws up a formal document listing everything they believe the child needs and how frequent the therapy should be.
- This document is presented to the PCP to sign. If they agree, they sign and submit it back to the rehabilitation company. If they disagree, I believe that the evaluator has to rewrite the document in a manner that the doctor will agree to. (I've never had a doctor not sign what the therapist recommended.)
- The rehabilitation company will submit the signed document to Medicaid for approval. If all goes well Medicaid will accept what the evaluator recommended. However, this is not always the case. Pumpkin, for example, needed intensive therapy and the evaluator recommended therapy three times a week. Medicaid only approved two sessions a week.
- After approval, therapies will begin. The process up to this point in time can take up to a month or longer. I often call the rehabilitation company, the PCP and/or Medicaid to make sure paperwork didn't get hung up somewhere.
Daisy is currently in OT and ST. We're still waiting for Medicaid to approve PT.
This process is common for much of the things you need when caring for a special needs child. For example, when Pumpkin needed her walker the physical therapist had to write an official order. Then the PCP had to sign it. Then it had to be approved by Medicaid. Then I had to find a DME (durable medical equipment) supplier to order it from. (Often your therapist knows which DME they prefer to work with and will get them involved right away. Again - make sure the DME takes the kind of Medicaid your child has.)
When Pumpkin got her leg braces the process was the same.
Everything a special needs child needs takes at least one month MINIMUM before you can actually get it. Often, it can take much longer. I spent a lot of time on the phone chasing paperwork when I had Pumpkin trying to speed up the process.
No real ending to this. Just figured I'd share the information rolling around in my head. Let me know if anything isn't quite clear or if you've got questions. I'd also be interested in hearing if it's different in other parts of the country.