“Do you accept [insert CMO insurance here]?”
This is often the first thing that an exhausted parent asks when seeking therapy services for their child. Why are they exhausted? Because they’ve been relentlessly searching for a therapist who will accept the type of Medicaid insurance their child is covered by.
It’s not an easy task to find a CMO widely accepted by rehab centers and private practices. For example, a well-known community staple in the Atlanta-Metro area is Children’s Healthcare of Atlanta (CHOA), and they are known to refer children with chronic communication disorders, who are covered by CMO insurances, to providers in the community. Parents are often surprised to find that CHOA will willingly evaluate their child, but they will not provide ongoing speech therapy to children covered by Amerigroup, Peach State, Wellcare, or CareSource. They will refer these children to providers in the community, like Atlanta Speech Therapy.
What is a CMO, you ask?
CMO stands for Care Management Organization. In Georgia, these organizations are Peach State, Amerigroup, Caresource and Wellcare). Several years ago, the Georgia Department of Health contracted each of these companies to manage the care of children who qualify for Medicaid based on household income. In doing this, the Department of Health took a huge weight off their own shoulders for the sake of being cost-effective, as the CMOs are now “gatekeepers,” and placed an even larger weight on the shoulders of private providers.
This transfer of management led to an increase of administrative duties for providers. For speech therapists, this now requires us to authorize ongoing therapy visits every few months by gathering and submitting documentation to the child\’s respective CMO — the paperwork shuffle. This process of authorization has become more and more cumbersome for providers, as therapy services can be denied, though there is a documented need. Denials often result in the therapist having to schedule discussions with the insurance reviewer to make a case and fight for the services a child needs.
The authorization process will ALWAYS delay the start of your child\’s therapy services.
When a child has an IEP, pursuing private therapy becomes a bit trickier, as these children may not be approved because all Medicaid insurances require a copy of the child’s IEP and can deny a child the right to individual private therapy and render it “duplication of services.”
How do you avoid the hoopla and ensure your child has FREE and/or affordable healthcare?
There are several ways to qualify for this type of Medicaid. Depending on the severity of your child’s difficulties, he/she may qualify for Medicaid based on medical diagnosis and/or financial need (see below). This is often referred to as traditional Medicaid by those in the medical community and this is the most widely accepted form of government insurance for children by all providers (therapists and doctors alike).
We often recommend parents seek a psychological evaluation, in addition to the speech-language evaluation. When two areas of need can be identified, this creates a stronger case for the approval process.
Programs you should explore are:
- Social Security Income (SSI) Benefits: Children are eligible for this program by having a physical and/or mental impairment, marked by significant limited function (as determined by your therapist), expected to last at least a year. Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) serves children and adults. The parents’ incomes are taken into account when the child is under 18. In addition to health insurance, this benefit can also provide supplemental income, which can be used for the care of your child. If your income is above the limit, apply for the Katie Beckett Deeming Waiver (see below). FAQs about SSI or Contact: 1-800-772-1213 (phone application) or Apply Online
- NOW/COMP Waiver Program: Georgia’s New Options and Comprehensive Supports Waiver applications is a Medicaid waiver that provides up to $25,000 of support services for children and adults. This waiver also allows the provision of ABA therapy, a treatment many insurers (even commercial) do not cover. FAQs about NOW/COMP Waiver or Contact: firstname.lastname@example.org
- Katie Beckett Deeming Waiver Program: The Deeming Waiver is a type of Medicaid that helps cover the costs of medical treatment and therapeutic services for children with physical or developmental disabilities. This program is available based on the level of care needed (not financial need). You must have been rejected for SSI benefits to receive this benefit. Use this link to help you locate state resources in your area, which can help complete these documents. Use this guide to help you complete the documentation. Contact: 678-248-7449
Which insurance carriers does Atlanta Speech Therapy accept? View a list of insurance here.