AN OPPORTUNITY FOR FAMILIES WITH DISABLED CHILDREN
On Thursday, May 6th, the United States Senate approved a bill that would make it easier for disabled children to receive necessary health care coverage. The Family Opportunity Act gives the various States the option of permitting middle-income families who have a child with a disability to buy into the Medicaid program.
Medicaid is a welfare program that provides health insurance to needy individuals. A State’s participation in the Medicaid program is voluntary. New Jersey has chosen to participate in the Medicaid program.
In order to qualify for Medicaid, an individual must be poor, that is, he typically must have less than $2,000 in assets and very limited income.
A child with a severe disability, such as cerebral palsy or autism, typically does not qualify for Medicaid until age eighteen. Until the child attains the age of eighteen, the assets and income of his parent are “deemed” to the child, meaning that whatever the parent has the child has.
Paying for the child’s care can be financially devastating to many families. Many of these families are un-insured or underinsured. Other families impoverish themselves and remain intentionally impoverished because the simple truth is, it pays for the family to remain poor.
The astronomical costs associated with health care and long term care are higher than the average family can earn, so why work in a job that will cause your child to be disqualified from Medicaid if all of your money is going to pay for the costs of care? Why not earn only as much as you can earn without disqualifying your family from the Medicaid program or nothing at all?
It is this type of work-disincentive that the Family Opportunity Act is designed to eliminate. It will allow States, at their option, to permit middle-income families to buy into the Medicaid program.
The Act requires such families to pay premiums for Medicaid coverage on a sliding-scale basis, meaning that the more income a family earns, the higher the “Medicaid premium” the family will pay. Families without income above the scale – that is, too much income for the scale – will continue to be disqualified from the Medicaid program. But families in the middle – not enough income to pay for care, too much income to qualify for Medicaid – can buy into the program.
The Act requires families to enroll in employer-sponsored health care coverage, in order to buy into the Medicaid program. In other words, the Act says, we’ll provide you with Medicaid coverage if you purchase other health care coverage that you have the option of purchasing.
Medicaid is the “payor of last resort,” so if a Medicaid beneficiary were to go to the hospital and that Medicaid beneficiary had private-health insurance in addition to Medicaid, the private health insurance would be the primary insurance and Medicaid would be the secondary insurance. From a cost-containment standpoint, the Medicaid program benefits from qualified individuals having other health insurance coverage, since the other health insurance will minimize or eliminate Medicaid’s share of the costs.
The Act encourages families to work and become productive members of society, freeing them from forced-poverty. Since there is a true incentive to work and earn money – without fear of being disqualified from the Medicaid program – parents can work.
Although the Act has received strong public support from both Democratic and Republican members of Congress (the bill was sponsored by Senator Charles Grassley (R) and Senator Edward Kennedy (D) in the Senate) and the President, the bills passage has been slow in coming. Its journey through Congress will now move to the House.
Hopefully, this bill will become law, and New Jersey will choose to participate in the program.