Insurance Issues & Social Security

The Katie Beckett Waivers and the 1115 Waivers

Medicaid Waivers are state-run programs that use federal and state funds to pay for health care for individuals with certain health conditions. Each state has different Waivers with different eligibility requirements or services. Two Medicaid statutes are currently waivered: 1915 and 1115.

To find out your state’s Waiver programs go to www.cms.hhs.gov/medicaid/waivers/waivermap.asp.


Social Security and Social Security Disability Income

The official website of the Social Security Administration can provide you with a wealth of information relations to Social Security Disability Income (SSDI) such as:

  • How to start and,
  • The Disability Planner explains how to qualify for SSDI and the benefits you will receive
  • Help you find your local Social Security Office

To find out more information about Social Security go to www.ssa.gov

To find out more information about Social Security Disability Income go to www.socialsecurity.gov/ssi/index.htm


Insurance Reimbursement

If your insurance company has denied your claim for certain treatment, including wound care coverage, the following sample letter can be used and edited and sent to an insurance company or your state insurance commissioner. These letters are only intended as an example.


Sample Letters
Family and Medical Leave Act (FMLA)

The following information is presented as a guideline. Individual state laws may affect your eligibility and rights. Please consult the Department of Labor in your state for more information.

Rights:

You are entitled to take up to 12 weeks of unpaid leave for three reasons:

  • The birth or adoption of a child

  • To care for a child, spouse or parent with a serious health condition, and

  • If you have a serious health condition

A serious health condition may include chronic conditions that require periodic and continuing treatments, such as epidermolysis Bullosa.

While on leave, your employer must maintain your benefits, but you must continue to pay your portion.

You retain the right to return to the same or equivalent position, pay and benefits upon returning from leave.


Eligibility:

You are “eligible” to take FMLA leave if:

  • You have worked for the same employer for at least 12 months and have worked at least 1,250 hours in the past year, and

  • Your employer employs 50 or more employees within 75 miles of your worksite, and

  • You provide 30 day advance notice to your employer for foreseeable events.

For more information about the Family and Medical Leave Act go to www.dol.gov/whd/fmla/index.htm