What is Medicaid?

Medicaid is a government program that covers the cost of medical care for eligible people who meet certain criteria. To get Medicaid, your family's income and assets must be below a certain level. These levels vary from state to state. Not all health providers take Medicaid.

Some examples of those eligible for Medicaid include the following:

• low-income families with children
• Supplemental Security Income (SSI) recipients
• infants born to Medicaid-eligible pregnant women
• children under age 6
• pregnant women whose income is below certain federal poverty guidelines.

Medicaid pays only a percentage of the direct cost of medical care to hospitals and doctors, but families are not billed for the rest. Children that Social Security determines to be disabled are usually eligible for Medicaid. Having insurance coverage does not make a person ineligible for Medicaid. Some children who are not eligible for Medicaid when they are diagnosed become eligible after the family acquires medical debt that affects their income and assets.

In some situations, being eligible for Medicaid can help a child or family, even if it is not used to pay direct medical costs. For example, most medical centers make their own determination of a family's ability to pay medical bills. A family with an income low enough to qualify for Medicaid may get special consideration that could result in a discounted hospital bill. Medicaid funds may also be used in some states to help pay the cost of transportation to hospitals and clinics and for food and lodging if a family has to travel for treatment or follow-up care.

The team social worker can give you more information on applying for Medicaid, or you can find out how to apply by contacting county social services or health departments. These numbers can be found in your local phone book's blue pages.

Can Medicare help with medical care costs for children?

Medicare is a federal program funded through the Social Security system. It provides health insurance for those who meet certain criteria. Young people with cancer who are disabled may get Medicare benefits after collecting Social Security benefits under the Supplemental Security Income (SSI) program for 2 years. In order for your child to get SSI, you must apply for it on behalf of the child, complete with household income and the child's medical and school information. Social Security will then determine whether the child is disabled. You can get more information on SSI and Medicare from the Social Security Web site (www.socialsecurity.gov/d&s1.htm), by calling 1-800-772-1213, or by talking with the team social worker.

Medicare beneficiaries who have low income and limited resources may get extra help paying for their out-of-pocket medical expenses from their state Medicaid program (see the "What is Medicaid?" section.)

What other public assistance programs might help pay for my child's medical care?

Children's Special Health (Care) Services (CSHS or CSHCS): This is a state-run program, financed by state and federal money. It may help pay some health care costs for children, usually those 21 and younger with certain chronic conditions, including cancer. In many states these programs may have different names. For more information about whether such programs can help you, talk to a hospital or clinic financial counselor or talk with the team social worker. Or you can try calling your state health department.

Hill-Burton Funds: A few hospitals and other non-profit medical facilities receive Hill-Burton funds from the federal government so they can offer free or low-cost services to those who can't pay. Each facility chooses which services it will provide at no or lowered cost. Medicare and Medicaid services aren't eligible for Hill-Burton coverage. But Hill-Burton may cover services not covered by other government programs. Eligibility for Hill-Burton is based on family size and income. You will need to find out if there is a facility in your area that has any Hill-Burton obligation for which you may qualify. If you are cared for at such a facility, you may apply for Hill-Burton help at any time, either before or after you receive care. Call the Hill-Burton Program for more information on this program. (See the "Additional resources" section for phone numbers.)

Can children who are not U.S. citizens receive Medicaid or Children's Special Health Services?

There are situations in which children who are not citizens of the United States may be able to get Medicaid or Children's Special Health Services (CSHS) to pay for some of their treatment. All questions about Medicaid eligibility rules and regulations should be discussed with your county Medicaid specialists. Talk to the hospital or clinic financial counselor about CSHS coverage. The services of an interpreter can usually be arranged if speaking or understanding English is a problem.

Will children covered by Medicaid or Children's Special Health Services be treated the same as children covered by private health plans?

Children and teens should get the same care, the same state-of-the-art treatment, and any other services available -- no matter who pays for their treatment. If parents have any questions or concerns about this, they should speak directly with the pediatric oncologist directing their child's care or with another member of the cancer care team.

Veterans' and military benefits may help children

What if the child's parent has TRICARE?

TRICARE is the Department of Defense's health insurance program for those in the military, as well as some family members, survivors, and retirees. It mainly consists of TRICARE Prime, an HMO; TRICARE Extra, a preferred-provider option; and TRICARE Standard, a fee-for-service plan. One U.S. option combines Standard and Extra; options may be different overseas. The TRICARE Reserve Select program is offered for certain reservists, who must pay premiums for their coverage. Options other than these may be available to some.

The service member must register eligible family members, including children, in the Defense Enrollment Eligibility Reporting System (DEERS) in order to get health coverage for them. Records can be kept up to date by the service member or the family members through the nearest military personnel office or ID card-issuing facility.

Each TRICARE plan has its own limits and requirements. Choose your plan carefully and know how it works. You can find out more on TRICARE at www.tricare.mil, including a way to compare different plans to find one that best suits your family.

What if a parent is a military reservist who has been called to active duty?

Members of the military reserve units who are called up for active duty from private employment have certain rights about the health care coverage they get from their employers. They are allowed to pay the full cost of their health plan, very much like COBRA, during their time away. When they return to work, their health coverage must be re-instated without any waiting period. Visit the U.S. Department of Labor on the Web at www.dol.gov/elaws/vets/userra/mainmenu.asp, or see "Additional resources" for U.S. Department of Labor contact information.

What if the child's parent died in the military or became permanently disabled due to military service?

A program called the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is available to certain spouses or widows(ers) and their children who are not eligible for TRICARE. CHAMPVA can cover the spouse or widow(er) and the children of a veteran who:

• is rated permanently and totally disabled due to a service-connected disability
• was rated permanently and totally disabled due to a service-connected condition at the time of death
• died of a service-connected disability
• died on active duty and the dependents are not eligible for TRICARE benefits

CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by the VA Health Administration Center in Colorado. You can find them on the Web at www.va.gov/hac (select CHAMPVA), or call 1-800-733-8387.

Back to Children Diagnosed with Cancer: Financial and Insurance Issues

Last Medical Review: 04/01/2009
Last Revised: 04/01/2009