Children with Medical Handicaps Program

$196,713.96

That was the total of our bill for Izzy’s inpatient stay in July (though it wasn’t mailed to us until January). That does not include any of her ongoing outpatient appointments or treatments.

Thank God for insurance and thank God for CMH.

What is CMH? CMH is the Children with Medical Handicaps Program; a program through the Ohio Department of Health that basically takes over as an insurance for families of children with special health needs, or medical handicaps.

We heard about this program through talking with a social worker while Izzy was at Akron Children’s. The hospital thought it might be beneficial for us since Izzy was deemed ‘medically handicap’ and was clearly going to have an astronomical inpatient bill, plus the need for so many specialists outpatient. The social worker warned us that the CMH process takes a while to get started, so she encouraged us to fill out the paperwork right away if we thought we might be interested. At first we were hesitant because there is the disclaimer that your child’s provider must be CMH-approved… however, once we looked into that, we learned that almost all doctors at all hospitals will accept this program, and if for some reason yours doesn’t, you just don’t use CMH for that particular provider’s service (or your public health department will find you a provider who does). There is zero harm in applying and having CMH, it can only help.

The Children’s social worker told us that once our application is approved, everything will move much quicker, and she wasn’t wrong. Since our application was filled out at the hospital, we had Izzy’s geneticist sign off on everything. All applications must be signed off by a diagnosing physician who will see the child at least once a year. If that person ever needs to change, they just fill out a new form. We submitted our CMH application from Children’s in July and didn’t have anything set up until February… but once we did, everything flowed with no issues and they were able to backdate for any outstanding bills within those missed months.

Between July and February, we received two letters in the mail – one to set up a home visit with a nurse from our county health department and another approving Izzy for CMH services. Although Izzy was approved prior to speaking with anyone, the visit was still nice because our nurse was better able to explain their program and services.

When I called to schedule the nurse home visit, we could choose to have an in-person visit or a visit over the phone. We chose a phone visit. (With CMH, your child is automatically provided a public health nurse at all times if needed.) It was very easy, a Q&A about Izzy, her diagnosis, and her doctors, along with a family and living questionnaire. There is a scheduled home visit once a year for every year your child has CMH. The home visits are not required, but the health department likes to do them because it keeps communication lines open. As our nurse explained, Izzy was already approved for CMH, we just needed to fill out and send back a notice of privacy practice form and a private health information form so that the county health department could have communication with Izzy’s doctors. We received those in the mail a few days after our phone call. We also received an informational brochure and another copy of the letters of approval. CMH serves through the age of 21 with yearly renewal (unless your child’s diagnosis falls under the CMH lifelong list, to which yearly renewals are not necessary).

You child’s letter of approval is critical. This is the paperwork you will submit to your provider when you want to or are able to use it. The letter details the child’s diagnosis, the managing physician, and the CMH approved services. For Izzy, her diagnoses for CMH purposes are noted as unspecified convulsions, failure to thrive, and DiGeorge syndrome, her managing physician is her geneticist, and her approved services are listed as “basic outpatient services, basic physician services, enhanced care management, inpatient hospital, emergency room visits, IVIG therapy, medical/surgical supplies, nutrition therapy consults, dental consults, routine dental services, PHN services, prescription medications, and special formula”. That is a MAJOR list of services that CMH will cover.

Having a child with special needs brings on a whole new world in many aspects, one being financial… every bit of help counts. Whether you have primary insurance, secondary insurance, or no insurance at all, I strongly recommend applying for CMH if your child has a medically handicap condition. If (and when) approved, they will be a lifesaver. If this could help your child or your family, contact your doctor or your county health department today!