PARTICIPANTS. Jane Gaulke- parent of Tim who is 21and has a disabilityLouis Terranova, MS- Manager of the Rockford office of Division of Specialized Care for Children and a participant in a Transition projectFaye Eldar MA- Moderator and parent of Maya who is deaf blind and has cerebral palsy. ISSU
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1. TRANSITION IN THE ERA OF MANAGED CARE
2. PARTICIPANTS Jane Gaulke- parent of Tim who is 21and has a disability
Louis Terranova, MS- Manager of the Rockford office of Division of Specialized Care for Children and a participant in a Transition project
Faye Eldar MA- Moderator and parent of Maya who is deaf blind and has cerebral palsy
3. ISSUES INSURANCE
How long can the child stay on their parents’ insurance? Do they have to be a full-time student?
When do they move from pediatric to adult care? What is the need for specialized medical equipment?
4. PEOPLE WHO CAN HELP YOU DURING TRANSITION Insurance case manager- you may want to ask for one or check your policy to see if it is a benefit
Staff and physicians at the pediatric facility
5. PEOPLE WHO WORKED WITH THE FAMILY DURING TRANSITION Staff & physicians at Shriners Hospital
Division of Specialized Care for Children
Insurance case manager
6. INSURANCE ISSUES Family needs to plan early and find out what benefits will be available when their child turns 21 or leaves full time school.
Begin planning process by age 16
7. INSURANCE QUESTIONS Can their adult child stay on their health insurance?
Does the adult child need to be a full time student?
Is there a state law that requires the option of keeping a disabled dependent on the parents insurance?
8. JOB RELATED INSURANCE Research indicates that 60% of people with disabilities are unemployed or under employed.
9. FACTORS IMPACTING INSURANCE & THOSE WITH DISABILITIES Level of individual’s abilities determine type of job they they can secure
Chronic illness may affect continuity of work
Individual needs to look closely at the level of benefits available
10. WHAT IS AVAILABLE BESIDES PARENTS’ INSURANCE AND EMPLOYMENT BASED INSURANCE? For medical care- may be state/federal program called Medicaid or Medical
Medicare for some
11. WORK INCENTIVES IMPROVEMENT ACT New law passed in 1999
May be called Medicaid buy-in
Allows individuals to become employed and still retain Medicaid benefits
in Illinois - call 312-223-9600
12. TRANSITION- HOW DIVISION OF SPECIALIZED CARE FOR CHILDREN HELPS BEGINS BY ASKING THE PARENT TO THINK ABOUT:
what is my child going to do at age 21 or for the rest of her life?
13. DAY TO DAY ISSUES Where do you see your child living?
Where is he/she in the process of becoming independent in self care and decision making?
Securing medical care
14. INFORMATION ON TRANSITION Talk to other parents
See our resources
Call agencies that serve those with disabilities in your area
15. GUARDIANSHIP Check the laws in your state
In Illinois, at 18 a person is considered an adult and can make their own decision
Who will make decisions for your adult child’s medical care?
16. THE GAULKE’S EXPERIENCE WITH GUARDIANSHIP Their concern was who would make medical decisions for their Tim
At 18 the family went to court to pursue guardianship
They talked to Tim about the issue
Tim went to court with them and talked to the lawyer and judge
17. SELF-ADVOCACY Involve the child in decision making
Encourage them to speak up for their own needs
Ask providers to talk directly to the young adult
18. CARE COORDINATION Working with a family and providers, a plan is developed that meets the family’s and young adult’s needs.
19. MEDICAL TRANSITION- moving from pediatric to adult providers Sometimes parents are reluctant to change care from a pediatrician or specialist that has had a long term involvement with their child
Sometime physicians are hesitant when turning over care to an physician for adults
20. TRANSITION IS A PROCESS Adult and pediatric care givers can consult with each other
The pediatrician or pediatric specialist can be a valuable resource to the adults provider
21. SELECTING A NEW DOCTOR Get recommendations from your current physician
Make an appointment with the MD before anything is wrong
Take your child with you and see how everyone gets along
22. SUMMARY It’s never to early to start the transition process
Think about the level of medical care your adult child will need. How will it be paid ?
Get help from- other parents, case managers, your physician, school
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