Benefits and Coverage Counseling

Families often struggle to understand how their health insurance works and the services it covers. Some Title V programs and family leader organizations provide benefits or coverage counseling that help families understand the full range of health insurance benefits, in- and out-of-network providers, and any additional insurance options available in their state, such as Medicaid buy-in programs or Medicaid waivers. These options can reduce underinsurance by acting as a secondary payer and providing additional benefits that other insurance does not cover, as well as reducing out-of-pocket costs. Benefits counseling can also include connecting families with insurance representatives to solve coverage problems.

For more information about efforts to help families enroll in insurance coverage, please click here.

Title V Funded Benefits Counseling

All programs within Connecticut’s Medical Home Initiative assist families with benefits counseling. In addition to care coordination and family support services provided by five regional care coordination contractors working with 83 community based Medical Homes, an additional contractor provides information about respite services and extended services funding for medical equipment and other goods and services like prescription medications and nutritional support.

Maryland and the District of Columbia (DC) use Title V funds to support the Children’s National Health System Parent Navigator Program. Six navigators, who are parents of CYSHCN, provide resource assistance, care navigation, educational tools, and emotional support to caregivers. These services include assistance with insurance issues, barriers to accessing health care, transition, and access to resources.

The Rhode Island Title V/CSHCN program contracts with the Rhode Island Parent Information Network (RIPIN – home of the F2F and RI Family Voices) to solve health coverage problems. RIPIN serves as Rhode Island’s Resource/Call Center for children and youth with special health care needs (CYSHCN). The RIREACH (Rhode Island Insurance Resource, Education, and Assistance Consumer Helpline) Helpline is also part of the Call Center. Trained RIREACH advocates help consumers find and keep insurance, understand and use their health coverage, and respond effectively to benefit denials and other administrative headaches.

Family Connection, the Family-to-Family Health Information Center in South Carolina, contracts with the state Department of Health and Human Services (DHHS) to do outreach on behalf of South Carolina Medicaid and to provide families with the most up-to-date information about eligibility for services. They have two fulltime Healthcare Connections (SC Medicaid) employees who are trained by DHHS to assist families in understanding and responding to questions related to TEFRA, Medicaid waivers, and the new Autism services covered under the South Carolina Medicaid EPSDT benefit. Staff also address private insurance questions and provide information in plain language to help families understand the material. They will also meet one-on-one with families.

Maine’s Family-to-Family Health Information Center counsels families on using Medicaid benefits for school-based services.

Facilitating Communication Between Families and MCOs

In 2021, the Delaware Department of Public Health Children with Special Health Care Needs Division provided phone lines to Delaware Family Voices for monthly calls to connect families with representatives from Medicaid Managed Care Organizations. Topics of discussion on the calls include care coordination requests, in home care and private duty nursing, equipment, medication, therapies and denials. Representatives from Medicaid, MCOs, and partner organizations help solve benefits and coverage problems with families. If families have specific questions, an MCO representative will follow up with them directly. Two of the monthly calls in 2021 were conducted in Spanish.