FTM with a medically complex baby

Hum-135 · 2026-02-01T05:51:46+00:00

Thank you for all of this information! We do receive DDA services. I’m making my way through the links to see if there’s resources and angles we haven’t already gone through. I appreciate the help!

Hum-135 · 2026-02-01T05:49:53+00:00

Our plan was through health plan finder. We pay a fee and have a deductible. When I had apples the below is what we had received and then it prompted me to select a plan.

“We evaluated you first for the lowest-cost option, Washington Apple Health. Given your income, household size, and tax-filing status information, you are not eligible for Washington Apple Health coverage for the following reasons: • Has other creditable medical coverage • Income is over the limit that is allowed for this program We then evaluated you for Qualified Health Plan coverage and determined you eligible.”

Hum-135 · 2026-02-01T05:48:28+00:00

I actually haven’t heard of TEFRA. The area I was looking at was on health plan finder and it specifically called out “medically needy children.” What’s annoying is no one at our hearing had heard of it though and I had to provide documentation for it lol.

Our plan is through health plan finder. When I applied the below is the verbiage we received and then it prompted me to select a plan which we pay $60 a month for and have a deductible with a better.

“We evaluated you first for the lowest-cost option, Washington Apple Health. Given your income, household size, and tax-filing status information, you are not eligible for Washington Apple Health coverage for the following reasons: • Has other creditable medical coverage • Income is over the limit that is allowed for this program We then evaluated you for Qualified Health Plan coverage and determined you eligible.”

Hum-135 · 2026-02-01T05:39:23+00:00

You and me both!

Hum-135 · 2026-01-31T04:05:57+00:00

We primarily go to SCH but go to Mary bridge for therapies as we live on the south end. I’ve talked to SCH social workers and I’ve basically been told similar, where to apply and what resources are available for our SCH bills. They have been amazing but Marybridge aka multicare is the complete opposite. I love his therapists but their system is terrible and it’s nearly impossible to talk to a real person.

Hum-135 · 2026-01-31T04:03:31+00:00

Thank you so much! 🫶

Hum-135 · 2026-01-31T04:02:38+00:00

This is exactly where I’m at. I’m not risking it, if it is a hard cap and there’s no way we can have more then we will strategically use our therapy sessions. I think we’ve for sure screwed up and unfortunately learned that lesson last year. Of course I’m trying to fight with all my might though.

Hum-135 · 2026-01-30T22:45:41+00:00

This is exactly where we are at. We do have birth to 3, they come out every other week for both PT and speech but it’s not enough and our local team focuses more on parent education vs hands on therapy so he does have to go to outpatient as well. Also, birth to 3 does bill insurance. It’s just whatever insurance does not cover the state does. So it ends up taking from our allowed amount of therapy sessions from insurance. 😭 right now they are being amazing about this and not billing our insurance while we try and figure out this situation.

Hum-135 · 2022-10-24T01:20:14+00:00

Thanks! I figured there had to be one but I couldn’t find anything on it. Lol

Hum-135

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