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Health Coverage for All Children Campaign
CDF's Health Coverage for All Children Campaign, a national, state, and local initiative to guarantee comprehensive health and mental health coverage for all children and pregnant women in America.
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Kayle & Gavin
Kayle, 16, and Gavin, 12, Grove City, Ohio: Kayle and Gavin's mother, Twinkle, faces the tough choice of choosing between her pride and doing what she knows is best for her children. Her daughter, Kayle, is a middle school student with special needs and her son, Gavin, who has ADHD and binocular dysfunction (acute double vision), is a student in the South Western City School District.
Kayle was born with ataxia, a condition in which damage to the nervous system causes a lack of muscle control. Kayle’s father pays for the family’s health insurance through his employer. However, Kayle’s need for physical, occupational and speech therapies is regularly denied by their health plan because she does not require therapy as a result of an injury or accident. After a divorce last year resulted in reduced income and because of the ongoing problem of the family's private insurance policy not covering the complex needs of Kayle's therapies, Twinkle applied for Medicaid.
After making the difficult decision to apply for Medicaid, the enrollment process was an even greater struggle for this single mother, who works as an Early Childhood Mental Health Coordinator making $30,000 a year. Twinkle said, "One would think that working at Children's Hospital, I could navigate the system. Even with my experience and seeing this every day at work, it still took me three months to figure it out. I imagine that many parents who have no familiarity with the system would get frustrated and give up." But Twinkle knew she couldn't give up because, in addition to therapy, Kayle needed a new wheelchair.
Like many other "working poor" families, it was a struggle to choose to accept the publicly funded Medicaid program assistance. But Twinkle felt she really had no alternative, because even though she works full-time, she cannot afford to pay for the family's medical needs. She explained that Medicaid will help pay for Kayle because of her disability, but for Gavin, she still will have enormous co-pays. The family insurance plan would pay for his medication, but not the therapy he needs to cure his binocular dysfunction condition. Again, Twinkle is faced with a difficult decision—pay $75.00 per 30-minute treatment or let his condition go untreated.
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