Autism-World

I have a couple of questions – I am trying to justify to Medicaid that these two things are “necessary” for our 6-year-old son rather than just a convenience, and was wondering if you thought we might be able to be successful or how you might word it ??for what it’s worth, his therapists agree that he needs them but are also not sure if Medicaid will agree.

The first is a Stokke type chair for eating – it’s a wooden chair with a base that looks like the bottom part of a Z, and with two wooden platforms, one for sitting and one for resting your feet on. The platforms are adjustable to accommodate different sized children and can be used throughout adulthood since it will hold up to 200 pounds or more. Right now our son does not fit properly in the regular boosters, plus I haven’t figured out a way to support him well in a regular chair since he has short little legs and he always ends up W-sitting to get comfortable, but even then he is mostly at armpit level with the table, which of course does not promote easy eating or support him well with his low muscle tone issues.

Since his previous SLP was not able to get it preapproved through Medicaid she said if we submit the claim then we have to sign a form saying we will pay whatever Medicaid refuses to pay – which could be up to the full price of $200. Our other option would be to submit a request through Family Support, which I have done in the past. They have only agreed to pay about 1/4 of the cost since “they already bought him a chair thing,” which actually was an adapted swing for our swing set – apparently the person in the Family Support office is clueless about special needs since there is no way I can set the swing up to the table to help him eat, and she clearly did not understand after several attempts to explain it to her the difference between the two. She said, “well, it said it’s a vestibular motion device,” and apparently that was supposed to mean that he doesn’t need another “chair thing.”

So, that is our first request.

Our second request is a free standing youth size potty chair. We have three levels in our home, with a bathroom on the upper level with the bedrooms and a bathroom in the basement, but none on the main level where we spend the majority of our days. Again, the therapists are afraid Medicaid won’t cover it since they will see it as a “convenience” for me. My argument is that with my son’s low tone, which makes it very difficult to hold his urine for any length of time once he realizes he has to go, along with the communication issues (he will have to ask me for help to get upstairs or downstairs soon enough to make it to the toilet on time since we have to gait the stairs off due to safety issues with him and his younger brother – both seizure related and balance/coordination problems along with developmental levels), which combined basically means he will have a much higher chance of successfully learning to use the potty independently if we have an option here on our main level.

What do you all think? Are these requests you feel could be realistically presented to Medicaid? The potty chair the PT recommended is over $200 as well. We just can’t afford them – one alone will be difficult, both are just not feasible. The letter of recommendation the PT wrote to Family Support for the potty chair mentioned nothing of his low tone or communication difficulties – she mentioned his poor coordination and balance briefly and that he doesn’t fit on standard toddler potty chairs any more but mainly focused on how it just won’t be safe for our family as a whole because I would have to bring both his younger brother along with our newborn come fall up or downstairs to the bathroom along with us – I’m not sure how convincing an argument that is going to be, however true it is. She said the other option would be to make modifications to our existing toilets (such as support bars and alternative seats) but that still we would have the problem of the two younger children to consider.

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This entry was posted on Sunday, November 18th, 2007 at 5:56 pm and is filed under Autism Stories.