LAST UPDATED: June 5, 2003
This page offers information on the following funding sources:
*TEIS
*TennCare
*Social Security Disability
*Children's Special Services
*Department of Mental Retardation (information to be added soon)
*Local School Districts
*Private Insurance
*Medicaid Waivers (information to be added soon)
TEIS: Tennessee's Early Intervention System
TEIS
TEIS is an incredible service provider for children under the age of 3. If your child meets their criteria for developmental delays, TEIS will immdediately put you in contact with the services you need, including:
*Speech Therapy
*Occupational Therapy
*Physical Therapy
*Sensory Integration Therapy
*Applied Behavioral Analysis (ABA) Therapy
*A private teacher to work one-on-one with your child in your home or daycare
*Small Play Group Therapy
*A Parent Advisor from TIPS (Tennessee's Infant Parent Services)
*Hearing Evaluations
The services provided by TEIS are FREE, and many of the appointments can be done in your own home or in your child's daycare center.
Many different agencies can refer you to TEIS, including:
*your pediatrician
*TIPS (Tennessee Infant Parent Services)
*The Department of Mental Retardation
*The Infant Stimulation Program
Once you are referred into the system, you will be assigned a TEIS coordinator who will do the initial evaluation of your child in your own home. Eligibility for TEIS services is based on the degree of your child's delays.
If your child qualifies for TEIS services, your coordinator will put you in contact with all the therapies your child needs. These services, including the therapies themselves, are FREE.
TennCare:
Contact Department of Human Services in your county
TennCare offers state medicaid insurance to cover medical costs associated with your child. It may or may not be based on your child's disability (depending on which application you fill out). There are THREE ways to be eligible for TennCare:
*income-based
*spend-down
*disability
Basic TennCare is based on income. If your income is low enough, you are eligible. If you are turned down based on income, ask about spend-down. This is for excessive medical bills. This includes:
*any unpaid medical bills for you or your family
*any bills paid the month you apply for TennCare
*any bills someone else has paid that you are expected to reimburse them for
*any medications you purchase the month you apply for TennCare
For a baseline idea of what your spend-down is, mine was a little less than one month of my household gross income.
TennCare Medicaid for Disabilities
Finally, there is TennCare Medicaid for Disabilities. Autism IS COVERED and is considered an eligible condition to receive this. I will have to check on where to obtain the forms; I obtained mine from my TIPS advisor, who is Director of our local mental health facility. Your local mental health facility should have copies of the forms you need. Once you have the forms, you will need to have your pediatrician or neurologist fill out a section of the form and sign it.
Remember there are FOUR TennCare plans:
*Omnicare
*Better Health
*TLC
*TennCare Select
Be sure and check with the clinics and doctors your child visits to make sure WHAT TennCare they accept. For example, my son's neurologist does not accept Better Health, and the clinic he visits does not accept TLC. It was necessary that I SPECIFY to my caseworker what TennCare I COULD NOT USE. Also, be sure and list your pediatrician to ensure that TennCare does not assign a different one to you.
Social Security Disability
Contact: 1.800.772.1213
Have your child's social security number on hand when you call, as they will probably ask for it. Also have your calendar on hand, as they will want to schedule an appointment for you at your local Social Security Office for you to return your packet of applications to fill out and also to verify your income. On the phone, they will also give you a list of items/documentation you will need to take to that appointment.
The packet of applications is lengthy. It will take you some time to fill them out. The questions relate to your child's disability, including what problems/diagnosis your child has, your child's therapists and doctors, the clinics and schools your child has attended, etc.
I suggest you obtain a parent advisor from TIPS (Tennessee's Infant Parent Services) from the Early Intervention System. Your advisor can help you sort through the myriad of questions.
Don't be suprised if you are turned down immediately for SS Disability. I was, based on income.
You can appeal the decision (you will receive a letter from the SS Administration informing you of how to do this). I have heard that three times is the charm; apply, apply, apply; THEN you get SS Disability. I don't know that this is true.
Children's Special Services (CSS)
Children's Special Services
Children's Special Services is offered through the County Health Departments across Tennessee. They offer financial assistance for pediatric medical conditions. Currently, autism IS NOT COVERED by CSS. HOWEVER, if your child also has a medical condition that accompanies the autism, such as a seizure disorder, then you may qualify for CSS services.
Department of Mental Retardation
Local School Districts
Once your child reaches the age of three years old, your local school district is responsible for providing services. Traditionally, this will include (based on your child's needs):
*special education
*speech therapy
*occupational therapy
*physical therapy
*ABA
About Special education...
The special education teachers we have in Weakley County are incredible. You cannot ask for better spec ed teachers than ours. Still, it is always good to ask questions about the special education your child will receive. Here are some basic questions:
*What level of education does the spec ed teacher have?
*What is his/her specialty area? (for example, one of our spec ed teachers has a background in speech therapy)
*Has s/he ever worked with autistic children? If so, how many?
*Are there any autistic children currently in the class your child will be placed in?
*How does the teacher handle meltdowns?
*Is the teacher trained in ABA?
*What is his/her policy on discipline and restraint?
*Will the teacher/school follow a specific diet plan (such as GFCF) if your child is on it?
*How many of the children in special ed are eventually mainstreamed into regular classes?
*What are the disabilities of the other children in the class?
*Is the majority of the class high- or low-functioning?
*What is the ratio of students to teachers/aides?
*Is the classroom inclusive (are there typical peers in the classroom during the day for appropriate behavior modeling)?
About the therapies...
From my experience, the school districts do not provide these therapies through private channels, but rather through the school system itself. The school system has speech, occupational, and physical therapists on their staff; if you want them to pay for your services, you will probably have to use the therapists they offer.
It is crucial to ask the school district:
*How much time and how often will my child receive each therapy?
*How much of this time is one-on-one as opposed to group therapy?
*How much of this time is spent with a licensed therapist (as opposed to the licensed therapist's aide?)
*What level of education does the therapist have?
*Are the therapists trained in ABA?
*Are the therapists trained in sensory integration?
*Have the therapists ever worked with autistic children?
Private Insurance
Private insurance may or may not cover your child's therapies. It varies from provider to provider. They may cover one therapy but not another. I suggest filing insurance under the label of "developmental delay" as opposed to "autism." Try this first and see if your insurance will cover the cost of your child's therapies and doctors visits.
Using the label of autism with insurance can result in a denial of payment for services by your insurance provider. It could also result in "turf wars" once you find supplemental insurance (the turf war being both insurance providers claiming that coverage is the responsibility of the other provider).
My insurance does not pay for my son's speech or occupational therapy. They claim that my son's need for treatment was not caused by injury. Some insurance companies do, however pay for these services. Interestingly, however, my private insurance does cover my son's ABA therapy. It also covers about 70% of my son's visits to his pediatric neurologist.
Medicaid Waivers
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