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Healthcare & Health Insurance


Topics & Common Questions

Healthcare & Health Insurance

For Grandparents & Grandchildren

(Revised July 2005)

Health Insurance Coverage

Grandparent caregivers may find it difficult to find health insurance coverage for their grandchildren. Grandparents in the paid work force that have employer-provided group insurance still run into problems because employer provided group health insurance is generally unavailable for children in kinship care arrangements. Sometimes the policy does provide coverage even for legal custodians, so you will need to insist that the insurance company find out for sure what coverage you have.

Contact the Erie County Senior Services HIICAP program (716) 858-7883 for general information on health insurance options.

Grandparents who are retired and on Medicare are either forced to buy an individual policy or to try and qualify their grandchild for State Medical Assistance. On the Internet you can find information at this New York State Health Department web site: http://www.health.state.ny.us/nysdoh/medicaid/mainmedicaid.htm

For information in Erie County, visit this web site:

http://www.erie.gov/depts/socialservices/medicaid_eligibility.asp

a. Medicaid
In New York State, the medical assistance program is called Medicaid. It is a program funded by state and federal government that helps people who are receiving public assistance and/or have a low income pay for doctor and hospital bills and some medication. You may apply for Medicaid on your grandchild's behalf at the Social Service Office in the county where your grandchild resides. In Erie County, contact:

Erie County Department of Social Services
95 Franklin Street
Buffalo, New York 14202-3959
(716) 858-8000

Make sure you apply and sign the application form as soon as you realize you need Medical Assistance because payment for medical expenses can only go back three months from the date of application.

  1. Eligibility
    Federal law requires states to provide Medical Assistance benefits to individuals who receive Family Assistance (formerly AFDC) grants or Supplemental Security Income (SSI) and children in foster care.

    Note: Even if you have grandchildren in your care who, for any reason, are not eligible for Family Assistance or SSI, you should still apply for Medicaid on their behalf by going to your local Social Services Office.

  2. Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT)
    EPSDT is the Early and Periodic Screening, Diagnosis and Treatment Program. It is a provision of the federal Medicaid program that provides financially needy children with preventive health care. Every child who is eligible for Medicaid is eligible for federally funded EPSDT services. EPSDT is a critical program for your grandchild because it provides many services that may not be available to adult Medicaid recipients.

    When you see your doctor for an EPSDT exam (sometimes called a well-child visit or a check-up), your grandchild should receive the following health checks:
    • A complete physical exam
    • Eye and hearing tests
    • Lab tests, including levels, if needed
    • Immunizations, if needed
    • Dental assessment
    • Health education about issues of concern for you and your grandchild
    • Nutrition assessment
    • Developmental assessment
  3. Medicaid Managed Care Plans
    If your grandchild or you are granted Medicaid benefits, you may need to sign up for a Medicaid Managed Care program. In Erie County, call (716) 858- 6105 or (716) 858-8666 for information about Medicaid Managed Care. Under this program, you may need to select an HMO (Health Maintenance Organization) within 60 days; otherwise you and/or your grandchild will be assigned to one. “Exception” situations, where a child is cared for by the grandparent(s), are subject to a review of the case and its history by the Managed Care Unit; and when an “exemption” status is given, grandparents are not required to enroll the children in an HMO but have the option to do so if they wish. Be sure to read the information that the Department of Social Services sends you about the HMOs (Health Maintenance Organizations) serving Erie County Medicaid recipients. Then call the HMO's that look best for your grandchild or family. Ask them for more information about what you need to know. They can send you a list of doctors and pharmacies and give you details on the services they offer.

    When choosing an HMO, consider the following:
    • Do my family's doctors belong to this HMO?
    • Does this HMO have doctors, clinics, hospitals, and pharmacies near my home?
    • Are there enough specialists to treat my family's health needs?
    • Does this HMO offer special services or "extras?" For example, will they pay for any health care items not prescribed by a doctor? Do they offer free parenting classes?
    One option is Gold Choice, a Medicaid Managed Care option offered by Family Medicine of the University at Buffalo, for those receiving Medicaid and also receiving mental health or addiction services. Call (716) 898-5971 or toll free, 1 (888) 419 1722. Unlimited counseling for mental health issues or addiction treatment is available. For any questions, call Program Director, Julie Krause-Kelly at (716) 898-5971. Information is available at this web site: http://www.smbs.buffalo.edu/fam-med/goldchoice

b. Child Health Plus

In addition to the Medicaid program, New York State also offers a low-cost health insurance plan for children under age 19 called Child Health Plus. It is a program available to New York State families who are not eligible for Medicaid or who have limited or no health insurance. Even if your family income is high, you can enroll your grand child in the program, although you will have to pay more for your coverage.

The fees for Child Health Plus are based on family size and income.

The following insurance companies provide coverage to families in Erie County:

Blue Cross/Blue Shield of Western New York: 1(800) 888-5407
Univera Community Health: 1(800) 494 2215
Fidelis Care of New York: 1 (888) 343-3547

You may call these companies directly to request an application. For the names and telephone numbers of insurance companies in other counties, or to learn more about Child Health Plus, call 1 (800) 698-4KIDS.

Medical Consent

Under New York State law, only parents, legal guardians, or custodians can give consent for the medical, dental, health and hospital care of a child under age 18. Generally, grandparents do not automatically have the legal right to consent to necessary medical care on behalf of a grandchild in their care. However, many medical providers let grandparents consent to care even though medical providers do not have a legal obligation to honor their consent. A statement from you, the parent, or from a social worker, which shows your relationship to your grandchild may help you get medical care for your grandchild. In addition, the New York State Legislature recently enacted policy allowing parents to legally authorize a care giver’s consent to medical care, for up to one year. Such authorization must be in writing, and contain the name of the care giver, minor child, the parent’s signature and date of signature. A parent lacks authority to sign such authorization if prohibited by court order. Further, if a court order exists directing both parents to agree on health decisions concerning the child, both parents must sign.

New York State law does allow grandparents and older sisters and brothers to consent to a young child's immunizations.

In case of an emergency, take your grandchild to the emergency room of a hospital. You do not need legal guardianship or custody of your grandchild to get emergency medical treatment for your grandchild. In an emergency, the doctor will decide whether the child needs immediate medical attention. If there is not time to get consent from the parent and the life and health of your grandchild would be in danger if the child does not get medical treatment, then the doctor can treat the child without the parents' permission.

If a grandparent is having difficulty obtaining medical care, legal guardianship or custody may be necessary.

Call Legal Services for the Elderly, Disabled or Disadvantaged of W.N.Y. (716) 853-3087 for help (http://www.lsed.org).

Health Care Services

In addition to your grandchild's pediatrician or family physician, the Erie County Department of Health offers many low and no cost health services for children and adults residing in Erie County. If you would like to receive any of these services or have a question about a particular service, please call 858-7690. Visit the Erie County Department of Health web site at: http://www2.erie.gov/health for information.

Services for Children with Disabilities

Erie County Health Department Early Intervention Program (858-6161) http://www.health.state.ny.us/nysdoh/eip/index.htm

The Early Intervention Program is a statewide program that provides many different types of early intervention services to infants and toddlers with disabilities and their families. The mission of the Early Intervention Program is to identify and evaluate, as early as possible, those infants and toddlers whose healthy development is compromised and provide for appropriate intervention to improve child and family development.

Free services are provided to help your child grow and develop and to help you care for your child. These services include evaluation services (including hearing and vision screening); home visits; speech, physical and other therapies; child development groups; family counseling; and, sometimes, even help with transportation.

Here's what you can expect your child to be doing, from birth to age three.
At three months of age most babies:At six months of age most babies:At twelve months of age most babies:
turn their heads toward bright colors and lights follow moving objects with their eye sit without support
move both eyes in the same direction together turn toward the source of normal sound pull to a standing position
recognize bottle or breast reach for objects and pick them up crawl
react to sudden sounds or voices switch toys from one hand to the other drink from a cup
make cooing sounds play with their toes play peek-a-boo and patty cake
make fists with both hands help hold the bottle during feeding wave bye-bye
grasp toys or hair recognize familiar faces hold out their arms and legs while being dressed
wiggle and kick with arms and legs babble put objects in a container
lift head and chest when on stomach   stack two blocks
smile   know five or six words
If your child is having trouble doing some of these things, it may put your mind at rest to talk to someone. Early help makes a difference! Talk with your doctor or call your local Early Intervention Program.
At one year of age most children:At two years of age most children:At three years of age most children:
like to pull, push and dump things use two-to-three-word sentences walk up steps (alternating feet)
follow simple directions ("Bring the ball") say names of toys ride a tricycle
pull off shoes, socks and mittens recognize familiar pictures put on their shoes
like to look at pictures carry something while walking open door
feed themselves feed themselves with a spoon turn one page at a time
make marks on paper with crayons play independently play with other children for a few minutes
walk without help turn 2-3 pages at a time repeat common rhymes
step off a low object and keep balance like to imitate their parent use three-to-five-word sentences
  identify hair, eyes, ears and nose by pointing name at least one color correctly
  build a tower of four blocks are toilet trained
  show affection  

The Preschool Program for Children with Special Needs is a program designed to meet the educational needs of 3-5 year old children with significant delays in one or more functional areas related to:

  • Cognitive skills
  • Communication skills
  • Adaptive skills
  • Social-emotional skills
  • Motor skills which adversely affect their ability to learn.

A preschool child with special needs may be eligible to receive services via their school district which may include: Speech, Occupational or Physical Therapy, and Special Education. A preschool child who has been found to have special needs will receive services at no cost to the family.

Tips for Raising Healthy Grandchildren

Immunizations

Immunizations are shots that protect children from many contagious diseases. It is important for your grandchildren to get their shots at the right times in order to prevent them from getting sick with fevers and rashes or diseases that can cause more serious problems such as brain damage, heart problems, crippling, deafness, and blindness. School districts and daycare centers require proof of immunizations before a child can be enrolled. Locally, you may call the Erie County Department of Health Immunization Action Plan at (716) 961-6839 or the New York State Health Department at (716) 847-4385 to have your questions about immunizations answered. Visit the Immunization Action coalition web site for information on recommended immunizations for children and adults at http://www.immunize.org as well as the New York State Department of Health and Centers for Disease Control sites listed below. Since recommendations change from time to time, please check with your health care provider for the most up-to-date recommendations.

Because your health is also important, please review the recommended immunizations for adults. Information on immunizations for adults in Erie County may be found at the WNY Adult Immunization Coalition web site, http://immunizewny.org

Keeping a record of the immunizations you and your grandchildren have received is very helpful. Additional information is available at the Erie County web site http://www2.erie.gov/health the New York State Department of Health web site, and the Centers for Disease Control web site http://www.cdc.gov.

Lead Poisoning Prevention: (961-6800) http://www.erie.gov/health/offices/dc_lead_prevention.asp

A Lead Poisoning Fact Sheet is available at this link: http://www.erie.gov/health/healthinfo/family_leadpoisioning.asp

SIDS

For information on Sudden Infant Death Syndrome and what can be done to reduce the risk, visit this site: http://www.health.state.ny.us/diseases/conditions/sids/index.htm or call: NYS Center for Sudden Infant Death, 1 (800) 336-7437

Updated, July 2005