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No Insurance - 5 weeks - Oregon


Forum: Unplanned Pregnancy

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  #1  
February 8th, 2011, 05:00 PM
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Join Date: Feb 2011
Posts: 1
I want to continue with my pregnancy, but don't know if I will be able to. I applied for state assistance (I am low income), but there is an issue I am trying to understand and resolve - basically that of the father of the baby being stuck with reimbursing the state after I give birth and paternity has been established.

First of all, I DO NOT HAVE ACCESS to health care on my own. I am not married to the father of my baby, so obviously, he cannot add me to his health insurance. We aren't even living together (although we may if I can proceed with the pregnancy, contingent upon getting health coverage that he will not be responsible for later).

Second, he has a job and health insurance - adding the baby to his health insurance AFTER the baby is born would not be a problem. The problem is now - me getting proper prenatal care. Our concern is that because he has a job, the state will pursue him for reimbursement of the health care they provided for me/baby once paternity has been established. It's all so ridiculous. He would gladly help pay premiums and wants to be involved, but because I didn't have health insurance before I got pregnant (my group coverage expired), most private insurance companies will not cover the pregnancy on the condition of a pre-existing condition. I have called the Oregon Health Plan info line and the person I spoke to could not give me any real information - she said that yes, most likely the state would request reimbursement from the father, but couldn't give me an amount they might pursue (If it added up to premiums, that would be ok, but if they wanted the full amount of the cost of prenatal care, it would not).

So, what do to?? I suppose I could have lied about even knowing who the father is and had no issue like this, but he wants to be involved, wants his name on the birth certificate and wants to be a part of the baby's life (and I want that too).

I was getting excited about being pregnant (first time), but now saddened that I'll likely have to terminate because I don't have access to health care (affordable). If he has to pay thousands of dollars back to the state, it would be like not having health insurance to begin with and what point is there to that?? It makes no sense to me.

If anyone has thoughts, similar experience, please help! I really don't want to terminate.
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  #2  
February 8th, 2011, 08:04 PM
Mega Super Mommy
Join Date: Nov 2010
Posts: 3,972
Are there no programs or places you can get free or low cost help? I didnt think just knowing the father makes him liable for the health care of the pregnant mother. Can planned parenthood help at all (just throwing out a possible suggestion)? Did you also look at their WIC program?

I hope you dont have to terminate given that you want this so badly. I hope you are able to find some answers (I dont know a lot about this topic, sorry).
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  #3  
February 8th, 2011, 10:29 PM
Newbie
Join Date: Jun 2010
Posts: 8
I'm sorry that you're having a hard time finding out about OHP, you'd think they'd be more forthcoming about this information. I don't know much about the resources in your area, so I'm just going to through some ideas out there.

I looked at their website and they mentioned something else called Family Health Insurance Assistance Program, where basically the pay part of your monthly deductible if you can find a plan that will take you. That might be worth looking into.

Do they have a local office that you could go to in person? They might go out of their way to find out the info if they see you.

Also, if you can't find insurance and the baby's father is willing to help out, maybe you could go the homebirth route? It's not my personal cup of tea, but one of my friends is going to do it. It's a lot cheaper than hospital birth (between $1500 and $3000). It would still be good to be insured though.

I hope that you find someone who knows how much he would have to pay for the OHP, that really seems like the best option if it would work out. I'm sure some of the other ladies here will have some other ideas.
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  #4  
February 9th, 2011, 05:31 AM
Veteran
Join Date: Mar 2009
Posts: 317
Is it possible to check all the indiv ins plans and see if one will take you w/o considering the pregnancy as a pre-existing condition? I can't believe all of them look at it that way.

That said, in MD I was able to get state health insurance for me during my first pregnancy (when I was 19 and had a lower income job). I added the baby afterwards, but I didn't have to. I could have dropped the entire thing after the pregnancy.

As for his name being on the birth certificate, maybe he can just do that later so that you can get the coverage you need?

Another option, if you're under 26, you are probably eligible to be on your parent's health insurance.

Someone else mentioned it, and I'm going to second it; it might be worth it to go talk to a social worker/WIC counselor, in person. Explain your situation and ask them if there are any programs for which you'd be eligible.
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  #5  
February 9th, 2011, 09:00 AM
Newbie
Join Date: Feb 2011
Posts: 1
Please consider calling the Oregon Health Plan again at 1-800-699-9075. OHP can also fast track your application so you can get pre-natal care, vitamins. While pregnant you can also get dental and glasses, etc. I hope you consider calling them. Sometimes talking to a different person gives you a different answer. Also, you can go in person to a local state office. They are practically in every city.

The Oregon Insurance Division can also answer your question about your boyfriend's health plan. I think you might be able to be added as a partner with his child. Their info: Speak to a Consumer Advocate: 503-947-7984 or toll-free 1-888-877-4894. E-mail: cp.ins@state.or.us.
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  #6  
February 9th, 2011, 10:29 AM
Member
Join Date: Feb 2011
Posts: 14
Please call the medical assistance again. I believe they persue it through child support if you file for that and if need be only give them limited information about him so you can get your insurance. He can still be listed on the birth certificate. I know here in MD in order to get help with daycare they want you to file for child support and collect money from the father but that generally doesnt happen if you give them limited information. Once the baby is born and you switch insurance you will be fine. Lets say you really didn't know all his information, they can't deny you healthcare just because of that. So call back and apply so you can get your prenatal care.
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  #7  
February 9th, 2011, 11:25 AM
Member
Join Date: Feb 2009
Posts: 37
You need to call back, or better yet go to planned parenthood and ask them, or a local office.

We are in Kansas and had insurance for Jennifer during pregnancy and now Savannah through the state. And we will have insurance through the state with this pregnancy as well. I have not been asked nor expected to pay back that money.

I am in the construction trades, and insurance is not provided through my company(nor any company I've worked for in the trades) and due to the work that I do, any outside insurance is extremely expensive.

/EDIT TO ADD: I would definitely go the Planned Parenthood route, when someone walks in there and actually WANTS to keep the baby they go above and beyond to help out. Jenny has been twice in order to confirm pregnancy for insurance reasons, and the women in there get all excited when she says shes keeping it. Sad really.


Goodluck!
Steve

Last edited by hungry4knowhow; February 9th, 2011 at 11:29 AM.
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  #8  
February 9th, 2011, 06:09 PM
Regular
Join Date: Sep 2010
Posts: 75
You are not married to the father and he has no legal obligation to cover your medical expenses. I really feel that they are trying to scare you or something. I am reading the manual for Oregon Medical Assistance Programs and I cannot find anything about the noncustodial parent being required to repay medical expenses. The most relevant part of information is below:
Quote:
Cooperation with the Division of Child Support

Applicants for Medicaid assistance are required to agree to cooperate with the Division of Child Support to obtain health care coverage or cash medical support through a noncustodial parent unless they have good cause not to cooperate.

Exceptions to the requirement to cooperate with the Division of Child Support:

* Parents of OHP-CHP and HKC children are not required to cooperate with the Division of Child Support;

* Pregnant women are excused from cooperating with the Division of Child Support;

* Persons with good cause not to cooperate with the Division of Child Support (see the Good Cause subsection below).

Most Medicaid clients cannot be required by the department to complete paternity affidavits or pursue health care coverage or cash medical support at initial application or at redetermination of Medicaid eligibility. Signing the application is proof the client has agreed to cooperate. However, if the Division of Child Support sanctions an adult applicant for failure to cooperate during the application process, the adult applicant who failed to cooperate is denied. Use the CSM case descriptor to identify applicants denied for failure to cooperate.

What cooperation with the Division of Child Support includes:

Medical program recipients (except OHP-CHP clients, HKC clients, pregnant women and persons excused for good cause) are required to:

* Assist the department and the Department of Justice, Division of Child Support in establishing paternity for a child and obtaining health care coverage and cash medical support;

* Assign cash medical support payments to the department. Once Medicaid coverage for a child receiving cash medical support begins, the Division of Child Support will send the cash medical support payment to the Division of Medical Assistance Programs (DMAP).
It does say that applicants are "required to agree to cooperate" but then right after it says "Pregnant women are excused from cooperating with the Division of Child Support."

By signing the application you are "agreeing" to cooperate, but that is all that you are required to do. They cannot force you to do anything besides sign the application and the rest is out of their hands. The Division of Child Support would then be the ones who pursued the support and if you think about it... they don't have the time.

I handle Medicaid applications in Virginia and there is similar policy here, but I have NEVER seen anyone actually get contacted by DCS.

Go ahead and get the assistance you need and just have the father add the baby to his insurance when the baby is born.
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  #9  
February 10th, 2011, 04:55 AM
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Join Date: Mar 2009
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The Division of Child Support would then be the ones who pursued the support and if you think about it... they don't have the time. 

I handle Medicaid applications in Virginia and there is similar policy here, but I have NEVER seen anyone actually get contacted by DCS. 
I dunno which part of VA in which you work, but if it's in or near the DMV, Dept of Social Services (DSS) absolutely WILL pursue the father/non-custodial parent for repayment. I can go into the Maryland casesearch system and pull up PLENTY of cases where it's DSS vs. a non-custodial parent.

As for what seems to be contradictory language, it's not. As a pregnant woman, you can't be forced to comply...the child isn't here. However, when you go to recertify, that's when that "agreement to cooperate" comes into play.

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Go ahead and get the assistance you need and just have the father add the baby to his insurance when the baby is born.
I agree. Again, Unknown you can probably get away with the medicaid for the pregnancy without adding the baby when it's born or recertifying for medicaid, but if you put down the father's name, eventually they will pursue him (at least in my neck of the woods they do).
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  #10  
February 10th, 2011, 09:37 AM
Member
Join Date: Feb 2011
Posts: 14
As long as you are not pursuing child support it looks like you are fine.
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  #11  
March 1st, 2011, 01:57 PM
Mega Super Mommy
Join Date: Mar 2011
Posts: 1,069
i work in another states doing medical assistance. Dont provide what they call "the absent fathers" info. The only time they need it in my state wish for childrens medicaid. Then its only medical support payments they try to go after. In texas its $75 per month.
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