Thursday, October 29, 2015

My Fire Is Back. My Fight, My Tenacity, Is For Thomas.

The Wasteland--Medicaid
(picture credit: bungie.net)


Okay, I'm back and I'M ON FIRE! I saw this day coming and made the conscious choice over and over not to face it because, to be honest, at the time, it wasn't directly affecting Thomas and I but the thing is, it's here now and I am putting on my armor, sharpening my sword and getting on my beautiful black stallion ready to fight the good fight.

This fight won't just be for Thomas and for me but it'll be for all of you out there that are in the exact same or similar situations. My entire reason, MY PURPOSE for starting this blog in the first place a few years ago is back now and I have over 7,000 followers and I am going to include every last one of you in any way you want to be included.

Here is what we're facing:

The day is fast approaching that Thomas will be dropped from his FABULOUS (at least that has been our experience) health insurance, TRICARE. For those of you who are not familiar with it, it is a U.S. Federal Government insurance supplied to military members and their dependents. Thomas's biological father is a retired Marine and despite a contentious divorce and despite the fact that neither of us are each other's greatest fans, he has graciously kept Thomas on his insurance past Thomas reaching legal adulthood at 18. The problem now, though, is that on Sunday, Thomas will be 21 (we will celebrate that milestone here on the blog on Sunday, November 1st) and TRICARE is dropping Thomas. By law, because Thomas isn't pursuing a college education, they don't have to cover him anymore. However, there is a caveat to that rule in the form of a possible consideration by them to continue to insure Thomas into perpetuity because he is deemed disabled and is on SSI (Supplemental Security Income--A.K.A. "Disability"). This is, however, totally in their ball park to approve or deny and it appears that after both my ex and my attempts to get them to continue to cover Thomas, they won't be making the concession to cover Thomas beyond his 21st birthday.

So, because we held out hope that Thomas had a good enough case and we had a good enough argument for them to keep him insured, I didn't fully look into the truth behind Medicaid and what it covers--and more importantly what it DOESN'T cover--when it comes to mental health care. It wasn't the wisest choice on my part to put it off but I really thought TRICARE  would come through for us since they have seen years of records from Thomas's treatment and seen the gravity of what he faces with this cruel illness.

Yesterday, I finally gave up hope on Thomas being covered by TRICARE. There's a minute chance that they'll still cover him but it is oh so small.

It is time for me to say goodbye and it is time to move on to not-so-greener pastures, those that are the wasteland that is Medicaid.

I, first, began with looking up what medications they cover. My worst fear about losing TRICARE has been losing coverage for Thomas's Latuda because it is a new medication and it is EXPENSIVE and I thought that there was no chance that they'd cover it. Through my research, I discovered, happily, that I was VERY wrong about that. Not only do they cover it but they cover all of Thomas's most crucial medications. The one unknown, however, and it's just more research to be done on my part, is:

HOW MUCH OF IT DO THEY COVER?

We could be looking at serious co-pays and that has ramifications that I will get into in another post to be written soon.

I told you I'm back here and I'm on fire and I'm not kidding. Thomas and I are starting a journey that many of you are already on and perhaps some of you are just now embarking on like us, or you face this issue soon yourselves. Nobody will be alone in this, at least as much as I can control by giving voice to these issues that I will be talking about from this point forward. I have spent days, recently, feeling helpless, defeated, depressed, angry and DEAD TIRED as I have anticipated what was looming with Medicaid and the loss of TRICARE and so help me God, I am going to do my best to make sure that as many of you as I can, will no longer feel alone in this process and this fight.

Thomas and I are facing a harsh reality now, with the loss of TRICARE, and the journey we take, we will take you with us. I will post about this a lot, I'll be writing, again, more often, and as I educate myself on all things Medicaid, I will share that with you and hopefully help you sort through any similar messes to ours that you face.

I have felt INCREDIBLY ALONE for months now, caught in grief over the losses I see in Thomas, caught in the glaring reality about schizophrenia and some of my "alone feeling" has been self-imposed because I just didn't have the strength anymore to fight. But, true to form for me, I am never down for long, not much in life has ever totally brought me down, and therefore I'm back on my feet and I'm ready to fight the good fight.

For Thomas--most especially.

For me.

And for all of you.

2 comments:

  1. I still don't understand the system, but my 23-year-old son is on Social Security, and as a result, he is automatically on MaineCare, which I thought was Medicaid? His co-pays for meds are $3. His SS pays for his group home, and he has about $300 left over for internet, supplemental vitamins, and spending money.

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  2. Melanie,

    Hooray! You are back to form and have your "A-game on!! You are a fighter and can definitely help yourself, Thomas, and so many others with your efforts.

    Keep moving forward one step at a time. We are all pulling for you in this fight to help Thomas and others with schizophrenia. Thank you for all you do... you have no idea how important you are to so many!

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