When a child faces a serious illness, families encounter not only emotional challenges but also complex financial considerations. At Carolina Caring, our Cardinal Kids program is designed to provide comprehensive support that addresses both the medical and financial aspects of pediatric palliative care. This guide will help families understand insurance coverage, financial assistance options, and the unique aspects of financing pediatric palliative and hospice care.
Understanding Pediatric Palliative Care Coverage
The Concurrent Care Difference
One of the most significant aspects of pediatric palliative care financing is the Concurrent Care for Children Requirement (CCCR). Established through Section 2302 of the Affordable Care Act in 2010, this provision allows eligible children to receive both curative treatments and hospice services simultaneously.
Unlike adult palliative care, where patients often must choose between curative treatment and hospice care, children under 21 who are enrolled in Medicaid or CHIP can receive both. This means your child can continue treatments aimed at curing their condition while also receiving the comfort care and family support that hospice provides.
Medicaid and CHIP Coverage
Medicaid and the Children’s Health Insurance Program (CHIP) provide critical coverage for many children requiring palliative care:
- Medicaid: Covers a wide range of palliative care services for eligible children, including concurrent care for those with terminal illnesses.
- CHIP: Provides coverage for children in families that earn too much to qualify for Medicaid but still need assistance with healthcare costs.
Both programs vary by state in terms of specific benefits, eligibility requirements, and implementation of concurrent care provisions. In North Carolina, these programs cover most services provided through Cardinal Kids, including:
- Doctor and nurse visits
- Medication for symptom management
- Medical equipment
- Mental health counseling
- Care coordination
- Family support services
Private Insurance Coverage
Private insurance plans often cover many aspects of pediatric palliative care, but coverage can vary significantly between plans. While the Concurrent Care provision is mandatory for Medicaid and CHIP, private insurers are not required to offer concurrent curative and palliative services.
If your child is covered by private insurance, we recommend:
- Contacting your insurance provider to understand specific coverage for palliative and hospice services
- Asking about any pre-authorization requirements
- Confirming whether concurrent treatment is covered
- Understanding your deductibles, copayments, and out-of-pocket maximums
Carolina Caring’s Financial Approach to Pediatric Palliative Care
At Carolina Caring, we believe that financial concerns should never prevent a child from receiving essential care. Our Cardinal Kids program reflects this commitment through a compassionate financial approach.
Our Financial Policy
Most services provided through the Cardinal Kids Program are covered by Medicaid, CHIP, and commercial insurance carriers. We handle the billing process directly with your insurance provider and maintain complete transparency about potential out-of-pocket costs.
Most importantly, we believe every child deserves access to quality care regardless of their family’s financial situation. That’s why we offer a flexible billing policy based on need and never turn a family away because of inability to pay.
The Cardinal Kids Commitment
Founded in 2019, our Cardinal Kids program has served hundreds of children and families across North Carolina. Our interdisciplinary team provides an extra layer of support for seriously ill children in our 12-county service area.
Families who have participated in our program consistently report high satisfaction levels, with 100% of Cardinal Kids families reporting they are “extremely satisfied” with the program and would recommend it to other parents.
Unique Financial Considerations for Pediatric Care
Understanding Eligibility Requirements
Even with concurrent care provisions, there are important eligibility requirements to understand:
- Children must still have a life expectancy of six months or less to qualify for hospice care under Medicaid’s concurrent care provision
- The determination of a six-month prognosis can be particularly challenging for children due to the unpredictable nature of many pediatric conditions
- Each state implements concurrent care differently, which can affect service availability
Navigating Complex Care Coordination
The financial aspects of coordinating care across multiple providers and settings can be challenging. Pediatric palliative care often involves:
- Hospital-based specialist care
- Home-based services
- Medical equipment and medications
- Therapy services
- Social and psychological support
Each of these services may have different billing procedures and coverage requirements. Our Cardinal Kids team helps families navigate this complexity by coordinating with all care providers and insurance companies.
Financial Assistance Options Beyond Insurance
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
This comprehensive benefit provides important additional coverage for Medicaid-eligible children under 21. Under EPSDT provisions, many states provide coverage for necessary palliative care services regardless of prognosis, which can be particularly valuable for children with serious but not immediately terminal conditions.
Charitable Foundations and Grants
Various organizations provide financial assistance specifically for families of children with serious illnesses:
- Disease-specific foundations often offer grants for medical costs, equipment, and family support
- Community organizations may provide assistance with practical needs like transportation, meals, and household expenses
- Religious organizations frequently offer both financial and practical support
Provider-Based Assistance
Carolina Caring’s commitment to serving all families regardless of ability to pay is backed by various support mechanisms:
- Sliding fee scales based on family income
- Payment plans to manage out-of-pocket expenses
- Foundation support for families in need
- Connection to additional community resources
Practical Steps for Financial Navigation
1. Start Early with Financial Planning
As soon as your child is diagnosed with a serious illness:
- Contact your insurance provider to understand coverage details
- Connect with a social worker or financial counselor to explore assistance programs
- Discuss financial concerns openly with your healthcare team
2. Document Everything
Maintaining organized records helps manage financial aspects of care:
- Keep copies of all medical bills and insurance statements
- Document all communication with insurance companies
- Track out-of-pocket expenses for potential tax deductions or reimbursement
3. Utilize Available Expertise
You don’t need to navigate this alone:
- Social workers specializing in pediatric care can provide invaluable guidance
- Financial counselors at hospitals and palliative care organizations can help identify resources
- Patient advocacy organizations often provide guidance on insurance appeals
Getting Started with Cardinal Kids
If your child is facing a serious illness and you’re concerned about managing the financial aspects of their care, Cardinal Kids is here to help. Our enrollment process is straightforward:
- Contact us: Call 828.466.0466 or reach out online. No referral is necessary to begin the process.
- Consultation: Meet with our medical team for a one-on-one assessment of your child’s needs.
- Care planning: We’ll develop a comprehensive care plan that includes addressing financial concerns.
Conclusion: Focusing on What Matters Most
At Carolina Caring, we understand that when your child is seriously ill, your focus should be on their well-being and creating meaningful moments together—not on financial worries. Our Cardinal Kids program is committed to removing financial barriers to high-quality palliative care.
By combining expert clinical care with compassionate financial policies, we ensure that families can access the comprehensive support they need during an incredibly challenging time. No family should face the journey of caring for a seriously ill child alone, and financial concerns should never prevent a child from receiving the care they deserve.
Download our Cardinal Kids eBook: Get our comprehensive guide to navigating the emotional and practical aspects of pediatric hospice and palliative care.
Contact us today at 828.466.0466 or visit www.carolinacaring.org/cardinalkids to learn more about our pediatric palliative care services.
Carolina Caring’s Cardinal Kids program proudly serves children and families in Alexander, Burke, Cabarrus, Caldwell, Catawba, Cleveland, Gaston, Iredell, Lincoln, McDowell, Mecklenburg, and Rowan counties.
