What do I need to know about right away?

Supplemental Security Income: Supplemental Security Income (SSI) is a federal program run by the Social Security Administration. Many babies in the NICU qualify for this program.

If you are from Iowa, the SSI benefit is $30 per month* and Medicaid of Iowa while your baby is in the hospital. It is based on your baby’s income while your baby is in the hospital. Even if you have insurance for your baby, Medicaid can help pay for deductibles, out-of-pocket maximums, and co-pays. SSI-related Medicaid will stay in place for one year. After one year, it will be based on family income. (*Other states give $30 but the Medicaid is based on income; for example, Illinois residents may apply for Illinois Medicaid).

Cash aid from SSI is $30 while in the hospital. When your baby is discharged, you will need to let the Social Security Administration know. Cash amount will then be based on income and resources. Cash aid can be up to $733 per month.

If your baby meets any of these, they may be able to receive SSI:

  • Weighs less than 1200 grams at birth (about 2 pounds, 10 ounces) or
  • Weighs less than 2000 grams AND is diagnosed Small for Gestational Age (SGA)
SGA Guide
# of weeks Weight in grams Pounds/ounces
37-40 weeks Less than 2000  
36 1875 grams or less (4 pounds, 6 ounces)
35 1700 grams or less (3 pounds, 12 ounces)
34 1500 grams or less (3 pounds, 12 ounces)
33 1325 grams or less (2 pounds, 15 ounces)
  • Has a condition that is SSI eligible such as possible developmental delays, long-term (12 months or longer) medical issues, or surgeries.
  • Has been readmittedto the hospital, meets SSI medical eligibility, and has been in the hospital for 30 days in a row. Medicaid then goes back to admission date. SSI is based on baby’s income, not parent’s income.

Please contact your NICU Social Worker for help or:

1. Contact your local Social Security Administration (SSA)
2. Contact the SSA toll free number: 800-772-1213
3. Apply online at socialsecurity.gov

More Medicaid of Iowa Programs:

Even if you have insurance, you and your baby may be eligible for Medicaid, which can help with costs not covered by your insurance for up to one year. With Medicaid, you also may be able to get help with health insurance premiums. With Medicaid, baby and baby’s mother may apply for WIC (Special Supplemental Nutrition Program for Women, Infants, and Children).

Talk to your NICU social worker for more information about these programs: 

For food and formula, Medicaid allows you to receive WIC: If a baby is eligible for WIC, so is the baby’s mother.

For help with insurance premiums: Health Insurance Premium Payment (HIPP):
If you have insurance and Medicaid or apply for Medicaid or Facility Medicaid, the (Iowa?) Department of Human Services may pay the cost of your insurance premium. Ask your NICU social worker for help with this. 

Medicaid is available for one year if your baby has been or may be in the hospital for more than 30 days. If a baby is eligible for Medicaid through Facility Medicaid, Medicaid may continue until the following Medicaid income review (usually in one year).

Cash and Medicaid through FIP: Family Investment Program (FIP) provides cash and Medicaid Health care coverage to families with limited income or resources. You can apply online at dhs.iowa.gov.

Medicaid for the Medically Needy: If your income is too high for Medicaid but your medical costs are high, you may be eligible for this program You may pay some of the costs.

Home and Community Based Services (HCBS) Waivers: HCBS waivers provide services in the home for those who otherwise would need to be cared for in the hospital because they are not eligible for Medicaid or Medicaid services.

Illinois Medicaid: Healthcare for All Kids, Family Care, and Moms and Babies Health Insurance For more information, call the All Kids Hotline toll free at 866-255-5437

Illinois:
For information about Illinois programs, contact the Division of Specialized Care for Children toll free at 800-322-3722, or online www.uic.edu/hsc/dscc.

Other Resources

Food assistance: Supplemental Assistance Nutrition Program (SNAP): Also known as food stamps, SNAP provides nutrition assistance for families with limited income and resources. Apply online at dhs.iowa.gov.

Handicapped Parking Permit: For babies who will be discharged with needs such as oxygen. See your baby’s nurse practitioner.

COBRA:
COBRA (Consolidated Omnibus Budget Reconciliation Act) may allow people who work to keep their insurance if no longer employed.

Disability Rights Iowa (Iowa Protection and Advocacy Services):
400 East Court Avenue, Suite 300, Des Moines IA 50309
Phone: 515-278-2502 or toll free 800-779-2502

Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT):
The EPDST program is for Medicaid recipients under age 21. It may cover medically needed services such as private duty nursing and home health aides.
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Exception of Policy:
For medically necessary services not covered by Medicaid, a medical statement will need to be sent to Iowa Department of Human Services, Office of Appeals. For more information, call 515-281-8438.

Iowa Department of Public Health:
The Department of Public Health offers well-baby and genetics clinics with a sliding fee scale.