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AUTISM financial RESOURCES

*Each underlined resource is hyperlinked for your convenience.

Figures from the Centers for Disease Control and Prevention (CDC) confirm that autism is a critical public health issue that deeply impacts millions of Americans.  We know that access to resources and services are greater than ever.  The Autism Hero Project (AHP) was founded on the idea that what we advocate for is a human's basic right to access the medical care and treatment they need to reach their full potential.  More importantly, we believe that finances should NEVER be a barrier to access and take pride that we have become the financial bridge for parents by offering our Medical Insurance Grants in order to gain access to Applied Behavior Analysis (ABA) Therapy.  Therefore, AHP will not rest until every child has access to ABA Therapy.

We know that in the State of Illinois, the Medicaid program does NOT typically cover ABA Therapy but the Illinois Department of Human Services (IDHS) does offer a program referred to as The Health Insurance Premium Payment (HIPP) .  This is a resource eligible for Medicaid recipients to enroll and gain access to ABA and other Therapies.

Health Insurance Premium Payment (HIPP) Grant

HIPP is a program that helps to pay/reimburse health insurance premiums for some clients who have high medical insurance expenses.

Clients must cooperate with HIPP to be eligible for medical. Clients with high cost medical conditions must provide information for any health plan that they:

  • are enrolled in; or

  • are eligible to enroll in but are not; or

  • may enroll in due to loss of employment, layoff, or retirement (COBRA or conversion policy).

HIPP is limited to clients who have high cost medical conditions, such as:

  • severe arthritis;

  • cancer;

  • heart ailment or defect;

  • liver disease;

  • kidney disease;

  • brain disease or disorder;

  • neurological disease or disorder (such as Autism);

  • diabetes;

  • AIDS;

  • organ transplant;

  • any other medical condition requiring high cost ongoing medical treatment, such as pregnancy.

In order to be eligible, you must meet the following requirements:

  • Be currently enrolled in Medicaid,

  • Have private insurance (through an employer or private insurance.)

  • Be cost effective (monthly expenditure on health costs must be 2.5x greater than your monthly premium. For example if your monthly private insurance premium is $400, the combined cost of all therapy and medical treatment would need to be $1,000/month or greater. With ABA therapy typically ranging from $90 -$120/hr, you would need to receive a minimum of 12 hours of therapy a month to be eligible.  Most children meet that minimum requirement in one week, let alone a month.

  • Be able to show 6 months of "Explanation of Benefits" (EOBs) - the statements from your insurance showing the cost of care) demonstrating that they are cost effective. (You can export all of your EOBs into an excel file format as evidence from your insurance providers online dashboard.)

For families with Medicaid who do not have medical insurance available from an employer, you will need to first purchase a private medical insurance plan from an insurance broker by December 15th but it CANNOT be The Affordable Care Act a.k.a ACA from The Marketplace healthcare.gov because technically ACA is considered another government insurance plan and you legally CANNOT have two government plans therefore it must be PRIVATE INSURANCE (attained through a private health insurance broker.)  After receiving a minimum of 6 months of ABA therapy you may then be eligible to apply for HIPP because you must provide at least 6 months of EOBs to seek approval. To qualify, you will also need to submit the following items:

  • A complete application - Form DPA3459B (click to download), (If emailing, you must send completed application as a PDF.)

  • A copy of your medical diagnosis, a physician's statement describing child's condition and diagnoses.  This should be comprehensive so that the HFS/DHS has a clear picture of your child's medical needs. (If emailing, scan as a PDF.)

  • A copy of the FRONT and BACK of your medical insurance card. (If emailing, scan as a PDF.)

  • The address where premiums should be reimbursed. (If emailing, scan as a PDF.)

  • 6 months of EOB’s (To streamline this process, they will offer to access your account for you and download what they need if you are willing to provide them with your online portal login information, they can look up and download the information for you so you don’t have to scan and/copy all of it.  But there is a very simple way you can do it yourself without giving them your personal credentials.  You can just export into an excel.xlsx file all of your EOB's and send them the full excel file and that will suffice for their needs to verify what they need.

  • A copy of your insurance policy booklet (If emailing, scan as a PDF.  The booklet explains what is covered by your insurance. This booklet can also be found in your online portal.)

 

The above items can be submitted via email (HIGHLY RECOMMENDED for quicker response time) to hfs.boc.hipp@illinois.gov or mailed to:

 

HFS/HIPP Unit

PO Box 19149

Springfield, IL 62794

FAX OPTION: 217-524-3047  (But you may be required to mail DPA3459B Application because they need original.

For more information on this grant, you can call the main office at (217) 524-8268 or email hfs.boc.hipp@illinois.gov.

When all necessary information is obtained, an eligibility decision can be made within 30 days.  Decisions are sent to the family in writing.  If eligible, HIPP pays the client's share of the health insurance premium directly to insurance company, employer, union or client.  

Once approved by HIPP you will need to submit at minimum the following items for reimbursement monthly (not limited to):

  • Copy of your monthly invoice.  (A screenshot or picture will not suffice, you must send invoice as a PDF if emailing.)

  • Evidence of medical insurance premium payment/paystub deduction. (A screenshot will not suffice, you must send as a PDF if emailing.)

P.U.N.S (Prioritization of Urgency of Need for Services)

is a database of Illinois infants, children, adolescents, and adults with developmental disabilities who have needs for developmental disability services or supports. The PUNS database helps us identify and plan for your immediate needs.

How do I sign-up for placement in the PUNS database? Click here 

Individuals, along with their primary care giver and/or guardian, must meet face-to-face with a pre-admission screener at their local coordination agency to fill out an Illinois PUNS registration form.

The individual must provide information on their medical condition, living arrangement and need for new, additional or different services. This will allow the pre-admission screener, on behalf of the State, to determine whether the person's needs are fully served, and if not, to categorize the need for developmental disabilities services. Your information will then be entered into the PUNS database.

You can also call the Developmental Disabilities Hotline at 1-888-DD-PLANS and 1-866-376-8446 (TTY) to assist you with the process.

Note: Completion of a PUNS form does not guarantee eligibility for services or the provision of services, but it does make sure that the State is aware of individual need for services.

What assistance can I receive if I sign up for PUNS?

  • In-home Supports

  • Respite Care

  • Job Coaches

  • Residential Living Arrangements

  • Adaptive Equipment

  • Other Supports

Even though resources are limited, the State works hard to make sure services are allocated as fairly and efficiently as possible, and they are continuously looking for new ways to increase access to assistance for those who are in need.

How do I find an Independent Service Coordination Agency in my area?

To find an Independent Service Coordination Agency in your area you can call the Division of Developmental Disabilities Hotline at

1-888-DD-PLANS and 1-866-376-8446 (TTY), or you can click here to find a local coordination agency in your area.

United Healthcare Children's Foundation Grant

Covers up to $1,500 in out-of-pocket medical costs (co-pays and deductibles), services and equipment.

  • Medical Services, Treatments and/or Therapies MUST be administered by a licensed medical professional.

  • Services or Treatments MUST be provided no more than 60 days prior to the date of your complete application. Don’t wait, apply right away! Grants are available for medical costs incurred within 60 days from the time UHCCF determines the application to be complete. It will then be good for one year following the month in which it is approved.

  • Medical Services and/or Purchased Equipment MUST be administered or purchased in the United States (excludes U.S. Virgin Islands, Puerto Rico, and other United States Territories)

Applicants must meet the following criteria to be considered for a grant:

Child must be 16 years of age or younger at the time of application.
Child must have a Social Security Number issued by the Social Security Administration. TIN numbers are not accepted.
Family must not exceed maximum eligible family income as documented on IRS Tax Form 1040.

  • $55,000 or less for a family of 2

  • $85,000 or less for a family of 3

  • $115,000 or less for a family of 4

  • $145,000 or less for a family of 5 or more

Primary coverage for the child must be by a commercial health plan, either through an employer or individually purchased. Secondary insurance through Medicaid or CHIP is permissible.
Child is under the care of a licensed medical professional and family is applying for treatments/equipment/services prescribed by a Medical Doctor (M.D.), Doctor of Osteopathic Medicine (D.O.) or Doctor of Audiology (Au.D.) for hearing conditions.

Click here for Required Documents
Click here to complete the application
Autism Care Today Grant

Autism Care Today grants up to $5,000 per family and are designed to provide access to individuals and families affected by Autism Spectrum Disorders. Grant payments will be made directly to pre-approved treatment providers, assessors or materials vendors.

If you have additional questions that are not answered on this page, please contact the grants department at 818-340-4010 or 877-9ACT-TODAY (877-922-8863), or email to grants@act-today.org.

 
State and Federal Disability Benefits
 
Supplemental Security Income (SSI)

Supplemental Security Income, or SSI, is a monthly government payment through Social Security which is designed to support people who are aged (65 and older), blind, or disabled. Individuals with autism may be eligible to receive SSI to help support them financially.

Information on this and other programs can be found at www.ssa.gov. You can also review the following links which further explain the SSI program for children and adults with disabilities, family financial criteria, how to apply, and more.

Social Security Disability Insurance (SSDI)

Social Security Disability Insurance is another financial benefit through Social Security. This payment is available for adults who have a disability that began prior to age 22. SSDI can be considered a “child’s” benefit because it is paid on a parent’s Social Security earnings record.

For a disabled adult to become entitled to this “child” benefit, one of his or her parents:

  • Must be receiving Social Security retirement or disability benefits; or

  • Must have died and have worked enough to qualify for Social Security.

These benefits also are payable to an adult if he or she is disabled at age 18, and if they received dependent’s benefits on a parent’s Social Security earnings record prior to age 18. We make the disability determination using the disability rules for adults. SSDI disabled adult “child” benefits continue as long as the individual remains disabled. Your child doesn’t need to have worked to get these benefits.

For more information on SSI and SSDI, see this booklet called Benefits for Children with Disabilities.

You can find many more SSDI resources and information here.

Chicago Autism Project

Some of the programs they offer include:

Scholarships and Grants – This program offers support for life-changing therapeutic services, such as speech therapy, ABA therapy, through grant and scholarship programs.

Key Information for Applicants:

  • You must have a child with a current autism diagnosis

  • Your child must be between 14 months and 5 years old

  • You must reside in the greater Chicago area

  • You can apply for up to $10,000 in scholarships (or the amount of your insurance out-of-pocket maximum)

To apply click here:  CAP Grant

Other things they offer:

Diagnostic Evaluations – It is not uncommon for families to be placed on waitlists for diagnostic evaluations that are several months long. We partner with clinicians to help families receive diagnostic evaluations sooner.

Therapeutic Services –  They work to increase access to high-quality therapy services for children with autism. We partner with providers in the community that offer a range of therapeutic services specializing in services for children with autism.

.

Key Information for Applicants:

  • You must have a child with a current autism diagnosis

  • Your child must be between 14 months and 5 years old

  • You must reside in the greater Chicago area

  • You can apply for up to $10,000 in scholarships (or the amount of your insurance out-of-pocket maximum)

Looking for a Diagnostic Evaluation (Without the long wait)
The Goldman Center of Chicago (Medicaid is Accepted)
Contact 773-998-8500
 
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