Complex Medical Help program paid $3.5M worth of medical expenses for local youth

The program pays for medical expenses for children and young adults with special health care needs who meet medical and financial qualifications. Patients will get connected with nurses at Public Health who help the families work through their needs and find care with approved providers through the Complex Medical Help program.

“If there is anything that they need, we walk the extra mile to try to meet that need,” said Helene Hill, nurse supervisor of the Complex Medical Help program at Public Health - Dayton and Montgomery County.

Credit: Jim Noelker

Credit: Jim Noelker

A wide variety of diagnoses are medically eligible for the treatment program, including chronic conditions like diabetes and sickle cell anemia to other conditions like cleft lip/palate and burns.

“We typically serve up to 2,500 families per year,” Hill said.

Asthma, which is a prevalent problem for Dayton-region families, is a medically eligible condition and can help pay for medical supplies, like inhalers. Dayton was ranked earlier this year as the second highest in the nation for emergency department visits for asthma, according to the Asthma and Allergy Foundation of America.

“Some of the inhalers for asthma are really very expensive,” Hill said.

Credit: Jim Noelker

Credit: Jim Noelker

Treatments for conditions like Crohn’s, a chronic inflammatory bowel disease, require regular infusions that can become costly, she said.

“Children who are approved typically do not have any out-of-pocket expenses for their condition, so no copays for things like doctor visits, for equipment, diabetic supplies, a wheelchair,” Hill said.

For the financial component, the program covers Medicaid-eligible families, along with certain families who are not eligible for Medicaid or may have traditional insurance coverage.

“We typically have many working families that make between $75,000 and $100,000 per year that are financially eligible,” Hill said. “So our program, in my opinion is very helpful to working families.”

The Complex Medical Help program can help working families pay large copays and hefty deductibles. The program also provides case management and service coordination for families with eligible children.

Families who did not have access to funding from the program might have had to put off care for their children, such as if they had to choose between going to the doctor or paying for life expenses, Hill said.

“If it was not for funding from the CMH program, many working families would suffer financially,” Hill said.

For families who want to apply or see if their children are eligible, they can call Hill at 937-224-1589 or apply on Public Health’s website at phdmc.org/programs-a-to-z/complex-medical-help. Applications are also available at all children’s hospitals in Ohio.

Examples of eligible medical conditions for the Complex Medical Help program include:

For the treatment and care coordination aspects of the program, the participants must be under 24 years old. For the diagnostic portion of the program, participants have to be under 21 years old. All participants must have an eligible medical condition and be financially eligible.