Disabled child's mother pays out-of-pocket during IL budget stalemate

Disabled child's mother pays out-of-pocket during IL budget stalemate
(Source: KFVS)
(Source: KFVS)
(Source: KFVS)
(Source: KFVS)
(Source: KFVS)
(Source: KFVS)

THEBES, IL (KFVS) - The medical needs of a child with severe disabilities are at risk, because Illinois is not paying bills.

Tamara Dougherty of Thebes, Illinois is currently allowed 56 hours per week of in-home care, primarily for her 14-year-old child, Marlee.

Marlee and her older sister were born with a genetic defect which hinders muscle, bone and brain development.

Tamera Dougherty is a recessive carrier of the culprit gene, which was active in two of her three children.

The insurance under which the family is supposedly covered was earned by Dougherty's husband Kevin, who's life was claimed in 2013 by cancer.

The disease forced Kevin to pull out of his employment at Tamms Supermax Prison in 2010, but he returned to work shortly before his death.

"Out of nowhere he said, 'I'm going back to work,'" Dougherty said. "And I found out after he died it was for me and Marlee...to bump us to that next level, so we would have insurance after he died."

Kevin met that requirement roughly three weeks before his death on February 13, 2013.

Marlee was able to walk until shortly after he father's death, when she suffered two strokes as a complication of her condition.

After that, 24-hour supervision became a "must," according Dougherty.

"One of the days I didn't have anyone around to help me take care of the girls, Marlee was sitting on the floor, and reached for a toy," Dougherty said. "She slipped; and the fall, just from a sitting position, broke her humerus bone. That's how fragile she is."

The bill for Marlee's care now exceeds $50,000, which would be fully-covered if the state was paying monthly premiums on Dougherty's health insurance plan, but they are not.

Dougherty received a call from her healthcare provider, explaining if she did not pay the bills accumulated since the beginning of the Illlinois budget stalemate, any healthcare and assistance she is provided with would cease.

"They weren't trying to intimidate me, they wanted to help," Dougherty said. "They were just wanting to let me know that since Illinois hasn't passed a budget, that they have not been paid since July of 2015."

Dougherty said she hoped to hear answers in Illinois Governor Bruce Rauner's State of the State of Address on Wednesday.

The governor didn't touch on the state-wide topic of state workers not receiving health insurance they were promised, but spent time discussing general damages reaped by the stalemate while requesting cooperation in Springfield.

In the mean time, Dougherty is paying more than $800 per month in premiums and her disabled children could face losing care.

The Department of Central Management Services normally handles distribution of some funds in cases like Monahan's and released a written statement on Monahan's scenario earlier this week.

CMS Spokeswoman Meredith Krantz said:

"CMS and the medical plan administrators are working diligently with healthcare providers to try to avoid having providers charge members up front for services and to ensure there is no interruption of service."

Dougherty said she is currently receiving some funds from CMS to assist with her premiums.

CMS asked that anyone in a situation where they are at risk of losing state-funded health service contact the agency at 800-442-1300.

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