AAPDDC

Here’s a summary of Medicaid benefits for disabled children and adults aged 3 through 21 years old.  Medicaid benefits for young people include home health care, health screenings, transportation, various types of therapy, and psychological services.  Anyone can apply for Medicaid, but that doesn’t mean everyone is eligible.  Because the program is jointly funded by states and the federal government, eligibility requirements vary widely from state to state.

The threshold requirement under federal law in order to qualify for Medicaid is to meet federal standards for either citizenship or be an eligible alien.  After that, the child must fit in one of the various categories under Medicare, and his or her income and other resources must fall within the eligible range.  Children who qualify for Social Security Disability Income automatically qualify for Medicaid.  Even if the child doesn’t qualify for SSDI, he or she can still qualify for Medicaid regardless of parental income if classified in the program’s “severely disabled” category.

Qualifying for special education services at school does not automatically qualify that child for Medicaid, because the standards for the two programs aren’t identical.  However, the same evaluation documents that qualified the child for special education programs may be submitted to Medicaid as evidence of the disability.

If the child is determined to qualify for assistance under Medicaid, he or she gets to carry an Access card.  This card funds all care that is deemed medically necessary by the child’s healthcare provider.  These services are free, and are unencumbered by deductibles and co-pays.  However, the card cannot be applied to rehabilitation or educational benefits.  Also, a family’s private medical insurance carrier, if one exists, must step in and pay first for the child’s health care, before the Access card can be utilized.

The Access card can be applied to psychological therapies for the disabled child, including inpatient treatment, psychotherapy and other behavioral therapies and medications, and inpatient/outpatient treatment programs.  The Access card also works for health services, such as nursing care, personal care support with tasks such eating and getting dressed, medical supplies, and devices to aid with communication.

Medicaid regulations entitled all recipients, disabled or otherwise, to fair treatment under the law.  Recipients must be allowed to:

* apply for benefits on the same day they request them.
* be accompanied by someone to assist in applying for benefits
* have a surrogate complete the application form if they are unable
* receive the assistance of a translator
* be evaluated for possible retroactive benefits extending back three months
* receive an Access card right away if the need is pressing
* not be discriminated against under U.S. law prohibiting such discrimination
* choose which health care providers to use
* be treated with respect and dignity
* apply for Medicaid without a home address if homeless
* receive a clear explanation of the benefits process
* receive notice in writing and a hearing if benefits are denied or discontinued
* appeal a denial or discontinuation of benefits
* receive benefits until an appeal is decided if filed within 10 days of the notice.

Medicaid is a powerful and vital health care program for children with disabilities.  Parents and educators would do well to gain familiarity with the assistance process so they can be of greater help to those who need it most.