Medicaid Health Insurance - Choice but Considerations

Nicol,

I recently gave a presentation here on SSI as that alone is a complex benefit for parents to understand, but I did mention Medicaid Health Insurance. Overall, I think it gives both the individual with the disability and the family options:

- As soon as the teenager - as a legal adult at age 18 - receives SSI for one month, then you can simply call your local Department of Social Services and ask for the "short" application form for Medicaid. It is a very seamless process.

- For the young adult with a disability, getting Medicaid means:

1- Medicaid Health Insurance can be used as one's primary or secondary health insurance.

a- And there are items that Medicaid may cover in full that a family policy may not - one example is 100% of most medications.

b- However, there are items that are not covered that may well be a reason for staying on a family policy such as dental care, vision care and glasses etc.

2- Medicaid Health Insurance need not be elected right away, but by establishing one's "eligibility" for it, when you may decide you want to start using it, you have the card etc. and don't need to wait at all.

3- Medicaid Health Insurance will pay for Active Case Management Adult Services which you will want as one transitions from public school to adult services once "Medicaid eligibility" is established.

4- Medicaid Health Insurance "eligibility" also needs to be in place should one get a MR Waiver slot.

5- Down Side and Note: It is true that not all doctors take Medicaid, and we have found this to be true in our area. Currently, I am not sure if I like our daughter's new PCP or not. So in a way, I would ask around early who others go to that accepts new Medicaid funded patients as young adults (when a pediatric setting may not be appropriate) and get started there early when you are a private pay patient and could just continue.


- For the family of a young adult with a disability getting Medicaid means:

1- If the family has had to limit their resources or a spouse's working to keep a child qualified for Medicaid Health Insurance, the family no longer needs to do so.

2- You will now have the option of keeping the young adult on your family health policy or not. It is true that some health care providers do not take Medicaid so this could be a reason to stay or a family's health insurance policy. Or if there are other children on a family policy, there really is not need to change.

3- ***You need to read carefully the dependent coverage section so that you have a clear understanding for all of your children:

a- How long any young adult may be covered under your health insurance policy. And, when you may need to get fuller information together for your private health insurance provider to have continued coverage of an adult child with a disability - you don't wait till the month before it would lapse.

b- Have a clear understanding of how long one can stay on your family health insurance coverage after approval by the provider. It usually means that you are declaring one a dependent on your tax return. And in our case after E had been working for a full year, she was actually earning more income than would qualify her according to the IRS rulings to be continued as a dependent. I know it is on some form, and I think it is around $3,600, but not certain.

c- NOTE: For other young adults with a health condition who do not qualify for Medicaid Health Insurance, it is also important to understand COBRA rules for continued coverage.

d- Remember if the employee with the health insurance is close to retirement age, then this will be another reason to have Medicaid in place for the young adult with a disability as the family coverage may lapse.

4- If family health insurance coverage is expensive, it would give you the option to perhaps go to just employee only or employee-spouse.

Frankly, for us it was just a hard decision to move her to Medicaid, as it just seemed to be not the same kind of health care that we know we can get on my husband's college policy. But the goal has been for her to be working so the time came that we could not legally claim her as a dependent. Others really say that Medicaid coverage has been fine, but the limited number of providers is an issue to also consider. I hope this has helped you sort things out.