Medicaid and Special Needs

By Carol S. Battaglia, Esq.

Medicaid, jointly funded by the federal government and individual states, is arguably the most important public benefit available to individuals with disabilities. While eligibility guidelines, services and payment rates vary widely, the federal government requires that all state Medicaid programs pay for physician visits, prescriptions, hospitalization, lab work, x-rays and nursing home care. In addition, all states must provide periodic health screenings and treatment to Medicaid-covered children under the age of six.

Although Medicaid is available only to those having limited income and assets, once an individual with disabilities reaches the age of 18, family assets are no longer considered, making it an important consideration in all special needs estate planning.

In addition, most states have established Medicaid “waiver” programs with less stringent income/asset requirements. The most common of these are intended to support the needs of individuals with severe disabilities who are eligible for long-term, institutionalized care, but whose families prefer that they remain in a community setting. Typical services include home aides, day habilitation, family respite and therapeutic services. Some states will cover expenses for individuals to live in small, community-based group homes.

Waiver waiting lists are notoriously long, and it can take years for an individual to obtain services. Parents should, therefore, place their child on appropriate waiver lists as early as possible.

The current tone of the budget discussions taking place at all levels of government poses a serious threat to Medicaid in general. It appears inevitable that services will be trimmed and that waiver lists will continue to grow. This is ironic, since community-based care is more economical than the institutional living which is its alternative.

This troubling situation underlines the importance of early family planning for the financial security of loved ones with disabilities. Establishing a third party special needs trust (SNT) to which family and friends can contribute funds without endangering a child’s eligibility for government programs is a means of supplementing bare-necessity services that are likely to be even more modest in the future.



  1. Eric Popkin March 28, 2015 at 4:48 pm

    Hi: Where does one find reliable information on specifics of how medicaid waiver programs vary by state. Information that would be useful would be: length of waiting period, what services are provided, CNA support – how does it work and vary by state, state rankings etc. Thanks for any leads. Currently in Colorado (so far a good waiver for us) and considering a move to Rhode Island or Virginia. Thanks!

  2. maria May 12, 2018 at 10:51 pm

    My husband has cll cancer from 2006 he had cemo and he was doing great.he has to take a pill which costs 2500a month .I do not have coverage I go through the hospital on afee scale, the pill is made special .Hopefully he is at 0-stage 1 when it was found in 2006 had cemo in no more chemo this pill I make to much money for Medicaid he is on his retirement. I believe he might be excepted for special needs medicaid. new York what do you think the hospital is trying many options for our family. If I am write and anyone out there knows what can be done let me know. thanks maria

  3. Mark L Shiffert November 6, 2018 at 8:22 am

    My fiance has four children all have special needs I have two children with special needs that are older my kids my old one there’s artistic is 22 is on a waiver and has helped her for get very little the developmental disability for Darke County doesn’t help much she needs additional funding so she for her to with PTSD one with muscular dystrophy and other with autism and the two as PTSD aren’t properly diagnosed as of yet we need help what do I do

  4. Virginia pugni November 29, 2018 at 2:28 am

    My son is 27 year old. We relocated from New York to South Carolina, He is dependent on me since we have been here I applied for services that he had in New York
    Medicaid Medicare
    Work activities
    I had his Medicaid caseworker s information for documentation
    He was in program s at age 2 1/2
    I received a letter he was denied Medicaid and that he is not eligible
    But can buy into a health care program
    Really with what money
    I want to get an attorney for him
    Because none of these workers did anything for him and the transition
    Can you refer me to an attorney for individuals with developmental disability s he has Fragile X I have guardianship from court everything with documents about his disability
    He can’t drive or read more than a few words
    Isolated and alienated right now since we left New York

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