Loud and Clear: A Special Needs Conversation

Medicaid and Special Needs

By Carol 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.

Posted: January 30th, 2012 | 2 Comments »

2 responses to “Medicaid and Special Needs”

  1. Eric Popkin says:

    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 says:

    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 2014.now 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

Leave a Reply

Your email address will not be published. Required fields are marked *