Medicaid is one of the primary supports for people with disabilities in the United States. Program titles may vary by state but most services are similar.
Medicaid is available to low-income families and those receiving Supplemental Security Income. Most families should apply for SSI, even if it is just for the denial, as a denial letter is often required for other services. Once denied SSI benefits many families may apply for Medicaid Waivers in their respective states.
Each State has it's own Medicaid program. Individuals with special needs may qualify for benefits and funding through these waiver programs once they have been denied benefits through traditional programs. Non-traditional waivers have more liberal eligibility guidelines that are not based on family income. People may be eligible if they have qualifying disabilities and substantial functional limitations in three or more of the following activities: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency, etc.
When a person is found eligible, generally an evaluation called a "critical needs assessment" is completed by a caseworker from the state Department of Services for People with Disabilities (DSPD). This assessment considers the individual's school records, when applicable, a questionnaire generally administered by a division support coordinator or manager, medical records, and psychological evaluations. In most states, once you have gone through the eligibility intake process, if you are found eligible, you will immediately receive services. In some states the demand for services is so great you may be put on a waiting list and prioritized.
*Note: It is important you make sure that once you are put on a waiting list, you contact your assigned case manager frequently to keep them updated on the current status of your family situation and any changes that may occur. This really is a case of the squeaking wheel gets the grease. If they do not hear from you, they assume everything is fine, and they will give you a lower priority. If you feel that you need to be moved up in priority then you need to be maintaining contact with your DSPD case manager.
Funding for these services are allocated by state legislatures every year and budgets are tight. As funds are available they will notify families and bring them on to the service. Be sure you keep your case manager updated periodically. Failure to do so can result in your being passed over for services. Keep your Case Manager informed.
Once you begin receiving services through DSPD, you may be eligible for a Medicaid waiver. By using Medicaid waivers, each state receives Federal-matching dollars to help fund services for people with disabilities. The different Home and Community Based Services Waivers that are available vary by state but in general fall under the following categories:
- Acquired Brain Injury waivers
- Community Supports waiver for Individuals with Intellectual Delays (ID)
- New Choices
- Physical disabilities waivers
- Autism (In Utah this program serves less than 300 children statewide ages 2-6 years, short term. This is NOT a full waiver program but a lottery. *Please ask about current program requirements when applying.
The biggest majority of applicants generally qualify under the last category. For more information about these specific waivers you will need to contact the department in your state directly. (See our "Resource Links" section for websites and contact information.)
You may need to apply for traditional Medicaid, be denied, and then apply for a waiver. Most individuals who do apply for traditional Medicaid do not receive it the first time because their family income does not meet Federal Guidelines. If this happens, then you will need to apply for a waiver. DSPD is the agency that you need to make your application through for that waiver here in Utah. They will also do an evaluation to assist the family with any further needs such as respite care, facility facilitation, individual rehabilitation programs etc.