Medicaid For Adults With Disabilities


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Why Is Medicaid Coverage Beyond The Ssi Pathway Important For People With Disabilities

‘Staffing crisis’ impacts people with disabilities

Even though their needs do not rise to the stringent SSI level, nonelderly Medicaid adults with disabilities but not SSI still report serious functional limitations that can affect their health, making coverage important. A majority of non-SSI Medicaid adults with disabilities report serious difficulty with cognitive functioning, and nearly half report serious difficulty with mobility.5 Two in five non-SSI Medicaid adults with disabilities report serious difficulty with independent living tasks, such as visiting a doctors office or shopping alone.6 Smaller shares report serious difficulty with vision , self-care tasks such as dressing or bathing , and hearing , compared to the other limitations that make up the ACS disability definition.7 Nearly half of nonelderly Medicaid adults with a disability but not SSI have multiple functional limitations, reporting impairment in two or more of the six ACS areas.8

Figure 2: Demographics of Nonelderly Medicaid Adults with a Disability But Not Receiving SSI, 2019

Medicaid Works For People With Disabilities

More than 1 in 3 adults under age 65 enrolled in Medicaid have a disability. Medicaid provides essential medical care and supportive services that help many of these individuals remain in their homes and communities.

Radically changing Medicaids structure to a block grant or per capita cap, as in recent Republican proposals to repeal the Affordable Care Act, would threaten the essential services that people with disabilities rely on to maintain their health and independence.

Support The Strong And Transparent State Implementation Of The Medicaid Home And Community

Home and community based services provide opportunities for Medicaid participants to receive services in their own home or community, rather than in institutions or other isolated settings. These programs serve a variety of targeted population groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or psychiatric disabilities. In 2014, the Centers for Medicare and Medicaid issued regulations that set requirements for the settings in which home and community-based services can be provided. Each state must develop a plan for how it will implement HCBS. The majority of states still need to complete their plans, which includes soliciting input from the public. Check the status of your states plan.

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Apple Health For Workers With Disabilities

HWD provides coverage to individuals with blindness or a disability who have earned income and purchase health care coverage based on a sliding income scale. HWD has no asset test and no upper income limit.

To be eligible, an individual must:

  • meet federal disability requirements
  • be employed full or part time
  • be at least 16 years of age
  • pay the monthly premium

Important: Due to the public health emergency, premiums for the Apple Health for workers with disabilities program are being waived. You don’t need to pay these premiums until further notice.

HWD enrollees pay a monthly premium determined as a percentage of their income, never to exceed 7.5 percent of their total income. American Indians and Alaska Natives are exempt from paying premiums for HWD. Find more information about HWD for individuals receiving services from Developmental Disabilities Administration or Home and Community Services. To learn more read the HWD fact sheet.

How Long Do Medicare Benefits Last For People With Disabilities

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As long as youre receiving Social Security disability benefits, your Medicare coverage will continue. In some cases, your Medicare coverage can extend beyond your disability payments.

For example, if you return to work and become ineligible for SSDI, you could stay on Medicare for another eight and a half years93 monthsas long as your disability persists. However, you have to opt in to your employers health plan if they offer one.

In this case, your employers health plan would become the primary payer, and Medicare would pay secondary . Unfortunately, if your employer offers only an HSA plan, you wont be able to use Medicare since HSAs and Medicare dont mix.

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Types Of Disability Policies

There are two types of disability policies.

  • Short-term policies may pay for up to two years. Most last for a few months to a year.

  • Long-term policies may pay benefits for a few years or until the disability ends.

Employers who offer coverage may provide short-term coverage, long-term coverage, or both.

If you plan to buy your own policy, shop around and ask:

  • How long do benefits last?

  • How much money will the policy pay?

Characteristics Of Recipients With Disability

It is estimated that there are more than 14 million people with severe disability in the United States under 65 years of age . Of these, approximately 3 million are covered by Medicare through Social Security Disability Insurance and adults over 22 years of age disabled as children. An additional 2.8 million are receiving Medicaid benefits by virtue of eligibility for Supplemental Security Income . Finally, about 900,000 individuals receive Medicaid benefits because of a persistent disability that prohibits employment. However, the latter are not eligible for SSI income payments because of income that exceeds the SSI eligibility limits .

The estimated number of people under 65 years of age with severe disability and the penetration of Medicare and Medicaid as health service coverage for this population aresummarized in Table 1. Fifty-six percent of Medicare- and Medicaid-covered disabled recipients are male , and nearly 50 percent have total income at or below the poverty level . Conversely, looking at the entire U.S. population, almost one-half of persons with incomes below $10,000 in 1990 reported a significant disability .

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Additional Eligibility Requirements For Ltss Coverage

Medicaid enrolleesâincluding the ABD populationsâmay have long-term care needs as well. In general, to receive Medicaid LTSS coverage, enrollees must also meet state-based level-of-care eligibility criteria. In other words, they must demonstrate the need for long-term care. In addition, such individuals may be subject to a separate set of Medicaid financial eligibility rules to receive LTSS coverage.

Level-of-care eligibility criteria for most Medicaid-covered LTSS specify that individuals must require care provided in a nursing facility or other institutional setting. A state’s institutional level-of-care criteria, in general, are also applied to Medicaid Home and Community-Based Services eligibility. That is, eligibility for Medicaid LTSS, both institutional care and most HCBS, is tied to needs-based criteria that require an individual to meet an institutional level-of-care need.

Medicaid Adults 65 And Older & People With Disabilities

Free help to Enroll in Medicaid for Seniors and People with Disabilities

The Medicaid program provides comprehensive medical coverage to seniors and people with permanent disabilities. People receiving SSI benefits automatically receive Medicaid. Seniors and people with disabilities who are receiving Social Security Retirement or Disability benefits and have income/resources that exceed the SSI limits may be eligible for Medicaid under the rules described in this section.

Note: People with disabilities who are waiting for a decision on eligibility for SSI or Social Security Disability Insurance benefits may be eligible for Medicaid under the MAGI category.

Who Qualifies?

  • People who have a severe physical and/or mental disability that has lasted or will last longer than one year or will result in death and prevents any substantial gainful employment.
  • Must be a citizen or eligible immigrant. Eligible immigrants include refugees or persons granted asylum. Lawful Permanent Residents who entered the U.S. on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.

Income and Resource Limits

How to Apply

You can apply on-line at You can also request a paper application from a DHS office by calling: 1-855-697-4347 or by downloading the form from the EOHHS website at:

For more information on Medical Assistance see the EOHHS website.

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Oppose Cuts To Medicaid

More than ten million people with disabilities receive health coverage, acute care, long-term services and supports , and home and community based services through Medicaid. The ACA repeal bills last year and the White House this year proposed changing how Medicaid is structured, leading to massive cuts. Instead of the current federal-state funding partnership, states would instead receive a set amount of money from the federal government in the form of block grants or per capita caps. This means that Medicaid funding would no longer be directly linked to the services that people need and, in all proposals, the funding will be slowly reducedMedicaid programs would have to limit the amount of services they provide per individual, limit the number of people who receive services, eliminate optional services , or some combination of the two. Either way, this change would result in major funding cuts and fewer services for fewer people. The disability community opposes repeal of the ACA and consumer protections for people with pre-existing conditions.

Medicaid For Aged Or Disabled

Medicaid for low-income individuals who are either aged or disabled is called SSI-Related Medicaid.

Florida residents who are eligible for Supplemental Security Income are automatically eligible for Medicaid coverage from the Social Security Administration. There is no need to file a separate ACCESS Florida Application unless nursing home services are needed.

Individuals may apply for regular Medicaid coverage and other services using the online ACCESS Florida Application and submitting it electronically. If long-term care services in a nursing home or community setting are needed, the individual must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen. HCBS/Waiver programs provide in-home or assisted living services that help prevent institutionalization.

Medicare Savings Programs help Medicare beneficiaries with limited finances pay their Medicare premiums and in some instances, deductibles and co-payments. Medicare Buy-In provides different levels of assistance depending on the amount of an individual or coupleâs income. Individuals may apply for Medicare Buy-In coverage only by completing a Medicaid/Medicare Buy-In Application.

Print the form, complete it and mail or fax it to a local Customer Service Center.

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How Do Medicaid Spend

If you receive SSDI and have high medical expenses that reduce your monthly income to the Medicaid eligibility level, you might be able to qualify for Medicaid if your state has a Medicaid spend-down program. These programs allow disabled individuals to qualify for Medicaid when they have high medical expenses . Contact your stateâs Medicaid agency to find out whether you qualify for a spend-down program.

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Manage My Adult With Disabilities Medicaid

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Medicaid participants enroll in the Healthy Connections Primary Care Program to achieve the best health outcomes.

Healthy Connections is the Idaho Medicaid program that is mandatory for most Idaho Medicaid participants. Participants will choose a primary care provider who will coordinate their healthcare needs.

Important program information

Healthy Connections referrals were suspended March 20, 2020 through June 30, 2021. Beginning July 1, 2021 Healthy Connections referrals will again be required.

Refer to the Idaho Health Plan Booklet for more information on Healthy Connections. If you need additional information you can contact Healthy Connections at 888-528-5861 or by email at .

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Medicaid For Older Adults And People With Disabilities

Working Ohioans with disabilities may be interested in the Medicaid Buy-In for Workers with Disabilities program.

When applying for this type of Medicaid, proof of income, resources, age or disability, citizenship or non-citizen status, and other health insurance is required. Applicants can ask an authorized representative to apply on their behalf.

Who Qualifies?

To qualify for ABD Medicaid, applicants must be:

  • Age 65 or older, or
  • Considered legally blind, or

Medicaid Provides Crucial Services For People With Disabilities And Their Families

More than 23 million adults under age 65 about 12 percent of all adults have a disability. Medicaid provides a broad range of medical and long-term care services to meet the needs of people with disabilities. These services include primary and preventive care, medical treatment for illnesses and chronic conditions, and nursing home care.

Working Ohioans with disabilities may be interested in the Medicaid Buy-In for Workers with Disabilities program.

When applying for this type of Medicaid, proof of income, resources, age or disability, citizenship or non-citizen status, and other health insurance is required. Applicants can ask an authorized representative to apply on their behalf.

Who Qualifies?

To qualify for ABD Medicaid, applicants must be:

  • Age 65 or older, or
  • Considered legally blind, or

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Emergence Of New Benefits

Perhaps the most significant consequence of Medicare and Medicaid entitlement for people with disability has been the rapid development of an entirely new and unique array of benefits and services designed to promote independence and autonomy. Medicaid became the primary engine for this development. Today, despite limitations, variability, and cost pressures, the State Medicaid programs function as the Nation’s only formed disability and LTC insurance program. Over the past 25 years, through the flexibility that States have had in the design and elaboration of optional benefits and the 2176 home and community-based waivers, a de facto benefits policy for people with disability has evolved where none existed before. Examples of these new benefits include: expanded home health aide services for people with chronic disability and/or personal care attendant services in 29 States, licensed residential care facilities in lieu of intermediate care facilities for the mentally retarded and nursing homes for the mentally retarded in 41 States, an array of 2176 case-management, residential, and home care services in lieu of institutional care in 50 States and Washington, DC, and adult day health services in 30 States . The availability of these services by State and their expenditures are summarized in Table 2.

Health Resources For People With Disabilities

State crackdown on Medicaid fraud hurt facilities treating disabled

Federal, state, and local government agencies and programs can help with your health needs if you have a disability.

Visit USA.govs Government Benefits page to learn more about government programs and services that can help you and your family.

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What If I Already Have Health Insurance Through My Employer

  • If you have health insurance coverage through your employer you should keep the insurance and talk with your local social services district worker. Medicaid may cover the cost of the premium for that insurance coverage. If you have family coverage through your employer you may wish to keep that coverage as the Medicaid BuyIn program for Working People with Disabilities does not offer family coverage.

Effective Date Of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

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Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

Medicaid For Ssi Recipients

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In most states, when a disabled person is approved for SSI, they are also automatically approved for Medicaid benefits. There are a few states, including Illinois and Ohio, that are exceptions to this rule. These states may have a lower income or asset limit for the Medicaid program than the SSI program, so they make their own Medicaid determinations.

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Medicaid Provides Health Coverage For People With Disabilities

More than 10 million children and adults with disabilities rely on Medicaid for their health coverage. This population comprises about 15% of all Medicaid beneficiaries. Their disabilities may include physical impairments and injuries, intellectual and developmental disabilities, mental and behavioral health disorders and other conditions. Medicaid provides a full range of coverage for people with disabilities, including preventive services, primary and specialty care, prescription drugs, medical equipment and long-term services and supports. About 40% of Medicaid beneficiaries with disabilities are also enrolled in Medicare, with Medicaid covering many of the services that Medicare does not cover, including long-term services and supports, and – depending on the state – dental, vision and hearing services.

Medicaid is a lifeline for people with disabilities. People with disabilities are unlikely to have access to employer-sponsored coverage and, because they are likely to have low-incomes, they may not be able to cover their health care costs on their own. Even with private coverage, people with disabilities may not be able to get the care they need since private plans typically do not cover the range of services available through Medicaid.

CMS is offering links/charts for informational purposes only, facts should not be construed as an endorsement of the organization’s programs or activities

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