Special Needs Planning: Medical Planning

The medical treatment required for special needs children can be expensive, often beginning at or shortly after birth. Without insurance, the cost of medical care is staggering!

If you have private health insurance, make certain you understand what the policy will and will not cover, particularly in regard to any specialized services, equipment or therapy. Make sure you obtain prior authorizations, or you could end up paying the bill. If your coverage is provided through a health maintenance organization (HMO) or preferred provider organization (PPO), confirm that the specialists needed by your child are part of the network. Understand when you can seek out-of-network care and what the cost will be to you. If a claim is denied, get a written explanation of the reason…you may want to appeal and resubmit the claim. Finally, a helpful tip is to request that a case manager be assigned to your child, which will then enable you to work consistently with someone who is familiar with your child's situation and needs.

Many private health plans cover students and disabled persons only until their 22nd birthday. By no later than September 23, 2010, however, all young adults under age 27 may be able to continue health care coverage through a parent’s policy. Some health insurance plans will provide extended coverage beyond age 22 (or 26) to a disabled dependent. Check with your benefits department or insurance company!

If your private health insurance stops covering your child at his or her age 22 (or 26), your disabled child may be eligible for Medicaid coverage. Check with your county health or Social Security office. (In some states, disabled children can receive Medicaid coverage as early as age 14.)

If you do not have private health insurance, check with your county social services or Social Security office to determine what assistance may be available. Medicaid is a health care program for people with low incomes and limited assets. In most states, children who get SSI (Supplemental Security Income) benefits qualify for Medicaid. In many states, Medicaid comes automatically with SSI eligibility. In other states, you must sign up for it. Also, some children can get Medicaid coverage even if they don't qualify for SSI. In addition, the State Children's Health Insurance Program (SCHIP) enables states to insure children from working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. Your state Medicaid agency can provide more information about SCHIP.

Beginning at your disabled child's age 18, Medicaid benefits are payable based on the child's own assets and income, even if your child is still living at home with you.