Question: Medicaid eligibility has expanded in some states and insurance is now a viable alternative for many families with special needs. How should they evaluate their options?
Answer:
Scrutinize Coverage
Medicaid obtained through the ACA marketplaces provides only traditional health care services. Those needing residential supports and services, a day program, or community – based aides to assist with daily living tasks, will need to apply for Medicaid benefits through local Medicaid agencies.
Insurance policies vary, so read the fine print. Ensure that important specialists, medications, therapies and medical devices are covered. Since some doctors won’t accept Medicaid, private insurance may offer more choices.
Run the Numbers
Medicaid obtained through the ACA marketplaces is free but has income restrictions. Some states have expanded eligibility to those with incomes up to 133 percent of the poverty level ($15,282). Compare insurance policy premiums, deductions and co-pays. Deductions and co-pays can prove costly in the event of serious illness. There are subsidies for families with incomes up to four times the federal poverty level ($94,200 for family of four), so parents with employer-provided insurance should compare its cost with insurance exchange offerings. Some families may wish to complement insurance with a Medicaid wraparound. Any time an individual will require means-tested government programs, a special needs trust (SNT) should be established to protect funds needed to ensure a decent standard of living without disqualifying them for benefits.
Flexibility
Dealing with Medicaid can be frustrating. Families may opt for insurance to preserve their privacy, save time and maintain greater control.
Seek Advice
Grants have been awarded to “navigators” who can help families understand the insurance exchanges, but they’re unlikely to be well versed in disability benefits. Families may wish to consult a special needs attorney to understand the implications for a child’s long-range care plan.
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