The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program forces states to extend Medicaid coverage to low-income children in just about every medical service, but adults are a different story. There are indeed indirect restrictions on Medicaid benefits offered to adults, as many, if not most, services that allow people with disabilities to maintain their function in their community have very limited coverage options. These include prescription drugs (Adderall for ADHD), respiratory assistance (inhalers for severe asthma), and therapeutic services (speech therapy for autism spectrum disorders), as a few common examples.
Although each state offers some degree of these additional services, none of them provide coverage for all additional services used by people with disabilities. For example, since 2012:
• Only 23 states offered benefits for private care (used by any person with a disability that precedes their cleanup)
• Only 26 states fully cover speech, hearing, and language problems
• Only 32 states fully cover points
• Only 25 states fully cover mental health services and
• There are 3 more states that have absolutely no mental health!
Limited access
The other side of this terrible coin is that there is no guarantee that a disabled young adult will be able to get coverage, even if the state offers a Medicaid program that meets their needs. This is because states are granted wide leave to limit the amount, duration and number of benefits offered to adults. For example, some conditions of prescription drug coverage limit any given person to receive three different prescriptions per month. Any parent of a child with severe ADHD can tell you that 3 prescriptions will simply cover someone who needs daily, school time and a “booster” dose of Concert to be able to function effectively throughout the day. Heaven forbids the same child to be diabetic and require insulin!
Similarly, many states offering therapeutic services, such as professional, speech or physical therapy, cover only a certain number of sessions each year, which is perfectly acceptable if you get someone with an injury that they are trying to repair. For someone those who have special needs for the fact that the exercises act as a service, and not a recovery, which requires a therapy session every week or more for the entire foreseeable future, is a complete disaster.
Refusal of support
Finally, many states are trying to lower the cost of medical care by offering less costly home and community-based services (HCBS), having received a special waiver from Medicaid that allows them to create a location-based program. These HCBS waivers are good in a sense, because many states will not offer any services at all without them - but they are also very bad, because anyone who cannot claim to refuse is put on a waiting list and does not receive any Services. Medicaid if they have no real emergency medical care.
How bad is it?
Indeed, the bad: one recent study found that out of about three million Americans who need daily help to perform the most basic activities (toilets, food, dressed, etc.), one million of them could not get all the help regularly . In particular:
• 80% said they regularly go for one or several days every month without clothes.
• 30% said that they got infected at least once in the last month because they had no other choice.
• 10% said they slept hungry at least once in the last month because they needed the help they needed to eat.
At the moment, you can think about senior citizens, but remember that about 10% of these three million people are between the ages of 19 and 35. This means that last month there were thirty thousand adult Americans who went to bed hungry because they could not feed themselves, and the programs that led them to the 19th year disappeared from under them.
