One of the main questions for any youth with a disability who is becoming 19 years old (21 in some states) is “Will I still be eligible to participate in the Medicaid program when I’m old from the early and periodical screening, diagnosis and treatment (EPSDT)? ”The answer to this question depends largely on whether the state you live in has agreed with the Medicaid expansion that came along with the Law on Accessible Help.
If your state accepted the Medicaid expansion
Children who become adults in states that participated in the Medicaid Expansion program (32 out of 51 accounts in the District of Columbia) continue to receive the same coverage as before, until their individual income remains at 138% of the federal level. poverty or lower. In addition, newborns who were not eligible to receive Medicaid because of their family’s income are now eligible to participate as long as their income remains low (as indicated above).
These extended forms of coverage end at the age of 26, and at this point many will return to the same hellish scenario, only slightly older - the exception is those adults with disabilities who remain legal dependents of their parents; they are covered until their parents work. Again, the transition will still occur, but it lingers until their parents retire. Moreover, see the next post for reasons why you may lose the coverage you need, even if you save Medicaid coverage in a broad sense.
If your state rejected the Medicaid expansion
Children become adults in the other 19 states (Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming) before they are a completely different struggle.
For them, there is only one way to Medicaid eligibility: they should qualify as low income (75% or less of the poverty level on a federal scale, about $ 7,250 per year in 2015), and they should earn additional income from safety (SSI as well as disability benefits). Although for many young people with disabilities to meet their income needs, it’s trivial that many of them cannot qualify for SSI, since about 3 out of 4 lose access to Medicaid because of SSI & # 39; strict disability standards.
This means that every year thousands of young people with serious illnesses that are often incapacitated - cystic fibrosis, diabetes, severe asthma, HIV and even cancer! - and that easily meet income requirements, are devoid of Medicaid and SSI with the same stroke of a pen.
Different standards for adults and children
This is due to the fact that the Social Security Administration (the government agency responsible for SSI benefits) applies a much stricter set of criteria for adults than for children. Of course, they also endure a reassessment on disability every time a person is 18 years old, at which point about 30% of all registered children lose their SSI benefits, which means they also lose Medicaid coverage.
More than half of those who lose SSI and Medicaid at the same time find themselves without any health insurance. This is due to the fact that the ACA was written, awaiting the mandatory Medicaid expansion (which the Supreme Court ruled unconventional and made optional). ACA health insurance subsidies were specifically written to omit people who made less than 100% of the federal poverty level, on the assumption that they would be caught. on expanding medicaid. When some states announced this program, they forced thousands of Americans into situations where they could not afford medical care, no matter how invalid they were.
