What if the parent is also disabled?

desertmom · **What if the parent is also disabled?**

Here's a scenario: Do you have an answer?

If a parent is disabled, on SSA (NOT SSI, which is based on income - SSA is based on what you made in your working years), they receive a stipend to cover each child.

So, what if this disabled parent, on SSA, has a Special Needs child? Is there an additional amount for the child? Even though there is health insurance on the child, can Medicaid/Medicare help pay for what this insurance isn't covering, such as deductibles and coinsurance, without the parent using Medicaid?

How is it determined if a Special Needs child is "disabled" for assistance in costs for therapies, doctors visits, blood tests, meds, etc.? Is there a severity chart they look at? What if it's High Functioning Autism?

Are you confused now? Is there a program out there that helps pay for therapies that insurance doesn't cover? One that doesn't go by income levels necessarily?

jabberwockygal · 06-17-2008, 01:55 PM

The child's diagnosing physician should be able to refer you to the local service agencies who would walk you through everything. Things with kids are, in some ways, less complex than adults--when it comes to funding. So, even if your federal sources of support are expended, your eligibility for state & local help need to be explored--thing is, it varies state-by-state and situation-by-situation. If you Dr. doesn't know who to refer you to, call your local department of family & children services and ask to set up an appointment (in some places a case coordinator will come to you). They'll tell you who to call if it's not them.

TommysMommy · 06-17-2008, 07:57 PM

In order for Autism to be considered a disability (according to SSI guidelines) the child must fall into this category:

12.10 Autistic disorder and other pervasive developmental disorders: Characterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity. Often, there is a markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive.

The required level of severity for these disorders is met when the requirements in both A and B are satisfied.

A. Medically documented findings of the following:

1. For autistic disorder, all of the following:

a. Qualitative deficits in reciprocal social interaction; and

b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; and

c. Markedly restricted repertoire of activities and interests;

OR

2. For other pervasive developmental disorders, both of the following:

a. Qualitative deficits in reciprocal social interaction; and

b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity;

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration.

Found at Appendix 1 to Subpart P

I know you're not looking to qualify the child as disabled to get SSI, but if you CAN meet the guidelines, Medicaid is automatically a part of the package, so to speak.

desertmom · 06-18-2008, 04:54 AM

The problem w/Medicaid is that there is a deductible of appx. $994. Does that apply in a case like this? Also, currently, there is a monthly deduction of around $78 for Medicaid part whatever, while the other part (A or B) covers only hospital stays. Would that monthly fee apply, since this would be SSI, not SSA?

And if you already get the max allowed for SSA, would this even be worth pursuing to get add'l for the disabled child covered?

TommysMommy · 06-18-2008, 06:09 PM

There should be no deductibles for Medicaid (Medicare for those retired/adult disabled yes, but not Medicaid). SSI is based on income. If you're getting SSA and it's still below your state's max allowance for income, the child would financially qualify.

To show what I mean...DH's income is about 1800 per month. The Max our state will allow us to make is just over $2000 for our family of 5. For Medicaid alone, the max is about $3000. Because we don't meet the maximum amount of income, Tommy gets a check every month to help with HIS living expenses. He also has what is called SSI/Medicaid. If he had medicaid alone based on our income (like Matthew and Brandon do), it is called Healthy Children/Medicaid.

I think if you're looking to apply for any benefits, it should NOT matter where your income comes from, as long as it falls into the income categories. You can also look into applying for Medicaid alone as a secondary insurance that will cover just copays and anything your regular insurance doesn't pay. You can apply for a Medicaid waiver (but from experience, I don't suggest it). The very best advice I can give you or anyone else checking out this information is to go online and apply. The date the SS office gives you will be your application date. Even if they tell you to bring stacks of paperwork that you don't have, go anyway. Once you do get all of the paperwork in and you've been approved, you will be paid retroactively from your appointment date, not the date you are approved.

It never hurts to be told no, or your not qualified. There's a very good chance you would be approved, but so many people don't know they could be qualified so they just don't give it a thought to try. You can go to Supplemental Security Income and use their screen tool to see if you'd qualify and to apply online.

I also found this on their website about Medicare:

A special note for people with Medicare
If you have low income and few resources, your state may pay your Medicare premiums and, in some cases, other Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. You can get more information from the publication, You could save in Medicare expenses (Publication No. CMS 10126). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.