Special needs health care is an issue faced by the parents of over 18 million children in the United States. In addition, it is one that needs to be addressed by the families of the 5.3 million Americans who live with disabilities arising from Traumatic Brain Injury, as well as other disabilities.
The Department of Health and Human Services defines those with special health care needs as “individuals who are at increased risk for a disease, defect or medical condition that hinders normal physical growth and development.” These more vulnerable individuals may require skilled nursing care in an institution or at home. Regardless of the level of care which they require, however, the system that caregivers must negotiate in order to obtain this care for them can be both confusing and overwhelming.
There are three major programs that provide funding for children with special healthcare needs administered by the United States Government. These are Medicaid, the CHIPS program and Title V.
Medicaid eligibility, according to Medicare.gov, is determined by 4 factors: Income level, disability criteria, eligibility for institutional care and out of home placement. Not all of these criteria necessarily need to be met in order to qualify for benefits, and eligibility is not restricted to children.
The CHIPS program covers those children whose household income is too high for Medicaid, yet do not have private insurance available. Children enrolled in it receive access to all of the federally mandated programs that children enrolled in Medicaid do.
Finally, Title V provides funding to states to provide rehabilitation services for blind and disabled children, as well as monies for children with special healthcare needs and daycare. The money is, however, allotted to children under the age of 16.
Caregivers of those with special healthcare needs face especially challenging circumstances as their children age out of some of the federal programs designed to assist them. Whether applying for supplemental security income or ensuring continued access to Medicaid, as well as transitioning to providers who care for adults, the challenges can be overwhelming for family members. For this reason, working with a healthcare consulting firm can be especially beneficial, due to their knowledge of which programs disabled adults qualify for, and how to achieve the absolute best care for them.
For more information on how to obtain the best special needs health care for your loved one, contact us.