As the primary health insurance program for persons with disabilities, Medicaid provides critical services allowing individuals to remain in their homes and communities.

In the United States, Medicaid is the major health insurance program for persons with disabilities. However, Medicaid is much more than a health insurance program. Medicaid also provides critical services to people with disabilities and their families, allowing them to remain in their homes and communities.

For many persons with intellectual disabilities and developmental disabilities (I/DD), Medicaid is the only source of financial support that allows them to live and work in the community with friends and family rather than in more expensive and segregated nursing homes or institutions. State and federal Medicaid programs combined provide for more than 75% of all financing for services for persons with intellectual and developmental disabilities (I/DD) nationwide. Many states, however, have significant waiting lists for these critical services, or they are only able to provide limited supports to qualifying persons with intellectual and developmental disabilities.

In many cases, Medicaid is essential for persons with disabilities who do not have access to employer-based or other private insurance, have more severe medical requirements, and frequently require assistance with activities of daily living throughout their lives.

Medicaid, which is jointly supported by the federal government and individual states, is likely the most significant public benefit accessible to people with disabilities. Medicaid is paid by the federal government and individual states. While eligibility requirements, services, and payment rates differ from state to state, the federal government requires that all state Medicaid programs cover physician visits, medications, hospitalization, lab work, x-rays, and nursing facility care, regardless of where the beneficiary lives. All states must also offer periodic health exams and treatment to Medicaid-eligible children under the age of six who are covered by the program.

Medicaid allows many persons with intellectual and developmental disabilities to live in the community since it is their major source of health care and community-based services.

The federal/state Medicaid program is the primary – and in many cases, the only – source of financing for long-term supports and services (LTSS), which many persons with intellectual and developmental disabilities (I/DD) rely on in order to live in the community. People with intellectual and developmental disabilities (I/DD) may live and work among their neighbors thanks to this practical and cost-effective initiative.

How Does Medicaid Work?

Despite the fact that Medicaid is a federally run program, states maintain the ability and freedom to determine how services are delivered. Medicaid supports both obligatory services, which are those that states are compelled to provide under federal law, and optional services, which are those that are not mandated. Some of the services covered by mandatory benefits include inpatient and outpatient hospitalization, physician services, laboratory and x-ray services, and home health care services, among other things. Services such as prescription medicines, case management, physical therapy, and occupational therapy are available as optional benefits.

Home and community-based services (HCBS) are optional services that can only be provided if a federal waiver is granted. Because home and community-based services (HCBS) including home attendants for special needs are optional or waivered services, there are sometimes significant waiting lists for participation in Medicaid-funded community-based supports and services in many states. The removal of institutional prejudice from government programs, the reduction of waiting lists, and the strengthening of the right to live a full life in the community are all priorities for Congress.

Despite the fact that Medicaid is only accessible to persons with little income and assets, once an individual with disabilities reaches the age of 18, family assets are no longer taken into consideration, making Medicaid a crucial factor in all special needs estate planning situations.

In addition, Medicaid “waiver” programs with less rigorous income and asset limits have been developed in the majority of states. They are meant to meet the requirements of persons with severe impairments who are qualified for long-term institutionalized care but whose families prefer that they continue to live in the community. Home health aides, day habilitation, family respite, and therapy treatments are all examples of what is offered. Individuals who live in small, community-based group homes may be eligible for reimbursement of living expenses in several states.

Medicaid and OPWDD

The majority of OPWDD services are supported by the Medicaid program in New York State, which is a cooperative venture between the federal and state governments. In addition, the OPWDD provides limited services with state financing.

The Home and Community-Based Services (HCBS) waiver is the most significant Medicaid program managed by OPWDD.

In order to get services and supports from the OPWDD, you must first apply for any eligible benefit programs (such as Medicaid) that will assist you in paying for the services you require.

Example: If you want to get HCBS waiver services, you will need to apply for, be determined to be eligible for, and be accepted into both Medicaid and the HCBS waiver in order for the government to pay for these services. If you do not want to participate in a benefit program, you can pay for the services you need with your own money instead.

People may require the intervention of speech-language therapy for many reasons. Some of these include:

Supports and services provided by the Office for People with Developmental Disabilities (OPWDD).
Children’s waiver services (for children up to the age of 18 who have severe medical needs as well as a developmental disability);
Care coordination;
Residential care;
and Additional health-related items and services are all available under the Home and Community-Based Services waiver (like Article 16 clinic services).

Medicaid provides funding for the majority of OPWDD services. As a result, in the vast majority of circumstances, persons seeking services from the OPWDD are required to enroll in Medicaid.

Enrolling in Medicaid

At AC Cares, we can help to get you started on the path toward receiving services as quickly as possible, beginning with your application for Medicaid. You’ll need your personal documents, such as your birth certificate; proof of where you reside, such as a rent receipt or utility bill; proof of income, such as a Social Security check; and proof of your financial resources, such as bank records to complete the application. You will require proof of disability, which may be provided by many of the same papers that were used to establish your OPWDD status.