Medicaid DisabilityEligibility, Services, and Changes

Medicaid Disability

• Must meet disability requirements• Does count resources/assets ($2000 Single or $3000 Couple), except for

house and 1 vehicle• Resources are counted include savings, retirement (401K) plans, life

insurance with cash value, land, farming equipment, etc.• Does not count parent income/resource for children over age of 18,

regardless of school status• Comprehensive plan with no cap for Durable Medical

Equipment (DME) and increased drug formulary/list• Children CAN be enrolled in Medicaid Disability (MAD)

Services CoveredThis list does not include everything Medicaid covers. Some services require Prior Approvals

Preventive Services - This includes medical services like:Family PlanningPrescription DrugsDoctor Office Visits

Behavior and Mental Health Services - Coverage includes outpatient mental health services you receive from:PhysiciansLocal Center for Mental HealthSocial workers in your community

Eye Care - Coverage includes exams and glasses every two years

Diabetes Self Care Management Training - Activities include:NutritionMedication counselingBlood glucose self-monitoringInsulin injectionFoot, skin and dental care

Inpatient/Outpatient Hospital Care - Services include:Rx DrugsLaboratories,X-raysOther diagnostic tests that are considered medically necessary during the stay

Home Health Care & Services - Medicaid covers:Durable Medical Equipment (DME)Incontinence SuppliesMedical supplies, equipment, and appliances

Transportation - Medicaid will pay for up to 20 one-way trips without prior authorization.Dental - Covered services include annual exams and preventive care.

Pregnancy Care - Medicaid covers:Prenatal CareDeliveryMidwife Services

Emergency Care - Medicaid benefits includeHospital AdmittanceTransportationMedically necessary screening services

Changes in Application Process

• Apply to Social Security Administration/ Division of Family Resources

• SSA will determine whether disabled• IF currently receiving SSI (Supplemental Security Income, then

eligible for Medicaid Disability• IF currently receiving MAD, will be asked to apply for SSI

Increase full coverage income eligibility limit to 100% FPL (going from $721/month to $973/month)

Spend-down Changes

The spend-down program has been eliminated. If you currently have a spend down and your income is less than $973/month (single) or $1,311 (married), you will receive full benefits without a spend down.

IF you are over on income/resources, you will be sent to the Marketplace to get an insurance plan with whatever tax credit that you are eligible.

Medicaid Waiver Changes

• IF you are receiving a Medicaid Waiver, you can have income up to $2,163/month. If your income exceeds this you are required to set up a MILLER TRUST.

• This trust must be established for you to remain eligible for Medicaid benefits and any extra income over the amount must be placed in the trust to help pay for medical expenses.

You will need an attorney to set up the trust and upon the death of trustee, all money will go to the state of Indiana.

1915(i) Eligibility Criteria

Targeting Criteria • Age 19 + • Medicaid Rehabilitation Option (MRO) eligible primary mental health diagnosis –(ex: schizophrenia, bipolar disorder, major depressive disorder, psychotic disorder)

Needs-Based Criteria –Income can be higher than 100% FPL• Demonstrated need related to management of behavioral & physical health • Demonstrated impairment in self-management of physical and behavioral health

services • 3+ score on the Adult Needs and Strength Assessment (ANSA), a behavioral health

screening tool • Demonstrated health need which requires assistance and support in coordinating

behavioral health & physical health treatment

If you have questions

ASK7172 Graham Road, Suite 100Indianapolis, Indiana 46250317.257.8683800.964.4746317.251.7488 (Fax)www.aboutspecialkids.org

Family Voices445 N Pennsylvania St Ste 941Indianapolis, IN 46204 317-944-8982 317-944-9760 (Fax)www.fvindiana.org