Medicaid for Autistic Children

Getting Medicaid for Autistic Children

   Medicaid is an insurance program funded jointly by the state and Federal governments that provided coverage for medical care when the insured would not be able to pay for them.  Caring for an autistic child is a life-long, expensive undertaking that would tax the most financially resourceful family, but Medicaid offers a fiscal means of taking the worry over paying for care out of the equation, allowing for more important things to be focused on.  The following account details the process for obtaining Medicaid insurance in most states.

  • When a child or person is diagnosed with a disability like Autism, the first step is to contact your county’s Department of Social Services and request an application for Medicaid.  You can do this in person or by phone to have the application mailed to you.
  • The Medicaid application asks several questions to identify the person who is applying, the nature of the qualifying disability, and financial resources of the person and/or family.  Please be honest in your responses; if you hold back on reporting your financial assets in order to better qualify for assistance, you may be found guilty of Fraud, face jail time, and disqualified for any Social Services.  Forever.
  • When you have the application completed, mail or return it in person to the office where you requested it from.  At that time, you will be given an Intake appointment to discuss the application with a Medicaid Case Worker and a list of documentation to bring with you to this appointment.  The requested documentation will include: proof of disability; identification (Birth Certificate for children); bank account statements and income information of the parents; and a list of expenses.
  • At the Intake appointment, the Case Worker will make copies of these documents and ask you some more detailed questions to complete your application.  These questions will refer to the documents you bring in, so the more thorough you are with bringing in the information, the fewer follow up questions will need to be asked.
  • By law, your Social Services department has to give you a decision on your application within 45 days once all the requested information is provided.  With a qualifying disability such as Autism, your Medicaid office can expedite the application by contacting either the Coordinator of Waiver Services at the local Disabilities Services Office or the Service Coordinator involved with the child for verification that the child has been tentatively approved for Waiver services, pending Medicaid acceptance.  Once verified, the acceptance of your application is hastened to about two weeks instead of 45 days.
  • Once approved, the parent is given a Temporary Medicaid Card until the actual hard plastic card is made and mailed out.  Both cards, when presented at any location that accepts Medicaid, allows the presenter and cardholder to receive any medical service that Medicaid pays for.  All services that an Autistic child can access in New York State is covered by the Medicaid/Waiver programs.
  • Usually, Medicaid recipients are required to recertify annually to make sure they are still qualified.  However, because disorders like Autism are a lifelong disability and not a medical issue that can be “cured”, most states do not require that such recipients recertify for Medicaid benefits.  The income of the parents or other financial resources accessible to the family does not impact the application.

Let’s view one of the case scenario with service coordinator.