Healthcare Considerations for Those with Developmental Disabilities
In our previous blog post, we covered the financial opportunities and challenges for people with developmental disabilities. However, proper healthcare coverage is another crucial part of becoming financially healthy. There are details to consider for people with developmental disabilities, like Medicare, Medicaid, special state services, access to specialists, and long-term care.
Medicare and Medicaid
If a person receives Social Security Disability Insurance (SSDI), they would automatically be enrolled in Medicare Part A and Part B after a 24 month waiting period. Within the waiting period, an SSDI beneficiary could be eligible for Medicaid coverage. Part A covers inpatient care in a hospital, skilled nursing facility care, nursing home care (if it is not custodial or long-term care), hospice care, and home health care. Part B covers outpatient care, care as part of clinical research, ambulance services, Durable Medical Equipment (DME), mental health care (through inpatient, outpatient, and partial hospitalization), and limited outpatient prescription drugs.
For people under 65 who choose to go back to work, Part A coverage would have to be paid for through a monthly premium after 8 and ½ years of work. Federally, there are a few programs that can offer help paying these premiums, including the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program, Qualifying Individual (QI) Program, and the Qualified Disabled and Working Individuals (QDWI) Program. Some states also offer assistance paying these premiums.
A person who receives Social Security Income (SSI) would be eligible for Medicaid, with no waiting period.
Medicaid coverage can be denied, either because the applicant has too much in assets or because of a broader issue of Social Security not agreeing that the applicant is disabled. While coverage can be bought through the Health Insurance Marketplace, an applicant can also appeal Social Security’s decision.
If a person receives concurrent benefits, meaning they receive both SSI and SSDI, then it gets a little more complicated. In this case, it is best to talk to a local Social Security office to determine how to receive healthcare coverage.
State services
The National Association of State Directors of Developmental Disability Services provides a directory to help one find your state’s point of contact for healthcare assistance and other types of resources.
Additionally, over 40 states have passed the CARE Act (not to be confused with the CARES Covid relief Act), which requires hospitals to record a patient’s caretaker’s name and educate them on how to perform care after a hospital stay.
Assisted Living and Long Term Care
Assisted living can take three forms: having an at-home caretaker, staying in an independent living facility, and assisted living. Long-term care is typically not an option to pay for these services, as the applicant with a developmental disability would have a pre-existing condition.
A designated caretaker can advocate for a person with developmental disabilities at their appointments, handle insurance claims, and help with day-to-day activities like taking medications while the person with a developmental disability lives at home. Often, this could be a family member. Medicaid and some states offer programs to pay a family member to be a caretaker.
An independent living facility is somewhat of a hybrid model, where there is 24-hour care available while maintaining independence through private or semi-private apartments. This is a higher cost option than having an at-home caretaker.
Assisted living offers the care of an independent living facility, but with the added benefit of hygiene help, housekeeping, and accident prevention. This is the highest-cost option, but may be the best option for people with severe developmental disabilities.
Medicaid can offer help with healthcare-specific costs, but it will not provide assistance with room and board fees. To request assistance for housing, reach out to the US Department of Housing and Urban Development and your local Public Housing Agency.
Traveling for specialists
Finally, traveling to see specialists related to a person’s developmental disability can be a big expense. While the expansion of Telehealth has an enormous opportunity to reduce these costs, travel expenses can be unavoidable.
Travel can be more complicated if transportation is not accessible. For example, rideshares and public transportation may not be wheelchair accessible, and specialists could be out of reach solely through public transportation, requiring trips hours away.
How the Financial Gym Can Help
Whether it’s planning for healthcare costs, weighing the pros and cons of assisted living options, navigating the application process, or planning for travel expenses related to seeing a specialist, your Financial Trainer can help. Schedule your warm-up call today!