Medicaid Disability

Eligibility, 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 Covered
This list does not include everything Medicaid covers. Some services require Prior Approvals
Preventive Services - This includes medical services like:
Family Planning
Prescription Drugs
Doctor Office Visits
Behavior and Mental Health Services - Coverage includes outpatient mental health services you receive from:
Physicians
Local Center for Mental Health
Social workers in your community
Eye Care - Coverage includes exams and glasses every two years
Diabetes Self Care Management Training - Activities include:
Nutrition
Medication counseling
Blood glucose self-monitoring
Insulin injection
Foot, skin and dental care
Inpatient/Outpatient Hospital Care - Services include:
Rx Drugs
Laboratories,
X-rays
Other diagnostic tests that are considered medically necessary during the stay
Home Health Care & Services - Medicaid covers:
Durable Medical Equipment (DME)
Incontinence Supplies
Medical 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 Care
Delivery
Midwife Services
Emergency Care - Medicaid benefits include
Hospital Admittance
Transportation
Medically 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
ASK
7172 Graham Road, Suite 100
Indianapolis, Indiana 46250
317.257.8683
800.964.4746
317.251.7488 (Fax)
www.aboutspecialkids.org
Family Voices
445 N Pennsylvania St Ste 941
Indianapolis, IN 46204
317-944-8982
317-944-9760 (Fax)
www.fvindiana.org