State healthcare benefits for adults with disabilities

As young adults transition from adolescence to adulthood, understanding state healthcare coverage can be a game-changer. Let’s take a look at how Medicare and Medicaid works.

Medicaid and Medicare are federally-funded healthcare programs which are available in every state. They may go by different names depending on the state you live in. For example, in California, the program is called Medi-Cal, in Massachusetts it is called MassHealth and in Kansas the program is called KanCare. 

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Good to know

In most States, SSI recipients may be automatically eligible for Medicaid; a SSI application is also an application for Medicaid. In other States, you must apply for Medicaid with another agency. For example, in Massachusetts, if an individual is approved for SSI, no additional application is needed to MassHealth. The insurance card comes in the mail within 6 weeks.

What is Medicare?

Medicare is federal health insurance for those who are aged 65 and over and some people under age 65 with certain disabilities or medical conditions (including blindness and vision impairment). Because it is a federal program, Medicare has set standards for costs and coverage which means that an individual’s coverage will be the same no matter what state they live in.

What is Medicaid?

Medicaid is a joint federal and state program that covers medical costs for individuals with limited income and resources. This means that the federal government has rules that all state Medicaid programs must follow, but each state runs its own program. Eligibility requirements and benefits can vary depending on the state you live in. 

Medicaid provides health coverage to individuals and families, including children, parents, elderly people with limited income, and people with disabilities. In many instances, young adults with disabilities including blindness and visual impairment will qualify for both Medicare and Medicaid based on their disability and income levels. 

Medicaid offers benefits that Medicare doesn’t normally cover, such as nursing home care and personal care services. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services.  

Transition tip

Depending on the state you live in and the young adult’s needs, Medicaid can provide supportive house services, day habilitation, employment, wheelchairs, lifts, and other medical equipment that private insurance may not cover. 

Can a Person qualify for both Medicare and Medicaid?

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In many instances people are eligible for both Medicare and Medicaid at the same time. This is known as being “dual eligible.” If your adult child is dual eligible, Medicaid and Medicare will work together to provide the necessary coverage. In most cases, Medicare will be the primary plan and cover most Medicare-eligible healthcare services. Medicaid is typically the secondary plan and may cover medical costs that Medicare doesn’t cover or partially covers. Some potential items and services covered buy dual coverage may include:

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