Medical care is one of the most important services, if not the most important service, that a person with special needs may need over the course of her life.  The transition from a parent’s health insurance to an individual plan can begin at age 18 and stretch until the child turns 26 or, in some cases, even longer.  Since proper medical care is literally a life-or-death matter, it makes sense to begin planning for this transition as early as possible.

Depending on her specific special needs, a child turning 18 could require significant health care or need no immediate coverage. Some parents have health insurance that covers their child with special needs if the child is still living at home due to significant disability. However, each health insurance company’s definition of a disability may or may not match the Social Security Administration’s (making it possible to receive federal disability benefits without qualifying for private insurance), the insurer may not offer coverage for the specific drugs or services the child requires, or it may not offer coverage for adult children with disabilities at all, making it all the more important to review the family insurance policy to determine what further coverage a child’s condition requires.

The Affordable Care Act has made some of these issues a little less complicated than they used to be because the Act requires all insurers to allow children to qualify for benefits under their parents’ plans until the child turns 26.  This significantly delays some of the headaches parents used to face when their children turned 18, but it does not remove the ultimate concern.  Rather, it pushes it out a few years and allows some additional time for proper planning.

If a parent’s private insurance is not going to provide the coverage their child needs and the child will not receive coverage through employment, then he must seek Medicare or Medicaid coverage.   The “easy” way to obtain access to these programs is to qualify for Supplemental Security Income (SSI), which automatically qualifies a beneficiary for Medicaid, or Social Security Disability Insurance (SSDI), which allows a beneficiary to receive Medicare two years later.

These are not the only ways to obtain government-funded health care. Many individual states may offer Medicaid to adults with disabilities who meet different income or asset requirements, and some states have taken advantage of the Affordable Care Act to dramatically expand access to Medicaid.  Furthermore, some states offer working adults with disabilities discounted health insurance or access to supplemental insurance that may improve upon the benefits provided by an employer.

Clearing the Housing Hurdle

Although medical care is probably more fundamentally important for a person with special needs, housing is right behind it on the list of necessities.  One of the most difficult hurdles for families of children with special needs is the question of where the child will live. Will she stay with her parents, go to college, live on her own, or move to a group home? Will she be able to support herself, need support from her parents or require subsidized housing?

Families may grapple with these tough decisions at the time a child reaches adulthood or at a later time when living at home with parents is no longer appropriate or possible. Whenever this transition occurs, it requires careful planning and extensive research about the options available in the particular community. Advance planning is important so that this vital transition does not occur under the sudden pressure of a parent’s illness or death.

Section 8 housing vouchers are the main government program for people with low incomes who need housing assistance.  Once an individual has obtained a voucher from his local housing agency (the process can take years), he is qualified to move into a subsidized housing unit in his community.  The resident will pay approximately 35 percent of his income towards his rent and the government will pay the landlord the balance, up to a certain amount.  Section 8’s income and asset rules are reminiscent of SSI’s rules, but they differ in fundamental ways, especially when it comes to the treatment of assets and how the housing agencies count income.

Because obtaining Section 8 benefits can be a very long haul, it is important for parents of children turning 18 to think about applying for a voucher at that time, even though the child may not be ready to move out of the family home.  Applying early will start the waiting game and make it more likely that a voucher is available when the time comes to use one.

Be sure to contact your local special needs planner for guidance as you navigate these roads.