Special Needs at Age 18Medical care is an essential life-long service for a person with special needs.   Transitioning to an individual plan from a parent’s health insurance could begin when your child turns 18 and last until the child turns 26, or even longer in some cases. Medical care is literally a life-or-death matter, especially for special needs children, therefore, planning for this transition as early as possible is absolutely necessary.

Insurance Coverage

In many cases, a child could require immediate and ongoing medical assistance upon reaching adulthood, while for others, immediate coverage may not be as essential.  Some parents’ health insurances provide coverage for children with special needs if they are still living at home due to significant disability. However, the definition of a disability by health insurance companies may or may not match the definition of the Social Security Administration (which would qualify the child to receive federal disability benefits without qualifying for private insurance). It is very important to review the family insurance policy before the child reaches the age of 18, in order to determine what additional coverage the child’s condition requires. In some cases, private insurance may not cover specific services or medication required by the child’s special condition. In other cases, it may not offer coverage for adult children with disabilities at all.

Some of these issues have been simplified by The Affordable Care Act, since the Act requires all insurance companies to provide coverage for children under their parents’ plan until the child turns the age of 26. Although the Act delays some of the issues that parents used to face when a child turns 18, it does not remove the ultimate concern. Thankfully, the Act provides some additional time for proper planning.

Parents should seek Medicare or Medicaid (Medi-Cal in California) coverage for their child if their private insurance will not provide coverage upon reaching adulthood and if the child is unable to obtain medical insurance thorough employment. The “simple” way to obtain access to Medicare or Medi-Cal is to qualify for Social Security Disability Insurance (SSDI), which qualifies a beneficiary to receive Medicare two years later, or Supplemental Security Income (SSI), which automatically qualifies a beneficiary for Medi-Cal.

There are other ways obtain government-funded health care. Some states offer Medicaid benefits to adults with disabilities who meet different asset or income requirements.  Other states, taking advantage of the Affordable Care Act, have dramatically expanded access to Medicaid. Additionally, in some states, working adults with disabilities may qualify for discounted health insurance or access to supplemental insurance that may improve upon the benefits provided by an employer.

Clearing the Housing Hurdle

Housing is almost as fundamentally important for a person with special needs as medical care. Families of children with special needs constantly face the concern of where their child will live in the future. Some families may ask the following questions: Will s/he be able to support her/himself, need support from parents, or require subsidized housing? Will s/he stay with parents, go to college, live on her/his own, or move to a group home?

Families struggle with these tough decisions when their child turns 18 or at a time when living at home with parents is no longer an option. This transition requires extensive research and very careful planning in order to select the best options available in any particular community. Planning this vital transition in advance and with enough time is essentially important so that the decision making does not occur under the sudden and unforeseen pressure of a parent’s illness or death.

Vouchers for Section 8 housing may be an option and are the main government program for people with low income who need housing assistance.  The beneficiary typically pays approximately 35 percent of their income towards rent, then the government pays the remaining balance to the landlord, up to a certain amount. Income and asset rules for Section 8 are similar to SSI’s rules, but differ in several fundamental ways, especially involving the treatment of assets and how the housing agencies consider the beneficiary’s income.

In some cases, obtaining Section 8 benefits can take several years, therefore, it is very important for parents of children under the age of 18 to consider applying for a voucher at the right time, even if the child is not ready to move out of the family’s home. An early application for Section 8 housing benefits will raise the possibilities that a voucher will be available when it becomes necessary.

To read the first part of this series, dealing with education and employment, click here.

To read the second part of this series, dealing with financial support, click here.

You don’t want to wait to plan for your child’s transition out of childhood. Contact your special needs planning attorney at (888) 597-9685 TODAY.