Medical Assistance for People with Disabilities, From Three to Twenty-One Years Old
Medical Assistance for People with Disabilities, From Three to Twenty-One Years Old
Medicaid, often known as Medical Assistance (MA), is a joint federal and state insurance program that helps cover medical expenses for those with disabilities, both children and adults. Health screenings, treatments, behavioral support services, transportation, and healthcare at home are all part of this category of services. Title XIX of the Social Security Act, which provides funding to states for medical assistance programs, authorized Medical Assistance on July 1, 1969. The federal government and the individual states each contribute to its funding. Federal regulations for medical assistance are also stated in Title 42 of the Code of Federal Regulations, which is the Public Health and Welfare. Although everybody can apply for Medical Assistance and get free services, not all people with disabilities are qualified to receive those services. The federal government lays forth general principles for the program, but each state decides on its own eligibility conditions, benefits, payment rates, and administration. Children who are eligible for Medical Assistance, ranging in age from three to twenty-one, will have their rights outlined in this article along with an outline of the services they receive and the prerequisites for eligibility.
A kid with a disability can be eligible for federal MA benefits provided they meet certain criteria, such as being a U.S. citizen or immigrant, falling into one of the categories established by MA, and having sufficient income and resources (Pennsylvania Health Law Project, 2003). According to the Pennsylvania Health Law Project (2003), MA eligibility in Pennsylvania is contingent upon being either a resident or a covered immigrant. People with disabilities are covered by multiple MA categories, each with its own set of criteria (Pennsylvania Health Law Project, 2003). Automatic eligibility for MA is extended to children with impairments who are eligible for Social Security Income (SSI).
Children who are seriously disabled and not receiving Supplemental Security Income (SSI) can also be eligible for MA if their parents' income is below the poverty line (which was $749/month in 2003) and there are no assets in the family. According to the Pennsylvania Health Law Project (2003), this category is referred to as the "loophole" by the Department of Welfare. Children in this group may still be eligible for CHIP (Children's Health Insurance Program) or a "Waiver" program if they need more extensive medical care, even if their family's income is higher than the federal poverty line (Pennsylvania Health Law Project, 2003). Services provided by MA are available to the majority of Pennsylvania children who have significant mental, behavioral, or physical disabilities (Education Law Center, n.d.).
Medical Assistance eligibility is not contingent upon a child's receipt of special education services or a specific diagnosis of disability (Parents Involved Network of Pennsylvania, n.d.). Massachusetts does not use the same criteria for disabilities as it does for special education. On the other hand, the Medical Assistance disability criteria takes a child's evaluation report (ER) into account (Parents Involved Network of Pennsylvania, n.d.).
If a child is eligible for MA and has a disability, they will obtain a "ACCESS" card that they can use to buy various services for prevention and treatment. Eligible children have the right to receive any and all medically necessary care. Educational and rehabilitation services are not covered by MA unless they are part of a "Waiver" program. No out-of-pocket costs or co-pays are required to get MA services. The family's private health insurance for the disabled child must be utilized prioritarily (Education Law Center, n.d.).
Residential treatment facilities, behavioral services (such as therapeutic support personnel and wrap-around services), medicines for behavioral issues, and partial hospitalization programs are all examples of behavioral health services that are covered by MA (Education Law Center, n.d.). Personal care services for children who require help with self-care skills like eating or dressing are among the many medical treatments that MA covers, along with therapies, communication devices, medical equipment, and nursing care either at home or in the classroom (Education Law Center, n.d.). Medicaid-eligible children also have the right to receive a nurse, a specialist hearing aid, or a member of the therapeutic support staff throughout the school day if these services are deemed required to address the child's behavioral or physical requirements. School districts must include these services on the child's Individualized Education Program (IEP) even if MA is paying for them since they are deemed "related services" according to IDEA standards (Education Law Center, n.d.).
There are certain rights that MA recipients in Pennsylvania have. A selection of the rights listed on the website of the Pennsylvania Law Project is as follows:
The ability to submit an application and have it reviewed the very same day you submit your request.
(2) The option to bring a companion to assist with the Master of Arts application.
3. The option to have an application filled out on your behalf by a friend, family member, or representative from a healthcare facility, government agency, etc., in the event that you are unable to do so due to illness or mental or physical handicap.
4. Access to translation services and written materials that have been translated.
5. The opportunity to start receiving coverage as early as three months prior to the application, if retroactive MA is an option for you.
6. You are entitled to an MA card that can be swiftly issued by DPW in the event that you require medical treatment "immediately."
7. The right to get the care you need for your health without being discriminated against because of your gender, race, color, national origin, or handicap.
8. The freedom to choose any health care provider that is enrolled with the Massachusetts Department of Health, unless you are a part of the Health Choices Program.
9. Being treated with honor and decency is a fundamental human right.
Having no fixed address does not prevent a homeless person from applying for MA.
11) You have the right to an explanation of the MA programs and assistance in figuring out which coverage options are appropriate for you.
12. You are entitled to advance notice of any decision by the MA agency or an MA HMO to refuse, terminate, or limit benefits, as well as a fair hearing to appeal such decision.
(Prince William's County Legal Aid, n.d.)
Recipients must be given written notice of every MA denial, reduction, or termination decision, along with details on how to file an appeal. According to the Parents Involved Network of Pennsylvania, recipients have 30 days to file an appeal. However, if the appeal is submitted within 10 days of the date of termination or reduction notification, MA payments will be maintained until the decision of the appeal.
To assist disabled children make real strides and become more self-sufficient, Medical Assistance offers important health and treatment services. In order for families to take advantage of the services and advantages that Medical Assistance offers, it is our responsibility as educators to give them information about the program.
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