For
families with special needs children, Medicaid and SSI are two programs that
provide crucial benefits. While many people associate Medicaid with
government-funded nursing home care, the program encompasses far more than this.
Medicaid is the nation's primary health insurance program for low-income and
high-need Americans, including children and pregnant women living under the
federal poverty level. It covers 60 million low-income Americans, including
nearly 30 million low-income children. The federal government and the states
jointly fund the program, and the federal government sets minimum eligibility
levels for coverage. Medicaid is a program where eligibility is based on income
and resources. So, when a special needs child turns 18, these benefits become
available if the child is unable to work and has minimal resources. Accordingly,
the child of a family that has financial resources would still be eligible for
Medicaid once the child turns 18, provided the child has no significant income
or resources.
The
income eligibility limit for community Medicaid is gross monthly income equal to
or less than $903 (the first $20 per month of income is excluded). Income
includes, but is not limited to, Social Security income, veterans' benefits,
pensions, annuities, interest, dividends, and payments from trust funds, and
rental income from real property. The current Medicaid resource maximum for an
individual is $4,000. Countable resources include, but are not limited to, bank
accounts, property other than principal residence, stocks, bonds, certificates
of deposit, annuities, and cash surrender value of life insurance, which exceeds
$1,500 in face value. Certain assets such as a principal residence, burial
spaces, one automobile and one wedding and engagement ring are
excluded.
While
Medicaid provides health insurance benefits, Supplemental Security Income (SSI)
provides supplemental income to people with low income and limited resources who
are 65 or older, or blind or disabled. If an individual is deemed eligible
for SSI, he or she will also receive full Medicaid benefits. For families
with special needs children, a child under 18 can qualify for SSI if he or she
meets Social Security's definition of disability for children, and if his or her
income and resources fall within the eligibility limits. However, for a child
under 18, the Social Security Administration considers the income and resources
of family members living in the child's household. To be considered disabled, a
child must meet the following requirements:
- The
child must not be working and earning more than $1,010 a month in 2012.
- The
child must have a physical or mental condition, or a combination of conditions,
that results in "marked and severe functional limitations."
- The
child's condition(s) must have been disabling, or be expected to be disabling,
for at least 12 months; or must be expected to result in
death.
When a
child receiving SSI turns 18, Social Security reviews the child's medical
condition, because the rules for determining disability for adults are different
than for a child. It makes sense for parents whose child is not receiving
benefits to reapply for SSI upon the child turning age 18. Social Security
does not count the income and resources of family members when determining SSI
eligibility for someone 18 or over. So, a child previously deemed
ineligible for SSI due to a parent's income or resources might be entitled to
benefits upon turning 18.
In New
Jersey, SSI recipients' maximum amounts (assuming no reductions for other
income) are:
|
Category
|
2012 Total Monthly Payment
|
|
Person
living alone or with others in
own
household
|
$729.25
|
|
Person
living with spouse who is not
eligible
for SSI
|
$851.00
|
|
Person
living in someone else's
household
and receiving support
and
maintenance
|
$509.65
|
|
Person
living in licensed residential
health
care facility
|
$908.05
|
|
Person
living in public general hospital or Medicaid-approved long-term health
facility
|
$40.00
|
|
Couple
living alone or with others in
own
household
|
$1,073.36
|
|
Couple
living in someone else's household and receiving support and
maintenance
|
$791.76
|
|
Couple
living in licensed residential
health
care facility
|
$1,786.36
|
An
important point for families with special needs family members to remember is
that the receipt of income or resources by a child receiving SSI and/or Medicaid
could result in the child becoming ineligible for benefits. This reality
prompts many families to create special needs trusts. These trusts allow assets
to be accumulated for the benefit of a family member with special needs without
causing a loss of these key benefits.
|
