If you have already applied and been approved for SSI (Supplemental Security Income), you may already qualify for Medicaid. Each state is different, so even if you're not eligible for SSI, you may be eligible for Medicaid. Unfortunately, there is not enough space on our blog to adequately detail each states qualifications, so checkout Medicaid.gov and start googling your states Medicaid requirements.
We initially applied for Medicaid before we applied for SSI and were denied. However, if you are approved to receive SSI, you are considered a "mandatory eligibility group" that cannot be denied coverage. Once we began receiving SSI, we were automatically enrolled in Medicaid.
Once you are approved for SSI and/or Medicaid, be sure to schedule an appointment with your pediatrician for your initial EPSDT (Early and Periodic Screening, Diagnostic, and Treatment). It is a basic yearly check-up required for Medicaid to begin covering your child's therapies. Each therapist will need this new referral from your pediatrician to begin filing claims to Medicaid.
We were not informed by Medicaid that he would need to recieve the EPSDT check up and have all new referrals sent to his therapists in order for Medicaid to cover his treatments. Luckily, a helpful therapist informed us that our son would need to see his pediatrician for the EPSDT.
Medicaid is the main source of health care coverage for about 1/3 of all autistic children in the country. Even people with autism who have primary health insurance still use Medicaid to access other medical services. Our son is still on our family's primary health insurance plan, but our primary health coverage does not cover the cost of ABA. We're thankful that our state has approved coverage for ABA.
NEXT STEPS
Research your states requirements for Medicaid. Sorry, we can't be more helpful with this at this time!
When you are approved for Medicaid, schedule an EPSDT with your pediatrician immediately.
Ask your pediatrician to send updated referrals to all your child's therapists
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