Medicaid
for Children
by
Herbert D. Hinkle, Esq. and Ira M. Fingles, Esq.
Herbert D. Hinkle
Law Office
2651 Main Street
Lawrenceville, New Jersey 08648
(609) 896-4200 or (215) 860-2100
Medicaid (or "Medical
Assistance" in Pennsylvania) is a federal health care program
that can be critical for children with disabilities. Medicaid pays
for all medically necessary care and treatment for an eligible recipient.
Even if a child has private health insurance, Medicaid may pay for
services that most private insurance plans do not cover such as private
duty nursing, medical supplies, or even residential placement.
Generally, Medicaid
eligibility depends upon a person's satisfying the requirements for
the federal Supplemental Security Income ("SSI") program.
SSI is a cash benefits program available to elderly, blind, or disabled
people who have limited income (generally, no more than around $700
to $800 per month) and no more than $2,000 of countable resources
(or $3,000 for a married couple). Countable resources are the person's
property other than certain exempt resources such as the house one
lives in and one car.
Under the SSI
rules, the income and resources of a parent are "deemed"
to be those of the children living in the home, as well. Thus, many
children are ineligible for SSI even though they are severely disabled.
In both Pennsylvania and New Jersey, however, Medicaid can be available
to certain disabled children even if their parentsâ income and resources
are too great for the SSI program.
Pennsylvania's
program is the most generous: any child who meets the SSI standards
for being disabled will be eligible for Medical Assistance regardless
of the parentsâ income and resources. (A child whose own income
and resources are too high will still be ineligible, but this is very
rare). A child is considered disabled for SSI purposes if he or she
has a mental or physical condition that causes "marked and severe
functional limitations" and that can be expected to last at least
twelve months.
Unlike Pennsylvania,
New Jersey does not offer an across-the-board exception to the "deeming"
of the parentsâ income and resources to a disabled child. However,
a few "waiver" programs have this effect. For example, the
Division of Developmental Disabilities Home and Community-Based Care
Waiver is available to people (including children) who are clients
of the Division of Developmental Disabilities and who are at risk
for institutionalization. Another "waiver" program applies
to people who have suffered traumatic brain injuries. Most of New
Jerseyâs Medicaid "waiver" programs have caps on the numbers
of people that can be served, but it still may be worth applying.
Copyright 2001
H.D. Hinkle. All rights reserved.
Mr. Hinkle maintains
a multi-state law practice with offices in Lawrenceville, Florham
Park, and Marlton, NJ, and Yardley, Pa. Mr. Hinkle and his colleagues
Ira Fingles, and Paul Prior lecture and write frequently on topics
of law, aging, and disability, and are available
to speak to groups in New Jersey and Pennsylvania
at no charge. Call (609) 896-4200.
