How your child, no matter income level, can get full medical coverage for their Special Needs!

Updated: Aug 30, 2021


Before we go straight to how your child, no matter income level, can get full medical coverage for equipment, medical needs, medicines and more I want you to know a few things about qualifying for Medicaid.


Whether a child qualifies for Children's Medicaid or Child Health Plus depends on gross family income. Children who are not eligible for Medicaid can enroll in Child Health Plus if they don't already have health insurance and are not eligible for coverage under the public employees' state health benefits plan (for Florida it’s Florida Kid Care). If you are unsure check out their website to see income qualification, you may be surprised about the income levels!


Medicaid Waiver is a totally different beast– every state offers a form of protection for special needs kiddos – that is NOT based on income level. Yes you heard it, you no longer have to feel bound by an income status, you can qualify for a waiver regardless of income level. However, hold tight because this ride is a bit long. When you get done with this blog you’ll know the steps you need to take to enroll your kid/young adult or self into the waiver program!


First, if your child qualifies for CMS (children medical services), Medicaid or/and SSI (social security income) you are currently all set with coverage, and are covered by Medicaid – But I would STILL APPLY for the WAIVER.



One of the most debilitating things for me as a mother, who currently qualifies financially for Medicaid, is worrying about my sons insurance coverage if we were to no longer qualify financially. This is one of the downfalls of such a wonderful aid during this journey.


So let me show you one way to protect your child with special needs no matter your income level. Because we all know, money can come and go, and financial debt can stack up when paying out of pocket for medical supplies, nursing care, equipment, therapies, medicines and more.


First to find your local Medicaid office, you simply need to click HERE. Each state has a local number which will help you qualify, answer questions and get set up with either the Medicaid plan or state insurance that works best for you (several are based on income level). If you do not qualify for Medicaid and do not have insurance for your child; there is usually a local state insurance they can qualify for, although a small monthly payment may be necessary. If your state has no options and your child needs coverage there is also Child Health Plus which is a national plan if there is no state plan available.


Now


if you make more money than the allowed housing income, you will no longer qualify for these programs. That stinks. I get it, but it’s no fun to feel stuck between financial stresses and your child’s needs. However the good ol’ USA came up with a solution that is offered a little differently state by state, but is indeed offered. The Medicaid waiver!


Here is the KEY! APPLY TODAY! Honestly it doesn’t matter if you are super wealthy or 100% covered by Medicaid….I would apply for the Medicaid waiver. This allows your child to be qualified for life! So apply not tomorrow, but today! Most states have a waiting list that is very long. Now there is an emergency waiver for some unforeseen circumstances, i.e. homelessness, a threat to ones self or others etc. If you come across those reasons please call your local office and let them know you need the emergency exception waiver to expedite you forward on the long waiting list.



Below I’m going to show you a step by step how to find the information for the waiver. The state of FLORIDA will be used as my example, specifically, Gainesville Florida. HOWEVER please know, if you live outside of Florida, follow along, the links leading up to the local state office. This will show you where to find your state office and you will realize the steps will be similar.


If you think this info could help someone, share this! These are things that have taken me hours of time to find once I had the time to actually sit down and sort through it all, wait in line, etc.! Now it’s all here for you, so let’s share the info!


1) Gather your child’s, SS Card, Birth Certificate, Proof of Diagnosis from their medical doctor, and IEP if available.

2) Go to this website….Click Here or call Toll-Free: 877-267-2323

3) Once you are there you will see this (image below), make sure you find the state that applies to you.





4) Florida is the state I’ll demonstrate, but first if you do not know if your child can qualify for Medicaid yet, please apply by calling the Department of Children and Families, simply dial 850-300-4323. This may also save you some time and resources.


a. Like I said before if your child receives SSI benefits, you already qualify for Medicaid, no need to go further to apply. If they do not, you will continue the process through Department of Children and Families.


b. Here is a list I found of those to be approved for the waiver:

i. APD provides services to Florida residents older than three years of age, who have been diagnosed with a developmental disability as defined in Section 393, Florida Statutes. By law, the Agency may only enroll individuals who have a diagnosis of Intellectual Disability Section 393.063 (31), Autism Section 393.063 (3), Prader-Willi Syndrome Section 393.063 (29), Spina Bifida 393.063 Section (35), Cerebral Palsy Section 393.063 (4) Phalen-McDermid Syndrome 393.063 (28) and Down Syndrome 393.063 (15) or individuals between the ages of 3-5 at high risk for a developmental disability393.063 (23).


5) Next you’ll want to apply for your waiver to make sure your child is always cared for. You will then call the Department of Aging and Disability at (FL #) 1-800-963-5337. They will give you the # for your local office.


6) 352-955-6061 is the local Gainesville regional Agency for persons with Disabilities. www.APD.Myflorida.com is also a place you can go to find your local office. This is also the place you can call to ask if your child qualifies for the waiver medically.


7) They then sent me to one more person (although this was only due to covid and people working from home….may not be the normal standard).


a. They will then send you the paper work to fill out for the waiver

*** Remember***This waiver is NOT based on income – this is based on disability. So apply no matter your economic status (I will be uploading waiver form to Relentless Hope Exclusively, subscribe for access)!


Submit the paperwork and begin the wait…..THIS NEXT PART IS SUPER IMPORTANT TO KNOW – Once a year, they will contact you to see if you are still wanting to be on the list. IF they cannot reach you, you will be DROPPED from the program. So it is VERY important to set a reminder of some sort to follow up with the program one month before your application anniversary to make sure they have what they need. Just incase you miss their call/mail.


Side note: There are other programs out there that have no wait list however are VERY specific. For a full list check this out! www.kidswaivers.org



That’s it. I hope this is helpful for you and someone you love!

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