Family-tested solutions
for Special Needs

Toddler and mother playing together

Family-tested solutions
for Special Needs

Toddler and mother playing together

Tips on Applying for Medicaid At Age 18 and Beyond (Transition Resources 5)

Medicaid

At or near age 18, young adults with disabilities must cross certain “bridges” between child and adult services within a specific time period. One such bridge is free or low-cost health insurance funded by a state’s Medicaid program. Even if a child already receives Medicaid, he or she must reapply based on current “status,which is a short word covered by a vast sea of regulations. (Note: Medicaid may be called by another name in your state. Here in Tennessee it is called TennCare. You can find the basics about your state’s Medicaid program by going to the national Medicaid website. Look into the details well ahead of that big birthday, because in some cases a young adult must have an evaluation showing major disability before the age of 18.)

Top Five Do’s for Getting & Keeping Medicaid

Young Adult Road Map Editorial Board Member Shelby Haisley (MSW, LSW, CYC-A) shares her top five “do’s for getting and keeping Medicaid coverage:

1. Do ask for support. Find someone who has applied for Medicaid before or ask a service provider for help if you have questions. You can also assign someone to be your “Authorized Representative.” This means they can call Medicaid on your behalf and receive the same mail you do. This is helpful, especially for your service provider to check on the status of your case.

2. Do turn in any supplemental documents as soon as possible. Medicaid will send you a letter asking for proof of address, income, etc. Ask your support system for help if needed. Take all documentation to the local Medicaid office. Don’t fax it. This way, all your documents will be stamped to show that the office received them on that date.

3. Do keep any stamped, dated documents sent from your local Medicaid office. If the office loses the originals, you can show you did turn them in on time. Do be patient. It can take up to three months for your case to be processed. However, if you have questions, go to your local office to get status updates on your case.

4. Do go to your local office to ask questions if you can. Many offices just have an 800 number, which is automated. You can go to the office and get your questions answered by a real person quicker than being on hold for an hour. The local office also will be more familiar with your case.

5. Do keep all your paperwork! Medicaid handles many cases and may lose documents or forget to scan them to your electronic file. If they lose your documents, you could lose your insurance coverage.

Wendy Lowe Besmann

Wendy Besmann, Founder and Content Director of Get There Project, is the mother of a son with autism and bipolar disorder. She is the author of Family Road Map: A Step-By-Step Guide to Navigating Health, Education, and Insurance Systems for Families with Special Needs, Team Up for Your Child: A Step-By-Step Guide to Working Smarter with Doctors, Schools, Insurers and Agencies, and (with Kimberly Douglass, PhD) Young Adult Road Map: A Step-By-Step Guide to Wellness, Independent Living, and Transition Services for People in Their Teens and Twenties. She founded Get There Project’s primary partner Team Up for Families, an advocacy and training organization for families living with behavioral, developmental, and other special health needs.

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