Gaining health insurance can be the most overwhelming experience our clients go through, especially if their child has special needs. Raising a child is expensive; raising a special needs child can be astronomical. There are government programs (local and federal) out there designed to provide for special needs children. Our Georgia clients typically face two options: Child’s SSI (Supplemental Security Income) or the Katie Beckett Medicaid Waiver.
Child’s SSI stands for Child’s Supplemental Security Income (SSI). This program is offered through the Social Security Administration (SSA). Similar to Adult SSI, Child’s SSI is a need-based program, and it is awarded based on two main criteria – financial need of the family and the medical condition of the disabled individual. The financial criteria is based on the household income and assets, and the medical criteria is based on the needs of the child under 18 years of age (or 19 years old if still in high school). A family has to meet both criteria in order to be awarded SSI.
The benefits of Child’s SSI are huge for those families that struggle to make ends meet. One, the child receives a monthly monetary amount to help pay for some costs of necessities. Second, and more importantly, each child that receives SSI is also enrolled in Medicaid, a state funded medical insurance program. With Medicaid, very rarely will a family have to pay out of pocket for any medical costs. This includes everything from prescriptions to medical equipment to in home nursing to specialists.
But what about a family that slips through the cracks of SSI? What about the family who does not make enough money to pay for the extensive medical care that their child needs, but they also do not qualify for SSI because their income level is too high? The option that is available for such families is the Katie Beckett Medicaid Waiver Program.
While Child’s SSI is a federal program, Katie Beckett is a state by state program. Most states have it, but each state may have slightly different requirements so it is important to go to your state’s Katie Beckett site. The Katie Beckett Program was established in 1982 to permit states’ to ignore the family income of disabled children who do not qualify for Child’s SSI because of the financial requirements. For a child to be eligible for Katie Beckett, he or she must be under the age of 18, must qualify as disabled individual under §1614 of the Social Security Act, and the child must live at home rather than at an institution. The qualification that a child must meet for Katie Beckett is not based on medical diagnosis; rather it is based on the level of institutional care the child requires. Similar to Child’s SSI, the greatest benefit of Katie Beckett is receiving health insurance through Medicaid. As we all know, the financial costs of a special needs child stems from the medical costs associated with the disease or disorder.
What is important to remember about these two programs in Georgia, is that Katie Beckett is only an option if the child does not qualify for SSI due to financial reasons. So a child has to receive a denial for Child’s SSI benefits to even be considered for Katie Beckett.
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Atlanta Divorce Law Group