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Medicaid for Family Members with Special Needs

Medicaid is a federal program that provides eligible military families with benefits beyond TRICARE. It covers basic health and long-term care services for eligible children, adults, pregnant women, individuals with disabilities and the elderly, and for families with low income and limited resources. This benefit may be available for military family members who have special needs and require medical care.

Who is eligible for Medicaid?

State governments generally determine which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. States are required to cover certain benefits and can choose to provide optional benefits through the Medicaid program. Medicaid coverage and income restrictions vary from state to state.

Those who qualify include:

  • Pregnant women and infants below 133 percent of the federal poverty level.Medicaid covers pregnant women and infants in families at or below 133 percent of the federal poverty line. That means that in 2015, a family of four can qualify if its combined annual household income is below $32,252.50. See the federal poverty charts for family size poverty guidelines. Additionally, if you live in a state that has expanded Medicaid, a family of four can qualify if its combined annual household income is at or below $32,913.
  • Pregnant women and infants above 133 percent of the federal poverty level. If your income is over 133 percent of the federal poverty line but at, or under, 185 percent of the threshold, you may qualify for Medicaid benefits.
  • Children, elderly or persons with disabilities above 185 percent of the federal poverty level. Medicaid may cover some people whose income is above 185 percent of the federal poverty level but who incur large medical or long-term care expenses. People in this category can qualify for Medicaid as "medically needy" if their income is reduced due to medical expenses. States that cover the medically needy may offer a different benefit package to the categorically needy, so check your coverage.
  • Children with disabilities receiving Supplemental Security Income. In many states, children with disabilities, who receive cash assistance under the Supplemental Security Income program, automatically qualify for Medicaid coverage. Check with individual sates about eligibility and enrollment of children in this category.

Waivers

States can apply to the Centers for Medicare and Medicaid Services for waivers to provide Medicaid to populations not traditionally covered. Persons in institutional settings; targeted services to particular groups, such as technology-dependent children; individuals with traumatic brain injuries; or persons with mental or developmental disabilities may qualify. For more information on waivers, visit Medicaid.

Medicaid benefits for individuals with disabilities

Medicaid-eligible individuals with disabilities are entitled to all medically-necessary services. Individual states establish and administer their own Medicaid programs and determine the type, amount, duration and scope of services, within broad federal guidelines. Each state is required to cover certain mandatory benefits and can choose to provide other optional benefits through the Medicaid program. Mandatory benefits include:

  • Hospital, home health, clinic and laboratory services. Benefits include coverage for inpatient and outpatient hospital, home health, physician, certified pediatric and family nurse practitioner, rural health clinic, federally qualified health center, and laboratory and X-ray services.
  • Early and periodic screening, diagnostic and treatment services. This benefit provides comprehensive and preventive health care services for Medicaid-enrolled children under age 21. These services are key to ensuring children and adolescents receive appropriate preventive, dental, mental health, developmental and specialty care.
  • Nursing facility services. Nursing facility services, through Medicaid-certified nursing homes, provide three types of services: skilled nursing or medical care and related services; rehabilitation needed due to injury, disability or illness; and long-term care.
  • Transportation. Mandatory benefits include transportation for medical care.
  • Optional benefits.Depending on state guidelines, benefits could include coverage for: prescription drugs; physical and occupational therapy; speech, hearing and language disorder services; respiratory care services; other diagnostic, screening, preventive and rehabilitative services; and services in an intermediate care facility for the mentally impaired.

How to apply for Medicaid as a Supplemental Security Income recipient

Supplemental Security Income recipients should apply at the local Social Security office. To find the nearest office, enter your ZIP code using the Social Security Office Locator.
When applying for Medicaid, you may need to bring the following:

  • Proof of income, such as check stubs
  • Proof of assets, such as bank statements, value of car, etc.
  • Social Security card
  • Two forms of identification, which can include your military ID or other photo ID, and your driver's license, birth certificate, etc.
  • Proof of residence such as a utility bill, telephone bill or a rent receipt

Contact your Social Security office to determine which documents you'll need to apply.

Where you can find more information