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. Medicaid coverage and income restrictions vary from state to state.

Waivers

States can offer a variety of medical and non-medical services under a waiver program. Standard services include but are not limited to: case management (i.e. supports and service coordination); homemaker; home health aide; personal care; adult day health services; habilitation (both day and residential) and respite care. States can also propose other types of services that may assist in transitioning individuals from institutional settings into their homes and community. See Military Medical Waiver Benefit Fact Sheet for more information.

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

In most states, if you receive Supplemental Security Income, you may be automatically eligible for Medicaid; an SSI application is also an application for Medicaid. In other states, you must apply for and establish your eligibility for Medicaid with another agency.

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

• Review more information on the general Medicaid program with links to Medicaid information by state.
• Learn more about benefits for family members with special needs.
• Read more about the Exceptional Family Member Program.
• Find more information through the Military OneSource eLearning module on government assistance.
• Access everything you need to know about Social Security Disability Insurance.