Medicaid for Adults With Disabilities Medicaid provides services for eligible children who have a developmental disability, covering services such as personal care, transportation, diagnostic evaluation, and intervention. They are provided under the Early and Periodic Screening and Diagnostic Treatment provision of the Social Security Act. However, when the individual turns 21 years old, those mandated ... Bottom Line
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Bottom Line  |   November 01, 2011
Medicaid for Adults With Disabilities
Author Notes
  • Laurie Alban Havens, director of private health plans and Medicaid advocacy, can be reached at lalbanhavens@asha.org.
    Laurie Alban Havens, director of private health plans and Medicaid advocacy, can be reached at lalbanhavens@asha.org.×
  • Janey McCarty, private health plans advisor, can be reached at jmccarty@asha.org.
    Janey McCarty, private health plans advisor, can be reached at jmccarty@asha.org.×
Article Information
Practice Management / Bottom Line
Bottom Line   |   November 01, 2011
Medicaid for Adults With Disabilities
The ASHA Leader, November 2011, Vol. 16, 3-23. doi:10.1044/leader.BML1.16142011.3
The ASHA Leader, November 2011, Vol. 16, 3-23. doi:10.1044/leader.BML1.16142011.3
Medicaid provides services for eligible children who have a developmental disability, covering services such as personal care, transportation, diagnostic evaluation, and intervention. They are provided under the Early and Periodic Screening and Diagnostic Treatment provision of the Social Security Act.
However, when the individual turns 21 years old, those mandated services become optional. Because Medicaid is state-administered, these optional services vary from state to state. Coverage of speech-language and other services provided to Medicaid-eligible adults with developmental disabilities, therefore, depends on the policy of the client’s state (contact information is available at the Centers for Medicare and Medicaid’s website [PDF]). Some general information, however, applies to all Medicaid programs.
Definition
According to the U.S. Department of Health and Human Services, developmental disabilities are severe, life-long disabilities attributable to mental and/or physical impairments that manifest themselves before the age of 22 years and are likely to continue indefinitely. They result in substantial limitations in a number of areas, including receptive and expressive language, mobility, learning, and self-care. According to information from the Centers for Disease Control and Prevention, individuals with developmental disabilities (including Down syndrome and autism spectrum disorders) compose 13.87% of the U.S. population.
Services
Medicaid services available to adults with developmental disabilities might include a day habilitation program with training and supported employment; adult day care; or support services that may include nursing, behavior services, physical therapy, occupational therapy, speech-language pathology services, transportation, and crisis services. Service settings include individual homes, community residential sites, and day programs. Individuals may live in an intermediate care facility for persons with developmental disabilities, previously (and in some states still) called an intermediate care facility for persons with mental retardation.
Home-based Services
Medicaid rules can require people with disabilities to live in institutions to receive services. However, under the Social Security Act, states may request waivers of certain of these requirements to develop community-based alternatives to placing Medicaid-eligible individuals in hospitals, nursing facilities, or other institutions. States may develop a variety of services under a home- and community-based service (HCBS) waiver program. Many of the state waiver programs arose as a result of the Olmstead decision, in which the Supreme Court ruled that Title II of the Americans With Disabilities Act prohibits unnecessary institutionalization of persons with disabilities.
Waivers allow services to be brought to recipients, rather than forcing them to be institutionalized. The number of services that can be provided is not limited. The programs may provide a combination of medical services, such as dental and skilled nursing services, and non-medical services, such as respite care and environmental modifications. Forty-eight states and the District of Columbia offer HCBS waiver services through 287 active programs. Arizona operates a similar program under a different section of the act.
Maryland’s Waiver for Individuals with Developmental Disabilities, for example, covers case management services, community residential services, community supported living arrangements, respite care services, behavioral support services, and adult day habilitation including supported employment.
Other states may offer services limited in duration and/or intensity to Medicaid-eligible adults with developmental disabilities. According to data compiled by the Kaiser Commission on Medicaid and the Uninsured in 2008, Medicaid services vary in coverage for speech-language pathology and audiology services: 35 states provide coverage at some level and 16 provide no coverage. In contrast, Kaiser data indicate that all states provide some level of home health care services. However, some states specifically exclude therapies in their home health coverage. For example, Alabama, Florida, Oklahoma, and the District of Columbia exclude speech-language pathology as a home health benefit. Some states (e.g., Georgia and Louisiana) require prior approval for therapy services, and many (e.g., Indiana and South Carolina) cap the number of therapy visits allowed per year.
State Information
Medicaid is a federally mandated program, but much of the design and implementation of the program is determined at the state level. Therefore, it is always necessary to check with the state Medicaid office to determine available services and eligibility. Despite budget cuts, funding options are still available for speech-language and audiology services.
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November 2011
Volume 16, Issue 14