Q & A: Medicaid and People with Disabilities

Q. In my state, many people with disabilities are not covered under the Medicaid program. Who must be covered under a state?s Medicaid program? How could my state cover more people with disabilities under Medicaid? Would expansion in coverage require a waiver?

A. There are many mandatory and optional categories of eligibility for people with disabilities. Some of these are new and have been added by the Deficit Reduction Act of 2005. Most of these options are available without needing a waiver. 

Discussion

Medicaid is a crucial source of insurance for people with disabilities. It is estimated that there are 38 million people with disabilities under 65 in the U.S. Eight million people with disabilities are covered by Medicaid.1 Half of the one million children with severe disabilities age four and under receive Medicaid benefits and 30 percent of the 5.3 million children ages 5 to 17 with disabilities receive benefits.2 Medicaid covers 70 percent of poor children and 41 percent of poor working adults.3

In general, to be eligible for Medicaid, a person must be (1) a U.S. citizen or fall into certain very limited categories of immigrants; (2) a resident of the state in which the individual is applying; and (3) have a limited income. In addition, an individual must fit into a specific category of eligibility. These categories ? more than fifty – consist primarily of children, caretaker relatives, low income Medicare beneficiaries, and people with disabilities. There are more than twenty different disability related eligibility categories.4

Some of the eligibility categories are mandatory, meaning that, if a state has a Medicaid program, it must cover people in these categories. Other categories are ?optional? and states may choose to include them in their Medicaid plans.