Brochures/Factsheets

Fewer and fewer of American children with mental health care needs are now covered under private insurance. In fact, the number of children with mental health care needs whose parents can keep them insured under the family's health insurance plan declines every year. Many other children with severe mental health care needs, even when covered by private health insurance, have inadequate coverage that often does not provide them the type or extent of care that they require. Medicaid has allowed eligible children with mental health care needs to receive important preventative and restorative health services while being nurtured at home by their families in their communities. Medicaid thus saves society the cost of keeping children with disabilities in institutions.

Children with Mental health care Needs Qualify for Medicaid in Several Ways. None of Them Is Simple.

Children under the age of six whose family income is up to 133% of poverty and children who were born after September 30, 1983, whose family income is up to 100% of poverty now qualify for Medicaid in every state. Some states have expanded coverage to even more children who live in families with a low income.

• As of now, children who have qualified for the Supplemental Security Income (SSI) Children's Program also receive Medicaid in 38 states. Children with disabilities must first meet the poverty guidelines. Then they must have a disability that is on the SSI medical listing, or their disability must be determined to be so severe that it prohibits them from functioning like other children. About 900,000 children are in the SSI program, but not all of them live in states where they can also receive Medicaid. The current Personal Responsibility Act (PRA), commonly referred to as the Welfare Act of 1996, puts limits on eligibility and benefits in the SSI Children's Program.

• Children in more than 30 states must qualify for Medicaid through special home and community-based waivers and amendments. Children must meet state-determined definitions of disability, but parents' income is not taken into account. These waivers provide children with critical home care services that might not be covered under their private insurance plans. The waivers also provide health coverage to children whose health care expenses have been so great that they have run through their private health insurance coverage and would have to live in an institution in order to quality for Medicaid.

• Medicaid guarantees that eligible children will receive all medically necessary health care through the EPSDT (Early Periodic Screening, Diagnosis, and Treatment) program. While private health insurance plans might not include all health care services required by a child with mental health care needs, EPSDT mandates that any health care service approved by Medicaid that is considered medically necessary to a child must be provided. This provision allows children who are eligible for Medicaid to receive appropriate corrective and preventive services, supplies, and equipment (including assistive communication devices, durable medical goods, nutritional supplements, personal assistance, speech therapy, physical therapy, and occupational therapy, among others).