Category Archives: Family Finance

Father’s Day Gift Guide Under $20

On a budget, but still want to get dad something he'll love? Check out this Father's Day Gift Guide where everything is under $20.

Father’s Day is just around the corner, and while it’s good to celebrate Dad, buying gifts should always be done within your budget. I’m not encouraging you to be chinsy. If you can afford something very expensive that would add value to his life, go for it. But if your budget is a little tighter, know that you’re not alone and that you can still get the father in your life something he’ll appreciate without draining  your bank account.

Here’s a Father’s Day Gift Guide for some inspiration. Keeping in mind that budgets may be tight, everything is under $20.

 MLB Watches

MLB San Diego Padres Men's Spirit Watch

Because this is ‘Murica and we love baseball.

Price: The majority of teams cost $19.99. For some weird reason, a few teams cost $24.99, like our beloved Pirates.

Where to get it: Bed Bath & Beyond

Pour and Shoot Mug

Pour and Shoot MugPerfect for all the Dads out there who are photographers–amateur all the way to professional. Help bring their day “into focus” with this clever coffee mug.

Price: $17.99

Where to get it: ModCloth

 

3-in-1 Soap for Men

Soap for Men - Cedar and CitrusSimplify his grooming routine with this 3-in-1 soap. It serves as shampoo, body wash and shaving “cream,” if you will. It’s all natural and smells manly.

Price: $6.95

Where to get it:  Thrive Market. This is a membership site, which is how their prices are so crazy low, but you get a free, 30-day trial to start so you can get this at the lower price without risk.

The Heroic Adventures of Super Dad Planner/Notebook

Super Dad Day Planner, Notebook, or Address BookTotally customizable with your own pic and <3(child’s name). Sure to make any dad feel good, and either document his journey or keep track of his Super Dad schedule.

Price: Starts at $16.00

Where to get it: Minted

Portable Lap Desk

Portable Lap Desk with Wrist Pad in Silver/BlackDid you know that using a laptop actively receiving a WiFi signal causes a decrease in sperm mobility and can even cause the sperm to no longer be viable? Well, now you do. If dad wants to be a dad again, or even just doesn’t want his computer messing with his reproductive parts, one way to cut back on the damage is using a lap desk. This one’s built for ergonomics FTW.

Price: $19.99

Where to get it: Bed Bath & Beyond

What Mon Mari Frugality Will Be Getting

Every year, we go with experiences for Father’s Day. The kids make some type of craft that costs us $0, and then we spend the day together. One year when I was not capable of leaving the house, he went on a Ducky Tour of the city with his offspring. Another year we all went to the zoo where dads get in for free on Father’s Day.

As our kids get older, this is getting admittedly more expensive. While we used to just have to pay for me or sometimes me and the husband to get in, now my kids are above the age where they get in everywhere for free. So we’re not in the $20 range anymore.

But if you would rather spend time together than give a gift, remember that spending time together can be the greatest gift. And there’s tons of ways to do that on the cheap.

LEGO® Brick Fest Live! Promo Code

Nice! Promo code to save on LEGO Brickfest Live! tickets in Pittsburgh.

A little over a year ago, we went to LEGO® Kidsfest. It was awesome. The event was insanely fun, the venue and staff were amazing.

The only not-so-awesome thing about it was that it was in Harrisburg. Driveable, for sure. And worth the miles. But it was a trek.

This year, I’m excited to let you all know that LEGO Brick Fest Live! is coming to Pittsburgh, and we have a promo code to help you save some money on your tickets.

Promo code to save money on LEGO Brick Fest Live! Tickets

What is there to do at Brick Fest?

There will be a ton of fun things going on at Brick Fest Live! this year. When we attended the LEGO event last year, we realized it was as much fun for us as it was for the kids. Brick Fest Live! looks to be in the same vein.

The Brick Show Experience

Meet popular YouTube LEGO show hosts from The Brick Show and be featured on in an upcoming video.

Brick Fest Derby

Build and race your custom built LEGO derby car down one of our 35-foot long timed tracks!

Collaborative Building Activities

Contribute to large-scale mystery floor mosaic.

Inspiration Stations

Add to existing LEGO cities and make them your own by building custom creations.

Video Game Arena

Have a favorite LEGO video game? Come challenge your family or make new friends in the Brick Fest Gaming Arena playing your favorite LEGO title head to head.

Mini Golf

A miniature golf course built to inspire! Take your game to the next level on the Brick-Links.

Brick Fest Theater Trivia & Entertainment

Participate in LEGO trivia all while taking a break from what will be an overwhelming amount of awesome!

Mosaics

Using a colorful variety of LEGO bricks, build a piece of art to proudly display for other attendees.

Shopping

Find new, vintage, rare, and custom LEGO sets and merchandise from one of the many merchants in attendance.

Get discounted tickets to LEGO Brick Fest Live!

LEGO Brick Fest Live! Pittsburgh: Time and Place

Luckily, yinzers don’t have to go far to enjoy the LEGO festivities this year. The event starts July 15 at 9a and ends on July 16 at 6p. It will be held at the Monroeville Convention Center.

LEGO Brick Fest Live! Promo Code

When you purchase your tickets, be sure to use the promo code USFGTHREE to save $3 off your tickets.

 

How to Make Poké Ball Cupcakes

Such cute Poke Ball cupcakes! You can even bake a pokemon inside--I choose Ponyta!

This winter, we had a birthday party for one of my kiddos. It was a great time. We went to an indoor bouncy place, got a lot of energy out, played with friends and ate some amazing cupcakes.

How do I know they’re amazing? When I asked the birthday child what their favorite part of the day was, they sat and thought for a second before saying, “The cupcakes.”

Just so you don’t think I’m tooting my own horn, Grandma made these. Our oven was unfortunately broken at the time, so I bought all the materials and passed my vision along to her. But in the end, the delicious and good-looking cupcakes were 100% done by her.

I should have known she’d pull it off. I grew up with Little Mermaid and Snow White cakes that looked like they were ordered from a bakery. They weren’t. Grandma’s just got that baking magic.

Not only did they end up being the favorite part of the day, but they ended up being the most frugal, too.

How do you throw a frugal birthday party in the winter?

That’s not a rhetorical subheading. I really, truly want to hear some comments on this one, because I have no idea.

We live in a small apartment with no yard. Even though this winter was pretty warm in Pittsburgh, it’s unpredictable enough to not plan an outdoor party at a park or something like that at the beginning or end of the season.

And all the indoor places are expensive.

I knew it was going to be costly to go to the bouncy kingdom, but their package looked cheaper than other kid-friendly spaces I could find. Then I got hit with a much larger bill than I was expecting because of overpriced add-ons suggested the day of. Mental math was not my friend that day.

I digress.

We were talking about our super frugal, super awesome Poké Ball cupcakes.

How to Make Pokémon Cupcakes

Here's how to make Poke Ball cupcakes for a Pokemon birthday party.

Making Pokémon cupcakes is actually a lot simpler than you may think. You only need to buy six things–assuming you’ve got a muffin tin at home.

Poké Ball Cupcake Ingredients

The cake mix and frosting should be cheap enough–especially if you shop sales and use coupons.

The sprinkles, pearl candies and cupcake liners all feature affordable options. You may have to buy two packs of the first two items–especially if you’re making two dozen–but one order of cupcake liners is more than enough.

The icing will probably be the most expensive part, but you can cut costs by buying a tiny tube.

Poké Ball Cupcake Directions

Now that you have everything you need, it’s time to start working your own baking magic.

  1. Bake cupcakes as directed on the box, using red cupcake liners. Let them cool.
  2. Ice with white frosting.
  3. Dump your red sprinkles out into a bowl. Dip half of each frosted cupcake into the sprinkles.
  4. Use the black icing to draw a line diving the red an white halves of the cupcake.
  5. In the middle, put a relatively large dot of black icing.
  6. Gently push a pearl candy into that black dot.

Simple! And fun.

We also thought about baking a small Pokémon toy in the center like a King’s Cake, but that was going to get expensive. If money’s no object or you find a great place to buy cheap Pokémon toys, I think it could be super fun to find one inside your Poké Ball!

Children, Medicaid & Autism: State-by-State Guide

In honor of Autism Acceptance Month, Femme Frugality will be hosting a series of Monday articles that focus on the financial challenges and triumphs that people with autism face and achieve. When they are children, these things also tend to affect their family’s finances, as well.

I didn't know there were so many ways to get children with autism on Medicaid! This state-by-state guide is incredibly helpful!

When you’re raising a child with autism, the largest expense you shoulder is healthcare. You learn that “healthcare” isn’t just doctor’s visits and the occasional dramatic visit to the ER. It’s therapy. Adaptive equipment. Communication devices. And more.

None of it’s cheap, and if you don’t have a good healthcare plan, a lot of it’s not going to be covered.

Even if you do have a good healthcare plan, some benefits will still not be covered. In many states, the most comprehensive way to get your child the services and equipment they need is through Medicaid, and many states allow disabled children access to Medicaid even if their parents’ income exceeds eligibility limits.

Want to find out how to shelter some of your savings from asset tests? Check out ABLE accounts.

Medicaid Coverage Saves Everyone Money

Medicaid coverage keeps kids out of institutions. Until the 1980’s, one of the only ways to get children with complex needs the services they required was through an institution. Whether a parent wanted to part with their child or not, they were often forced to.

This was also extremely expensive. Providing a child Medicaid benefits so they are able to live and thrive at home is far less costly than having them live in an intermediate care facility or nursing home.

Luckily, things have changed, but not all states are equal. Today we’ll be looking at Medicaid coverage options for children with autism across all fifty states–and Washington, D.C.

Before we get started, there’s some vocab I want to review.

State Plan

“State Plan” simply refers to the Medicaid coverage that anyone gets if they apply for benefits with their state. Eligibility is dependent on income limits–not disability or lack thereof.

ABA Therapy

ABA therapy, or Applied Behavioral Analysis therapy, is the most proven method for successful early intervention for children with autism. There’s just one problem: it’s insanely expensive.

Until recently, most insurers denied the evidence in favor of this therapy. Some still do because of its cost. But most states have enacted laws recognizing, and forcing insurers to recognize, it as an evidence-based therapy.

That doesn’t mean all states provide coverage. There was a mandate issued by the Federal government in 2014 that arguably required its coverage under Medicaid, but some states have interpreted this mandate differently.

I want to take a minute here to acknowledge that not everyone is behind ABA–even within the autism community. There are some autistic adults who are opposed to ABA therapy when it’s practiced with extreme rigor. However, there is also a general acknowledgement that there are ethical and non-ethical ways to practice ABA from the autistic perspective. You can get both sides of the argument here.

Level of Care

Required “level of care” indicates where a child would have been cared for prior to our culture’s shift towards keeping autistic children with their families. There are three levels commonly recognized in most states. In order from least “severe” to most “severe,” where “severity” means more healthcare is needed:

  • Intermediate Care Facility– Many parents may be surprised to learn that their child would have been institutionalized not so long ago. This level of care can, in some cases, be equivalent to the child who goes to outpatient therapy several times a week and has behavioral therapists in their home or community setting.
  • Nursing Home– This level of care would require skilled nursing/medical care on a regular basis. Today, you may have a nurse come into your child’s home and/or school to help provide these services.
  • Hospital– This level of care is required when you need more than a nurse. There may be monitoring of a condition or simply more advanced care needed on a regular basis.

In this guide, the lowest level of care required is listed. For example, if a state lists the required level of care as an intermediate facility, that will typically mean that those at a nursing home or hospital level of care are eligible, too.

Conversely, if the listed level of care is “nursing home,” those who are at an intermediate care facility level of care would not qualify for the listed program.

Waiver

A Medicaid waiver is simply a program that grants specific services to those who do not typically qualify for the State Plan. There are also waivers that provide services in addition to and including what’s available on the State Plan.

Wait List

You may notice that for most states, there is no reference to the wait list. This is done for two reasons.

  1. Medicaid programs are in flux at the moment. A wait list–or even a waiver–could change suddenly. It’s information we don’t have the capacity to update continuously.
  2. We want you to get in touch with the agencies that provide these waivers. Even if the wait list is too long for your child, state agencies may know of other programs or community organizations that could help in your unique situation.

The Map

In an attempt to make this guide thorough for all 50 states plus D.C., it is much longer than typical Femme Frugality content. We’ve created this map to help you navigate to your state. You can also use it to explore other states if you are considering a move or are just plain curious.


Alabama

Are autism services covered by State Plan Medicaid?

Some services, such as occupational, speech and physical therapies may be covered, but behavioral therapies are not.

Does coverage include ABA?

No.

Is there a program that allows for coverage even if income exceeds eligibility limits?

While Alabama does offer waivers, applicants must be SSI recipients in order to be eligible. Speaking in general terms, if your child qualifies for SSI, they will typically qualify for Medicaid, anyways—independent of a waiver.

Children can potentially qualify for additional services under the Intellectual Disabilities Waiver, or the Living at Home Waiver. More information on coverage under these programs can be found here.

Does severity of the disability matter?

Yes. Your child must have an IQ of 69 or below. They must also require a minimum level of care which has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Alabama?

If you qualify for Medicaid coverage based on income, you can apply here.

If you want to apply for a waiver, contact the Division of Developmental Disabilities.

Alaska

Are autism services covered by State Plan Medicaid?

“Many children with autism receive therapy and other needed supports through our Medicaid program,” explains the Alaska Department of Health and Social Services. “We currently cover Intensive Active Treatment which may include ABA-like services, as well as other ancillary services such Speech, Occupational and Behavioral Health Services.”

Does coverage include ABA?

ABA itself is not covered.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Children can apply for Medicaid through TEFRA, which is a federal regulation that allows children with disabilities to apply without counting their parents’ income. Not all states take advantage of TEFRA, but Alaska does.

Alaska also offers the Intellectual and Developmental Disabilities (I/DD) Waiver, for which children with autism may qualify.

Does severity of the disability matter?

Yes. For the I/DD Waiver, your child must have had the disability before age 22, which is a nonissue both because autism doesn’t have a late onset and because your child is not yet 22. They must also have significant limitations in three of the following areas, and those limitations must be expected to last for life:

  • self care
  • receptive and expressive language
  • learning
  • mobility
  • self-direction
  • capacity for independent living
  • economic self-sufficiency

For TEFRA, your child must require at least a level of care that has been traditionally met in an intermediate care facility.

How can I apply for Medicaid in Alaska?

You can start the process for the State Plan here. For assistance with the waiver process, contact your local waiver staff person.

Arizona

Are autism services covered by State Plan Medicaid?

“Yes,” says Heidi Capriotti of the Arizona Health Care Cost Containment System. “Physical and behavioral health services are covered under Medicaid.”

“In 2015, the Governor’s Office appointed an Autism Spectrum Disorder Advisory Committee to ensure that people with ASD received medically necessary services. On this webpage you can find a list of ASD Advisory committee members, meeting minutes, and the committee’s report of recommendations to the Governor, as well as all providers available under each of the three Regional Behavioral Health Authorities (RBHAs): Mercy Maricopa Integrated Care, Health Choice Integrated Care, and Cenpatico Integrated Care.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Depending on your individual situation, individuals with autism may be eligible for the Arizona Long-Term Care System (ALTCS) where familial assets are not counted—the state looks only at the individual’s resources.

Does severity of the disability matter?

Yes. To qualify for ALTCS, one of the requirements is needing a level of care that has traditionally been met by an intermediate care facility.

How can I apply for Medicaid in Arizona?

You can apply online or print and mail this application.

Arkansas

Are autism services covered by State Plan Medicaid?

Yes. They are available for children under age 21 when their primary care physician deems it is medically necessary.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes—there are two. Children with Autism can potentially qualify for the Arkansas Autism Partnership (AAP) or a TEFRA waiver. Under both, parental income is not counted.

“Parental income is utilized in some programs for the determination of a premium that is established on a sliding fee scale,” notes the Arkansas Department of Human Services. “Parental income, however, does not prevent financial eligibility.

Does severity of the disability matter?

Yes. Your child must meet a level of care which has traditionally been met in an institution. Which level of institutional care that would be required depends on the waiver.

“In the situation with Autism Spectrum Disorders, this may mean that children who would have previously been diagnosed with Asperger’s Syndrome…are often not eligible for waiver services,” says the Department of Human Services. “If ABA Therapy is deemed to be medically necessary, however, they could receive those services under EPSDT.”

EPSDT is the same program that enables medically-necessary coverage for children with autism (and other disabilities) under the State Plan.

How can I apply for Medicaid in Arkansas?

The department shares both ways to apply for coverage:

“To apply for services through the AAP, the family submits an application to:

Partners for Inclusive Communities
Attention: AAP
322 Main Street
Suite 501
Little Rock, AR  72201

The application is available on the Medicaid website or by emailing.”

Here is the address to email your request for an application.

“In order to apply for the services through EPSDT, the child’s Primary Care Physician must submit a DMS-693 Referral Form and required documentation to:

Arkansas Medicaid
Attention: Kiral Gunter
Division of Medical Services/Utilization Review Unit/ Slot S413
700 Main Street
Little Rock, AR 72203-1437 “

California

Are autism services covered by State Plan Medicaid?

Yes, as long as they are recommended by a licensed physician and surgeon/licensed psychologist. California’s Department of Health Services has an FAQ sheet outlining their behavioral health treatment services.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes and no. When parents’ income is too high for the state plan, children with autism may qualify under the Home and Community-Based Services Waiver for the Developmentally Disabled if their disability could qualify them for an intermediate care facility.

However, in 2014 Medicaid started requiring states to cover behavioral health services under their state plans. When this happened, California pulled behavioral health services from their waiver program. This means that while your child may qualify for a waiver, the services they can access will not include any behavioral therapies.

The only way to get those therapies is if they qualify for Medicaid traditionally, under the parents’ income.

If your child is ineligible for the waiver and Medicaid, they may be eligible for services under the Lanterman Act.

California renders these services at regional centers. “Regional centers are nonprofit private corporations that contract with the California Department of Developmental Services (DDS) to provide or coordinate services and supports for individuals with developmental disabilities,” relays the California Department of Health Care Services.  “They have offices throughout California to provide a local resource to help find and access the many services available to individuals and their families.”

Does severity of the disability matter?

To qualify for the waiver, your child must meet a necessary level of care that could warrant an intermediate care facility.

If your child qualifies for State Plan Medicaid, severity will not matter as long as they have an autism diagnosis and services are recommended by their licensed primary care physician.

How can I apply for Medicaid in California?

You can apply for the State Plan here. If you are applying for a waiver or want to inquire further about the Lanterman Act, it is recommended that you get in touch directly with the Department of Developmental Services.

Colorado

Are autism services covered by State Plan Medicaid?

“Yes. Pediatric Behavioral benefits are covered in Health First Colorado,” says Kim Tenure, Educator and Outreach Coordinator at The Arc of Arapahoe and Douglas Counties. Health First Colorado is Colorado’s Medicaid State Plan.

“These therapies are covered under Early, Periodic, Screening, Diagnosis and Treatment (EPSDT), and as a result they must be medically necessary.  You do not need an autism diagnosis to access the benefit.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“The Children with Autism Waiver currently provides ABA therapy for children under the age of six,” says Tenure. She notes that the waitlist for this waiver is significant.

She also relays that children may qualify for the Children’s Extensive Services (CES) Waiver, though it is extremely hard to do so.

Does severity of the disability matter?

Yes. In order to qualify for the Children with Autism Waiver, your child must meet the Social Security Administration’s definition of disabled and require a level of care that has traditionally been met in an intermediate care facility.

To qualify for the CES Waiver, your child must require a level of care so significant that “almost constant line of sight supervision” is necessary. This requirement is what makes the CES Waiver so difficult to qualify for.

How can I apply for Medicaid in Colorado?

Contact your Community Centered Board.

Connecticut

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes, Connecticut has an Autism Medicaid Waiver. The requirements for this waiver as provided by the Department of Social Services are:

  • Legal residency in the state of Connecticut.
  • Have a primary diagnosis of Autism Spectrum Disorder. An evaluation for ASD must include a standardized diagnostic instrument such as the Autistic Diagnostic and Observation Schedule (ADOS), Childhood Autism rating Scale (CARS) or Gilliam Autism Rating Scales (GARS). Evaluations that do not include standardized diagnostic instruments will not serve to qualify individuals for services from the DDS Division of Autism Spectrum Services.
  • At least 3 years of age.
  • A full scale IQ of 70 or higher. A diagnosis of intellectual ability must include tests such as the Wechsler or Stanford-Binet which assess intellectual/cognitive ability and generates IQ scores. Psychological testing must be current (within three years.)
    For children ages 3-7 where a valid IQ cannot be determined, eligibility will be based upon a diagnosis of ASD and developmental delays.
  • Medicaid Eligibility.
  • Impairment prior to age 22 years.
  • Impairment expected to continue indefinitely.
  • Live either in their own home or their family home (individuals living in residential or school settings are not eligible for the autism waiver services).

If your child requires a level of care that has traditionally been met in an intermediate care facility, they may also qualify for the Katie Beckett program, which allows your child to get on the state Medicaid plan without counting parental income.

Does severity of the disability matter?

Yes. To qualify for the Autism Medicaid Waiver, your child must have an IQ of 70 or higher. If they score lower, you will be referred to the state’s Intellectual Disability programming.

To qualify for the Katie Beckett program, your child must require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Connecticut?

If you are income eligible, you can apply for Connecticut’s state plan here.

Otherwise, get in touch with:

Lisa Bonetti
Administrative Assistant
Department of Social Services
55 Farmington Ave.
Hartford, CT 06105
Email
Ph: 860-424-5865
Fax: 860-920-3170

Delaware*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Children’s Community Alternative Disability Program does not include parental income for eligibility purposes. To qualify, you will have to apply for SSI benefits on behalf of your child. They will be denied because of your income, but it will affirm that your child has a qualifying disability.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met in an intermediate care facility to qualify for the waiver.

How can I apply for Medicaid in Delaware?

Apply for the State Plan here.

To start the process on the waiver, get in touch with your local Long-Term Care Medicaid Program.

Florida

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Developmental Disabilities Individual Budget Waiver—also known as the iBudget Waiver—covers disabled children whose income level is at or below 300% of the Federal Poverty Level.

This waiver covers:

  • Adult Dental Services
  • Behavior Analysis Services
  • Behavior Assistant Services
  • Dietician Services
  • Environment Accessibility Adaptations
  • Life Skills Development
  • Occupational Therapy
  • Personal Emergency Response System
  • Personal Supports
  • Physical Therapy
  • Private Duty Nursing
  • Residential Habilitation Services
  • Residential Nursing
  • Respiratory Therapy
  • Respite Care Services
  • Skilled Nursing
  • Specialized Medical Equipment and Supplies
  • Specialized Medical Home Care Services
  • Specialized Mental Health Counseling Services
  • Speech Therapy
  • Support Coordination Services
  • Supported Living Coaching Services
  • Transportation

Does severity of the disability matter?

Yes. There are many ways to qualify, but children with autism specifically must either have an IQ of 69 or below OR have severe functional limitations in at least three of the below areas:

  • Self care
  • Understanding and use of language
  • Learning
  • Mobility
  • Self direction
  • Capacity for independent living

How can I apply for Medicaid in Florida?

For those that qualify for the state plan traditionally, you can apply online or call 1-866-762-2237.

If you want to explore the iBudget Waiver as an option, you can contact the Agency for Persons with Disabilities using the contact info below:

Agency for Persons with Disabilities
4030 Esplanade Way
Suite 380
Tallahassee, FL 32399-0950
1-866-273-2273

Georgia

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

In some cases, yes. According to the Georgia Department of Community Health, “ABA services are currently reviewed for coverage through an authorization process through our medical management vendor.”

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. TEFRA, also known as the Katie Beckett program, ignores parental income for Medicaid eligibility purposes.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met in an intermediate care facility in order to qualify for TEFRA.

How can I apply for Medicaid in Georgia?

Get application information via Right from the Start Medical Assistance Group.

Hawaii*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Families can apply for the Development Disabilities/Intellectual Disability Waiver on behalf of their children. Parental income will not be counted.

Does severity of the disability matter?

Yes. To qualify for the waiver, your child must require a level of care that has traditionally been met in an intermediate care facility.

There are no such requirements to qualify for the State Plan; if you’re income eligible, your child will have coverage.

How can I apply for Medicaid in Hawaii?

To apply for the Waiver, you will need to get in touch with intake staff at your local Developmental Disabilities Division office.

If you don’t require the Waiver, you can apply for the State Plan here.

Idaho

Are autism services covered by State Plan Medicaid?

Yes, services commonly prescribed to children with autism can be obtained through the state’s waiver programs and a 1915(i) State Plan amendment.

Does coverage include ABA?

“Idaho Medicaid does not pay specifically for Applied Behavioral Analysis (ABA) Services,” says the Idaho Department of Health and Welfare.

There is, however, a way to obtain these services should your child’s medical team deem it necessary. The department continues:

“The therapeutic intervention services, called ‘Habilitative Intervention,’ allow for the implementation of various treatment interventions, including ABA if appropriate, that meet the needs of the individual child.”

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Children can qualify under:

Does severity of the disability matter?

“Idaho Statute defines the necessary criteria for developmental disability, which includes criteria for functional limitations as well as diagnostic requirements and level of care,” says the Department of Health and Welfare.

Specifically, if you are applying for Home Care for Certain Disabled Children, your child needs to require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Idaho?

Application and contact information for children with disabilities can be found here. We highly recommend reaching out to your local Family and Community Services office for further information on Idaho’s programs and how they may apply to your individual child, as these programs are many and varied.

Illinois*

Are autism services covered by State Plan Medicaid?

No. Some therapies may be covered, but coverage is not comprehensive for the purposes of a child with an ASD diagnosis.

Does coverage include ABA?

It’s complicated. ABA therapy is not a mandatory coverage on the State Plan in Illinois. However, managed-care plan providers can choose to cover the therapy.

At this time, there are no managed-care plans that cover the therapy.

Private insurers in Illinois are required to provide this coverage. There is an exception for employer-provided insurance when the company self insures. Self-insured plans are most common at larger companies and corporations.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Support Waiver for Children and Young Adults with Developmental Disabilities allows your child to qualify for Medicaid without counting parental income.

This waiver also provides the following services, which may make it advantageous to apply for even if you qualify for the State Plan with parental income:

  • Service facilitation
  • Personal support
  • Behavior intervention and treatment
  • Training and counseling for unpaid caregivers
  • Adaptive equipment
  • Assistive technology
  • Home accessibility modifications
  • Vehicle accessibility modifications
  • Temporary assistance/emergency respite care

Does severity of the disability matter?

Yes. To qualify for the waiver your child must require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Illinois?

You can apply for the State Plan here. To get started on the waiver process, contact your local Department of Human Services office.

Indiana

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. You can apply under the Community Integration and Habilitation waiver, or the Family Supports waiver.

The Indiana Family and Social Services Administration report that these waivers, “allow coverage through Medicaid if family or individual income exceeds eligibility limits. Each waiver has a limited waiver service capacity for each year, and individuals cannot be served by multiple waivers at the same time.”

Does severity of the disability matter?

Required level of care does matter for both waiver programs.

How can I apply for Medicaid in Indiana?

You can apply for general Medicaid here. If your income merits a waiver, you can apply for services at your local Bureau of Developmental Disabilities Services.

Iowa

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

“Yes,” reports the Iowa Department of Human Services. “ABA is a Medicaid state plan benefit for members aged 20 or under who meet applicable eligibility requirements.”

Is there a program that allows for coverage even if income exceeds eligibility limits?

“Iowa has seven Home and Community Based Services (HCBS) Waivers,” DHS shares. “There is no waiver designed specifically for children on the autism spectrum, although a person with autism sometimes qualifies for either the Intellectual Disability (ID) Waiver or the Health and Disability (HD) Waiver. ABA is not a waiver service, however, all members will have a comprehensive service plan developed by a case manager or care coordinator in cooperation with the member.

“The comprehensive service plan for members aged 20 or under must be developed or reviewed taking into consideration those services that may be provided through the individual education plan (IEP) and EPSDT (Care for Kids) plans.  Members shall access all other services for which they are eligible and which are appropriate to meet their needs as a precondition of eligibility for the ID Waiver.

“Iowa also has a state funded non-Medicaid program called the Autism Support Program (ASP), which can provide funding for ABA to eligible children who do not qualify for Medicaid coverage and do not have a private insurance benefit for ABA services.  To receive assistance through the ASP, a child must:

  • be under age 14 at the time of application.
  • have an autism spectrum disorder diagnosis made within the last 24 months by a qualified practitioner.
  • have proof of denial of coverage by their private insurer.
  • have a household income under 500% of the Federal Poverty Level.”

Does severity of the disability matter?

Yes. For the waivers, you must meet a minimum level of care, which will vary depending on the waiver. The necessity of ABA services are decided on a case-by-case basis.

How can I apply for Medicaid in Iowa?

You can apply online here. If you want more information about the Autism Support Program, you can email the Division of Mental Health and Disability Services directly.

Kansas

Are autism services covered by State Plan Medicaid?

“Yes,” says Angela de Rocha of the Kansas Department for Aging and Disability Services. “A number of autism services were recently moved from the Autism waiver to the State Plan, which, we believe, will allow us to serve more children.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

No.

Does severity of the disability matter?

Because coverage is only available to those who qualify for the state plan based on income, it does not matter.

How can I apply for Medicaid in Kansas?

You can start the application process here.

Kentucky*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

ABA is covered under Kentucky’s waiver programs.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Supports for Community Living (SLC) Waiver and Michelle P Waiver both only count your child’s income—not the parents’.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met at an intermediate care facility in order to qualify for the waivers.

How can I apply for Medicaid in Kentucky?

Kentucky directs all applicants to the Benefind portal.

Louisiana*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Children with autism may qualify for the Children’s Choice Waiver or the New Opportunities Waiver (NOW).

NOW is in high demand, so you will have to join the wait list. Typically, the Children’s Choice Waiver is offered as an alternative or interim solution to children who are on the NOW wait list.

SSI will need to determine that your child has a disability. In order to do that, you must apply for SSI benefits, even if your child is denied because your income is too high.

After SSI disability has been established, the state of Louisiana will not count parental income for purposes of waiver qualification. Both waivers also provide full access to the State Plan.

Does severity of the disability matter?

Yes. To qualify for either waiver, your child must require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Lousiana?

To apply for waiver services, contact your district office of Developmental Disability Services.

You can apply for the State Plan here.

Maine*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Your child may qualify under the Katie Beckett program, which counts the child’s income only.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met by an intermediate care facility.

How can I apply for Medicaid in Maine?

You can apply for the State Plan here. If you want to apply for the Katie Beckett program, you can get more information here, though it is an almost identical process.

Maryland

Are autism services covered by State Plan Medicaid?

“Yes, coverage began January 1, 2017,” says Rebecca Rienzi, Executive Director of Pathfinders for Autism. “However, roll out is very slow and there have been lots of implementation challenges – such as required re-evaluation to confirm diagnosis and abysmal reimbursement rates. As of March , there were still only 4 services providers enrolled in the entire state.  The state really did not consider the stakeholders’ input during the regulatory process and are now experiences a lot of challenges, which means many Medicaid families are not getting services.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes, though the waiting list is so long that you may be better off looking at other options.

If you do want to pursue the Autism Waiver, parental income will not be counted.

Does severity of the disability matter?

Yes. To qualify for the waiver, your child must require a level of care that has traditionally been met in an intermediate care facility.

Income eligibility is the only barometer to get on the State Plan.

How can I apply for Medicaid in Maryland?

You can apply for Maryland’s State Plan here.

To get more information on the Autism Waiver, including application procedures, contact the Maryland Department of Education at (410) 767-1446.

Massachusetts

Are autism services covered by State Plan Medicaid?

Yes. Medically necessary services are covered for children up to age 21.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“Generally, there is no income limit for disabled children for MassHealth eligibility,” says Sharon Torgerson of the Massachusetts Department of Health and Human Services. “Those who are over income for MassHealth Standard are eligible for CommonHealth and pay sliding scale premiums.”

Family income will not be included if the child applies for SSI and is determined to have a disability by the Social Security Administration (SSA).

There is also a waiver that may provide additional services. The Children’s Autism Spectrum Disorder Waiver serves children under age 9, and has the same income limits as the State Plan.

Does severity of the disability matter?

Yes. You must establish disability in order to reduce the income limits for MassHealth.

“An SSI application is not required prior to a MassHealth application,” explains Torgerson, “However, all benefits available to an applicant must be sought and obtained.  If a child has not been determined disabled by SSA, MassHeatlh has a process available in order to determine an applicant’s disability for MassHealth purposes.”

In order to qualify for the Children’s Autism Spectrum Disorder Waiver, your child must require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Massachusetts?

You can get the application process started here.

Michigan

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Children’s Waiver extends coverage to qualified children without counting family income.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met by an intermediate care facility.

How can I apply for Medicaid in Michigan?

Families can start the application process by contacting their local Community Mental Health Services Program.

Minnesota

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Parents can apply for their children through the TEFRA program. According to the Minnesota Department of Human Services, to be eligible for TEFRA:

  • The child must live with at least one parent.
  • They must be under age 19.
  • They must be certified as disabled by the Social Security Administration or State Medical Review Team.
  • They must, “need a certain level of care to stay at home that is similar to the level of care provided in a hospital, nursing home or intermediate care facility for people with developmental disabilities.” The State Medical Review Team will make this determination.
  • Home care costs must be less expensive than care in a facility.

If your child has needs that exceed what is covered under Minnesota’s state Medicaid plan, you can also apply for one of the following waivers:

  • Brain Injury (BI)
  • Community Alternative Care (CAC)
  • Community Access Disability Inclusion (CADI)
  • Developmental Disability (DD)

If you qualify for a waiver or TEFRA, you may be required to pay a parental fee.

Does severity of the disability matter?

Yes. For TEFRA in particular, your child must have a disability that is expected to last twelve months. The disability must be severe enough to limit your child’s ability to participate in daily living activities, or limit your ability to participate in work-related activities.

How can I apply for Medicaid in Minnesota?

You can apply for the state plan here. If you need to apply via waiver, print and fill out this form before mailing it to your county or tribal human services agency.

Mississippi

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes, but only when it is deemed medically necessary and only if it yields “significant developmental progress.”

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Disabled Child Living at Home Program waives all income requirements as long as your child is under 19, does not have excessive assets in their own name. It also must be cheaper for the state to provide coverage through Medicaid than to send them to an institution.

To qualify for this program, you will have to apply for SSI benefits for your child. You will be denied because of your income, but it will also prove to the state that your child is, in fact, disabled.

Does severity of the disability matter?

Yes. If it is determined that autism does not affect your child in a way that would render them worthy of institutionalization in at least an intermediate facility, you will not qualify for the waiver program.

However, you may be surprised at what happens at intermediate facilities, and you may already be doing the same work at home. Check out page 2 of this document to see Mississippi’s standard.

How can I apply for Medicaid in Mississippi?

Contact your closest Medicaid Regional Office. Contact information is listed in this self-same document.

Missouri

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes. It is covered under the state plan for children under age 21 on the spectrum. After age 21, you will need a Developmental Disabilities (DD) Waiver to gain access to this service.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“Missouri has autism services funded through the regional Parent Advisory Councils,” explains Debra Walker of the Missouri Department of Mental Health. These councils do not count income for eligibility.

“Also,” continues Walker, “Missouri operates the MO Children with Developmental Disability Waiver (MOCDD) which disregards parental income and allows individuals under 18 years of age to be Medicaid eligible.”

Does severity of the disability matter?

Yes. Your child must meet a level of care that could justify at least an intermediate facility.

How can I apply for Medicaid in Missouri?

Contact your local Division of Developmental Disablities’ regional office.

Montana*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

No. Until recently, Montana operated the Children’s Autism Waiver. When they expanded their coverages on the State Plan, they simultaneously applied to phase out the waiver. Those receiving services will retain coverage as they are phased into the State Plan over the next three years, but no new applicants can currently get on the Waiver.

Montana does have a state mandate requiring private insurers to cover autism services, including ABA therapy. It does not apply to self-insured employers, who usually operate larger companies or corporations.

Does severity of the disability matter?

Since coverage is only currently available under the State Plan, eligibility is based on finances—not disability.

How can I apply for Medicaid in Montana?

You can find application information here.

Nebraska

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“Yes,” says Julie Naughton, Public Information Officer for the state of Nebraska, “the Aged and Disabled Waiver for children who meet nursing home level of care. To qualify for this waiver, a disability determination is done per TEFRA to disallow parental income.  If approved, these children then have access to full Medicaid benefits.”

TEFRA is a federal option that allows states to cover children with disabilities independent of parental income.

Does severity of the disability matter?

Yes. To qualify for this waiver, children must qualify for SSI based on their disability, and require a level of care that has traditionally been met by nursing homes.

How can I apply for Medicaid in Nebraska?

All applicants can get further information here.

Nevada*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Katie Beckett program is a way for children with disabilities to qualify for Medicaid even if parental income is too high to qualify for the State Plan.

Nevada also runs the Autism Treatment Assistance Program (ATAP), which specifically helps with medical bills related to autism services.

Does severity of the disability matter?

Yes. In order to qualify for the Katie Beckett program, your child must require a level of care that has traditionally been met in an intermediate care facility. To qualify for ATAP, your child must have autism. You will be responsible for furnishing medical documentation that supports their diagnosis.

How can I apply for Medicaid in Nevada?

You can apply for the State Plan here.

To apply for the Katie Beckett program, contact your local office of the Department of Health Care Financing and Policy.

Those interested in further information on ATAP should call (775) 687-4210.

New Hampshire*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. In New Hampshire, Children’s Medicaid has a higher limit of 318% of the Federal Poverty Line. This includes parental income.

However, New Hampshire also runs a Katie Beckett program called Home Care Services for Children with Severe Disabilities. Parental income is not included for eligibility purposes.

Does severity of the disability matter?

It does not matter for the State Plan or Children’s Medicaid.

It does matter for the Katie Beckett program. Your child must apply for SSI and be determined disabled. They may not get SSI benefits because of your income level, but the disability determination is all that’s important for Medicaid purposes.

How can I apply for Medicaid in New Hampshire?

Apply for any of the above services using NH EASY.

New Jersey

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

“At this time Medicaid does not cover ABA,” says Elena Graziosi of Autism New Jersey. “However, some children who are eligible for developmental disability services from the NJ Department of Children and Families’ Children’s System of Care may qualify to receive ABA services.”

Families can find more information on this program here.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Community Resources for People with Disabilities Waiver does not count parental income.

New Jersey has two additional programs to assist individuals with extra healthcare needs that do not traditionally qualify for Medicaid: Medically Special and Medically Needy.

Medically Special is a way for children under age 21 to get onto Medicaid. This program is advantageous primarily for children ages 19-20 as it allows them to stay on their plan without aging out at age 18. There appears to be no change in financial eligibility requriements, though, when compared to the State Plan.

Medically Needy is a program to help families or individuals pay for healthcare expenses when they do not qualify for Medicaid.

Does severity of the disability matter?

To qualify for the waiver, your child must require a level of care that has traditionally been met in a nursing home.

The Medically Special and Medically Needy programs have no such requirements according to Graziosi.

How can I apply for Medicaid in New Jersey?

Apply for the State Plan through NJ FamilyCare. For the waiver, call (609) 292-4800.

New Mexico

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. While New Mexico does not have a waiver, it does have other programs for families with an income that disqualifies them from Medicaid.

“The Autism Flexible Services Program provides funding up to $2,500/person for assistance with ABA services or other services such as therapies,” says Kyler Nerison of the New Mexico Human Services Department. “This is available to individuals who do not qualify for Medicaid.”

This program opens up once a year, so you have to fill out your application for funding within a certain time frame. It does cover services, but it will not cover adaptive equipment or other goods.

The state also has a recreational respite program. Respite is for the caretakers of individuals with autism. A respite worker is provided through a state-contracted agency to allow the caregiver time to do other things. When both the caretaker and affected individual are taken care of, the rate of institutionalization goes down, which ultimately saves the health care system money. It also creates a better quality of life for everyone involved.

The University of New Mexico’s Center for Development Disabilities also offers services that may be available to those who are not Medicaid-eligible for income reasons. These services include:

  • Diagnostic evaluations
  • Parent home training
  • Family specialists

Does severity of the disability matter?

Because the only way to get on Medicaid is through income eligibility, severity of disability does not matter.

The requirement for the Autism Flexible Services Program funding is simply a diagnosis of ASD for children under age 22.

How can I apply for Medicaid in New Mexico?

You can apply for the state plan here. If you do not qualify because of your income, you can get more information about the Autism Flexible Services Program here.

New York

Are autism services covered by State Plan Medicaid?

New York State covers some autism services for qualified applicants under their Medicaid waiver programs.

Does coverage include ABA?

No, though other behavioral therapies are covered.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Office for People with Developmental Disabilities (OPWDD) has a 1915c HCBS waiver which does not count parental income.

“The OPWDD 1915c HCBS waiver program supports individuals in the community by providing a variety of services and supports that are uniquely tailored and individualized to meet each person’s needs,” says the OPDWW. “Services can include habilitation services, respite care, supported employment, and adaptive technologies.”

Depending on your child’s individual needs, another option is the Care at Home Waiver.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met by an intermediate care facility.

Need will be assessed by your local Developmental Disability Regional Office, and is judged against Section 1.03(22) of the New York State Mental Hygiene Law. You can view some of the tools used for assessment in this document.

How can I apply for Medicaid in New York State?

“To initiate the process, family members should contact the Front Door at the Office for People With Developmental Disabilities in the county where they reside,” says OPWDD.

North Carolina

Are autism services covered by State Plan Medicaid?

Yes, but coverage eligibility will become more streamlined in the near future. North Carolina has submitted a State Plan amendment which would define and affirm coverage of research-based interventions specifically for children with autism.

Does coverage include ABA?

It could potentially be covered under the new State Plan amendment as long as it is medically necessary and deemed a research-based treatment.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. You can apply for the NC Innovations Waiver. Only your child’s income will count.

Does severity of the disability matter?

Yes. Your child must require a level of care that has been traditionally met by an intermediate care facility.

How can I apply for Medicaid in North Carolina?

You can apply for the state plan here.

For the NC Innovations Waiver, contact the Local Management Entity-Managed Care Organizations for your region.

North Dakota*

Are autism services covered by State Plan Medicaid?

Yes. These services are covered under a section of Medicaid called EPSDT—known in North Dakota as “Health Tracks.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Parents can apply for the Autism Waiver on behalf of their children. This waiver only serves children through age 7, but does not appear to impose any income limits.

Does severity of the disability matter?

Yes. Your child will have to go through a psychological evaluation confirming the ASD diagnosis.

How can I apply for Medicaid in North Dakota?

To get set up on Health Track, call 1-800-755-2604.

For more information on the Autism Waiver, call 701-328-4630.

Ohio

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Ohio does require insurers to cover autism, so if you have private coverage you may not need to apply to Medicaid.

Ohio does have waiver programs, though none are specific to autism. Children with autism may qualify for them on the basis of developmental disability, though. These waivers are only available to those who are Medicaid eligible, so they don’t help with income eligibility.

Does severity of the disability matter?

It is not a determining factor for eligibility for the State Plan, which is based on economic tests.

Those applying for waivers must meet the state standard Developmental Disability Level of Care.

How can I apply for Medicaid in Ohio?

Get the process started here.

Oklahoma*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

No.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Parental income is waived for the Community Waiver and In-Home Support Waiver.

In order to get your income waived, you must apply for State Supplemental Payments on behalf of your child. You will likely be denied payments because of parental income, but regardless, this process certifies your child as disabled with the state, which allows you to waive parental income for the purposes of the waiver.

Does severity of the disability matter?

Yes. To qualify for either of these waivers your child must require a level of care that has traditionally been met in an intermediate care facility.

How can I apply for Medicaid in Oklahoma?

Apply for the State Plan here. To get the ball rolling on waiver services, contact your local Department of Disability Services area office.

Oregon

Are autism services covered by State Plan Medicaid?

Yes.

“In Oregon, our Medicaid program is called Oregon Health Plan, or OHP,” says Tobi Rates, Executive Director of the Autism Society of Oregon. “Covered services include speech therapy, occupational therapy, physical therapy and ABA, as needed by the individual. One unique feature of OHP is that services are administered by sixteen Care Coordinating Organizations (CCOs) across the state, not directly by OHP.”

Does coverage include ABA?

“Yes,” says Rates, “although OHP limits ABA coverage for children over age 12 and adults to ‘focused’ as opposed to ‘intensive’ ABA therapy. In practice, this means that the ABA therapy focuses on specific behaviors usually for a limited period of time.”

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Apply for SSI on behalf of your child. They will likely be denied benefits since your family income is too high to qualify for the State Plan. However, you only need SSI to determine that your child has a disability.

If they confirm, you can apply for the state’s waiver, which will only count your child’s income.

Does severity of the disability matter?

Yes. To qualify for the Medicaid Waiver, your child must require a level of care that has traditionally been met in an intensive care facility, nursing home or hospital.

How can I apply for Medicaid in Oregon?

You can apply for the state plan here. If you need to apply for a waiver, get in touch with your county’s Community Developmental Disability Program office.

For further information about Oregon’s Medicaid policies, Rates recommends Autism Insurance for Oregon, a blog with up-to-date information on Oregon, Medicaid and children with autism kept by a parent advocate.

Pennsylvania

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. If the Social Security Administration determines your child qualifies for SSI based on their autism diagnosis (though they will not receive benefits if your income is too high,) they qualify for Medicaid regardless of their parents’ income.

You will need to apply on behalf of your child for SSI, be qualified because of disability, but denied because of income level. Then that denial must be sent to the state so you can apply for your child’s Medicaid coverage.

Pennsylvania also recently passed Act 62, requiring some private insurers in the state to start covering autism-related services. This means you may not need to apply for Medicaid as your current insurer may cover these services. Get more details here.

Does severity of the disability matter?

Yes. Your child’s autism must “result in marked and severe limitations” to qualify for SSI, but let Social Security be the judge of what that means. You only need to turn in the application.

SSI appointments have long wait times. Schedule it now as your appointment will be months out from the time you call.

How can I apply for Medicaid in Pennsylvania?

You can apply for Medicaid here, but if your income disqualifies you for the State Plan, you’ll want to apply for SSI first.

Rhode Island

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Families who do not meet traditional income requirements may apply under the Katie Beckett program. Under this program, only the child’s income is counted for eligibility purposes.

Does severity of the disability matter?

It does if you are applying under the Katie Beckett program. Your child will need to meet a level of care that has been traditionally met by intermediate care facilities.

How can I apply for Medicaid in Rhode Island?

You can apply for Medicaid here, or get started on the Katie Beckett program here.

South Carolina

Are autism services covered by State Plan Medicaid?

Currently, they are not covered under the state plan, but they will be added in July of 2017. However, parents can apply for the Interim State Plan Autism Spectrum Disorder Program where more services are covered. Families will be transferred to the state plan after autism benefits are added in July.

Does coverage include ABA?

Coverage for ABA will be one of the added benefits come July, and it is the only covered evidence-based behavioral therapy until then. More will be added after the State Plan changes.

Currently, ABA is covered under the Interim State Plan ASD Program.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Income eligibility requirements are the same for waiver programs as they are for the State Plan. However, the consideration of parental income is dependent on each individual’s unique situation. It’s better to apply and get denied than assume you’re ineligible only to have your child go without benefits they may have qualified for.

Does severity of the disability matter?

It does matter for the waiver programs. Your child will have to apply for SSI. Whether or not they are granted benefits based on your income is irrelevant; the only thing that matters is that they are determined disabled.

Alternatively, you can fill out a disability packet for state-based evaluation. This evaluation is also scored against SSI standards.

How can I apply for Medicaid in South Carolina?

If you are applying between now and July 1st, the South Carolina Department of Health and Human Services recommends applying for the Interim State Plan ASD Program rather than the PDD Waiver. This will make the transition in July easier.

“Apply in the next few weeks. There will be a period before July 1 when the Interim State Plan and the PDD Waiver will be closed for applications.”

After July 1st, you can simply apply for the State Plan.

South Dakota*

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Family Support 360 Waiver allows for coverage while only considering the disabled person’s income. Family income has no bearing.

Does severity of the disability matter?

Yes. To qualify for the waiver, your child must meet the Social Security Administration’s definition of disabled. Disability can also be determined by South Dakota’s Department of Social Services.

How can I apply for Medicaid in South Dakota?

You can apply for the State Plan here. To apply for the Family Support 360 Waiver, fill out this application.

Tennessee

Are autism services covered by State Plan Medicaid?

Yes, but these are not covered under “autism.” Rather, they are benefits extended to all members. You can learn more about covered services here.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

No. Your family must meet Tennessee’s income limits for your child’s age, though medical bills can be used to bring your income down for purposes of qualification.

Does severity of the disability matter?

No.

How can I apply for Medicaid in Tennessee?

You can apply and find more information here.

Texas

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

No.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Children may qualify under the CLASS waiver, which will only count your child’s income.

Does severity of the disability matter?

If you are applying for the CLASS waiver, severity does matter. Your child’s disability must be at a level that would make them eligible for an intermediate care facility. You can find more of the qualification criteria here.

How can I apply for Medicaid in Texas?

You can apply for Medicaid here. If you need to apply for the CLASS waiver, get in touch with your local HHS office.

Utah

Are autism services covered by State Plan Medicaid?

Yes, for children under the age of 21.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

No—at least not one that’s currently open.

“We had a waiver from October 2012-2014  that was originally funded as a two-year pilot project to provide treatment for approximately 250 children, ages two through six, who had been clinically diagnosed with ASD,” says Kolbi Young of the Utah Department of Health. “Eligibility for the program only considered the income and assets of the child–not the parents.”

In 2014, when the Centers for Medicare and Medicaid Services issued new guidance to Medicaid agencies nationwide that ASD-related services must be covered under State Plan Medicaid for children up to age 21, Utah’s waiver program was pulled. Now families must apply based on parents’ income and assets.

”Approximately 100 children remain on the program until they age-out or voluntarily withdraw from the program,” notes Young. “We have not had an open enrollment period for new children to enroll in the waiver in more than two years.”

Does severity of the disability matter?

No, since the only way to access services is by qualifying financially.

How can I apply for Medicaid in Utah?

Families can apply online via the Utah Department of Health.

Vermont

Do you cover autism services on State Plan Medicaid?

Yes. According to Clare McFadden of Vermont’s Division of Disability and Aging Services, “Vermont passed Act 158 several years ago which requires private Insurance and Medicaid to cover the costs of diagnosis and treatment of ASD for children and youth up to age 21. “

“Home and Community-based Services are available to adults with ASD and some children with very intense needs.  Regular State Plan Medicaid covers many services used by people with ASD including SLP, OT, PT, psychiatry, counseling, etc.,” she adds.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. While there isn’t a program exclusively for children with autism, children on the spectrum may qualify under the Katie Beckett clause, which covers children with a high level of needs regardless of parents’ assets or income.

Does severity of the disability matter?

Yes. Your child must require a level of care that has traditionally been met by an intermediate care facility.

How can I apply for Medicaid in Vermont?

“Families of children with ASD can apply for Medicaid through Department of Vermont Health Access,” relates McFadden. “Once eligible for Medicaid, they can apply for prior authorization of ABA services though the same dept.  Families of children and adults can apply for other services through their local Designated Agency that provides Developmental Disability Services.”

Virginia

Do you cover autism services on State Plan Medicaid?

Yes. If you qualify for the state plan, services are covered for children up to age 22. If you do not, you can apply for a developmental disability waiver, which also covers services children with autism often require.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes, and only the income of the child is considered. We mentioned the developmental disability waiver above, but whichever waiver program your child qualified under, they will still be eligible to receive services related to autism as long as they are under age 22.

Virginia has also passed legislation requiring insurers to cover these services. That means you may not need to apply to Medicaid if you have a private policy.

Does severity of the disability matter?

Severity only matters if you need a waiver to qualify. You can view the qualifying evaluation rubric here.

Severity also matters because the state of Virginia prioritizes its waitlist. Severity may relate to your child’s abilities, but it may also relate to the severity of the living situation. You can view the various levels of prioritization here.

How can I apply for Medicaid in Virginia?

Locate and get in touch with your local Community Service Board or Behavioral Health Authority.

Washington (State)

Are autism services covered by State Plan Medicaid?

“Yes,” says Amy Huntley, Family Services Director of Washington Autism Advocacy. “Medically necessary, evidence-based services are covered under Medicaid.”

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“Yes,” says Huntley. “Waiver services come through Department of Developmental Disabilities (DDA). Children birth-three can be eligible for DDA with a developmental delay. After they are older, an ASD diagnosis is required, and they have an intellectual delay to qualify.”

Does severity of the disability matter?

Yes. To qualify for a waiver your child must have an IQ of 69 or lower. A professional must also have diagnosed a delay in one of these areas before age 3 if your child is qualifying on the basis of autism:

  • Social skills
  • Language
  • Communication skills
  • Symbolic/Imaginative Play

How can I apply for Medicaid in Washington?

You can apply for the State Plan here. If you are applying for a waiver, you can access eligibility forms here.

Washington, D.C.

Are autism services covered on “State” Plan Medicaid?

“When deemed medically necessary for a child,” says Melanie Williamson of the District of Columbia Department of Health Care Finance, “DC Medicaid covers autism services under its EPSDT services benefit–the pediatric component of the Medicaid program for all children under 21 who are enrolled in the managed care or fee for service delivery systems.”

Does coverage include ABA?

Yes, as long as it is deemed medically necessary.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. If your child could be put in an intermediate care facility or requires even greater care, they are eligible under the TEFRA/Katie Beckett program. This program gives your child access to all of the same coverage as any other child on Medicaid.

Does severity of the disability matter?

Severity only matters if you need to qualify under the TEFRA/Katie Beckett program.

How can I apply for Medicaid in Washington, D.C.?

You can find the process for the TEFRA/Katie Beckett program here. To find out if you qualify without the special program, check income limits at the bottom of this page.

West Virginia

Are autism services covered on State Plan Medicaid?

Under West Virginia’s Intellectual/Development Disability Program, services commonly required for children with autism are covered. These include behavior management services, speech therapy, occupational therapy, physical therapy, dietary therapy, respite care and more. The inclusion of a wide variety of services is impressive.

Does coverage include ABA?

If you qualify for the state Medicaid plan without a waiver, ABA is a covered service.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. The Intellectual/Developmental Disability program (IDDW,) referenced above, only looks at the applicant’s income for eligibility purposes. In this case, the applicant will be your child so they are unlikely to have income that will disqualify them.

Individuals with autism may also qualify under the Aged and Disabled Waiver or the Traumatic Brain Injury Waiver. “There may be individuals with autism on any of these,” reports Kim O’Brien, Executive Assistant at the Bureau for Medical Services, “but most utilize the IDDW.”

Does severity of the disability matter?

Yes. A state-appointed psychiatrist must certify that your child has “substantial deficits” in at least three of these areas:

  • Self-care
  • Receptive/expressive language
  • Functional academics
  • Mobility
  • Self-direction
  • Capacity for Independent Living

How can I apply for Medicaid in West Virginia?

The West Virginia Bureau for Medical Services site provides information for applying for State Plan Medicaid and the IDDW.

Wisconsin

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

Yes. Children who do not qualify because of family income may qualify for Medicaid under the Katie Beckett program. These children will have full access to autism-related services.

Children who do not qualify for the Katie Beckett program may qualify for the Children’s Long-Term Support (CLTS) waiver. However, behavioral services have recently been removed from the waiver program as Wisconsin started covering these services under state plan Medicaid. If your child qualifies for this program, they will still receive benefits listed in this document—except for the recently removed behavioral health service.

Does severity of the disability matter?

Yes. Under the Katie Beckett program, children must require a level of care that is traditionally met in nursing home or hospital.

Under the CLTS waiver, children must meet at least the level of care that has traditionally been met by intermediate care facilities.

State Plan Medicaid only has income restrictions. Severity of disability does not matter for those eligible.

How can I apply for Medicaid in Wisconsin?

You can apply and learn more about the process for each program using the links below.

Wyoming

Are autism services covered by State Plan Medicaid?

Yes.

Does coverage include ABA?

Yes.

Is there a program that allows for coverage even if income exceeds eligibility limits?

“The Children’s Mental Health Waiver will cover high-functioning children with autism,” says Brenda Stout, Medicaid Behavioral Health Manager at the Wyoming Department of Health.

“Sometimes children are referred to the Comprehensive or Support Services Waiver [program] depending on the level of care needed. Children’s Special Health covers children with autism, but it is limited to medical services–they don’t cover the therapy.”

Does severity of the disability matter?

Yes. Your child’s required level of care will determine which waiver is most suitable for application, and if your child end up qualifying for it.

How can I apply for Medicaid in Wyoming?

You can apply for the State Plan here, and find more information about the waiver application process here.

 

 

 

*Intensive research was performed for each state program. The majority of states had a governmental agency or independent advocacy group provide information regarding their programs. While all states received an inquiry, those with an asterisk did not furnish any additional comment or information.

 

This information is accurate to the best of our research as of April 24, 2017. It will be reviewed and updated annually.

Frugal Ways to Teach Your Children Literacy

Number one is such an awesome freebie! Can't wait to implement these five frugal ways to teach literacy.

Literacy–and education in general–is very important in our house. We’ve been reading books to our kids since before they could sit up. We’ve been encouraging them to practice writing their letters since before preschool.

And it’s paid off. My kids can now either read or sound out words, depending on the child and their age. It’s an amazing thing to watch. One moment you have this tiny little baby who can’t do anything for themselves, and a few short years later they have the skills they need to consume any bit of knowledge they seek after. I’m simultaneously proud and awestruck.

Along the way, we’ve used some tools that have been super helpful. They just happen to be pretty darn frugal, too.

ABCmouse

ABCmouse.com has been one of our favorites since toddlerhood. It’s a curriculum disguised as a computer game, built by educators. The kiddos actually beg me to play it.

Not only has it been a huge help in teaching them how to read, but it’s also been great for teaching them computer literacy. A year-long subscription is affordable as far as I’m concerned, but you can check and see if it’s a good match for your kids by trying it for free for 30 days.

Super Why

Super Why: Puppy PowerTrue story: sometimes our kids watch TV. We noticed that after they started watching Super Why their interest in reading in general skyrocketed. It’s not like they weren’t interested at all before, but they started working harder at things like writing their letters and learning what the heck a “rhyming word” was.

We did this for $0 through Netflix, but the program will likely get rotated out eventually. You can also find episodes at Barnes & Noble.

Alphabet Magnets

Uppercase and Lowercase Magnetic LettersBefore they could write, we would practice “writing” their names on the fridge with their alphabet magnets. As they got older, we started using them to sound out words. Today, we’re using them to sort out when to use a capital and when to use the lowercase.

We got ours for free at the library, but you can find an affordable set via Discount School Supply.

Magnetic Doodle Board

The Doodle Pro SlimOur magnetic doodle board was the number one thing that encouraged our kids to work on their fine motor skills–which enabled them to write letters. While we’re definitely going to work on writing more legibly with lined paper, this device is what sparked interest at all.

Our first was a hand-me-down, and the second was a birthday gift. You easily find one for under $25, though, if you’re buying new.

The Library

Frugal tools to teach your kids literacy

The library, of course, has been our number one tool to teach our kids literacy. Every time they go, they have the freedom to pick out a book that meets their current interests. When they were younger, we did weekly story time. Every year, we participate in the summer reading program. As a reward, the library gives them a book to take home for keeps.

The best part of the library? It’s absolutely free, and odds are, there’s one near you.

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