Tag Archives: Autism

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.

How to Invest in ABLE Accounts

In honor of Autism Acceptance Month, Femme Frugality is running a series of Monday articles focusing on the triumphs and challenges those diagnosed with autism conquer as related to their finances and careers.

Joining us for the third post in our series is Tara Falcone, CFP®. Falcone is a CERTIFIED FINANCIAL PLANNER™, former Wall Street analyst, and founder of ReisUP LLC.

ReisUP is an early-stage financial services company dedicated to increasing investing education and access for everyday investors. Her mission is to empower people to “rise up” and play a more active role in achieving their financial goals. 

Totally sending this to my sister! How to invest in ABLE accounts.

A couple of weeks ago, we kicked off our Autism Acceptance Series by looking into a new financial vehicle: ABLE Accounts.

ABLE accounts allow individuals with disabilities, or their guardians, to stash away some money without having to worry about failing an asset test when they go to apply for state or federal benefits. These accounts can also be used to grow your savings tax free.

There are currently nineteen states that offer ABLE accounts. For simplicity’s sake, we’ll be looking at only Pennsylvania’s investment options today, though the same concepts can be applied in generality.

What are ABLE investment options?

The PA ABLE account has the following seven allocation options:

  • High-yield checking account
  • Conservative Investment Portfolio
  • Moderately Conservative Investment Portfolio
  • Moderate Investment Portfolio
  • Growth Investment Portfolio
  • Moderately Aggressive Investment Portfolio
  • Aggressive Investment Portfolio

“The Conservative and Moderately Conservative options invest 70-90% of their portfolios in cash and bonds, with the rest (10-30%) invested in a variety of stocks,” says Tara Falcone, CFP® of ReisUP LLC.

“The primary goal of these investment options is to preserve your principal, which is the money you deposit into your ABLE account, while offering limited to small returns on your investment. Small potential risk equates to small potential reward.

“The Moderate and Growth options’ portfolios are split roughly 50/50 between bonds and stocks. These investment strategies focus less on principal protection and more on generating a slightly higher return on the invested assets. Moderate potential risk means moderate potential reward.

“Finally, the Moderately Aggressive and Aggressive options are invested primarily in stocks (75-90%) with a small portion of the portfolios invested in bonds (10-25%). These options’ primary goal is to achieve the highest growth possible with little regard for principal preservation.”

Figure Out Why and How to Invest

Before making any investment, it’s important to identify why you’re investing, and what limitations your specific life situation may impose. Falcone advises looking at the following factors before choosing your allocation strategy.

Risk Tolerance

Investments are not stagnant. At times they’ll go up, and at others they’ll go down. Your risk tolerance is how much sleep you’ll lose over that fact.

“Generally, more conservative investment options are less volatile, meaning your account balance fluctuates less,” Falcone explains. “However, that also means it’s unlikely to grow as much since less risk yields less reward.”

“Meanwhile, aggressive options typically generate larger investment returns, but also subject your account balance to bigger positive and negative swings. This could put you at risk of not having sufficient funds to cover expenses when you need it.”

Time Horizon

How long can you let your money sit without touching it? That’s your time horizon.

“If a beneficiary needs to access a large portion of his or her ABLE account every year to pay for qualified expenses, a conservative investment strategy is likely more appropriate,” explains Falcone. “If someone in this situation were invested more aggressively, they may discover that their account balance has decreased in a market downturn, leaving them unable to pay for current expenses.”

If, however, you’re saving to provide for your child after you’re gone, you may have a longer investing horizon.

“Someone with a longer investing horizon who doesn’t need to withdraw a large portion of their account for five or more years may want to consider a moderate or aggressive option,” says Falcone.

“The larger growth potential inherent in these investment strategies could allow that person to take greater advantage of the tax-free growth nature of ABLE accounts. In this case, the beneficiary should consider reallocating to a more conservative strategy as the time when they will need to withdraw money from their account approaches.”

Savings Ability

“In theory,” Falcone continues, “the more someone can deposit into their ABLE account every year relative to their expected expenses, the more aggressive they can afford to be from an investment perspective.”

Check out this example with Ella and Ari:

This article is PACKED with helpful info for people deciding how to invest in their ABLE account for people with "disabilities."

 

Overall Goal

There are two basic reasons ABLE accounts are so attractive. The reason you were drawn to it probably says a lot about your overall goal.

Reason #1: Savings isn’t counted for asset tests.

If you’re applying for government benefits like Medicaid or SNAP, savings in your ABLE account will almost never count against you. This is important when you’re trying to build up savings for medical equipment, therapies, or even just a basic emergency fund that you will need in the near future. In these cases, Falcone notes that a conservative approach is probably the best fit.

Reason #2: You’re taking advantage of the tax-free growth.

If you’re saving for your child’s future but don’t have a large enough nest egg to justify a special needs trust, ABLE accounts are particularly attractive due to their tax-free growth. Falcone notes that any time you’re making a longer-term investment, you can afford to be more aggressive.

It is possible that you’re taking advantage of both perks. You’re saving large sums of money for a date far off in the future, but are only able to do so because that savings won’t count against you in an asset test. In these cases, Falcone says you can yet again afford to be more aggressive.

Risk Capacity

While risk tolerance is how you feel about the volatility of your investments, risk capacity looks at the risk you can take on from a concrete, objective perspective.

“Due to the assets test that owners/beneficiaries of ABLE accounts must pass in order to qualify for Medicaid and other social programs, risk capacity is arguably the most important factor to consider in these unique circumstances,” notes Falcone.

“Asset tests often prevent families with disabilities from building substantial emergency funds that could cover expenses temporarily should the ABLE account balance drop in a market downturn. Therefore, even though someone may be comfortable with more investment risk, he or she may not be able to afford being exposed to such risk due to lack of other cash sources.”

If you have friends and family who want to contribute, but you also want to extend your investment time horizon, you may want to direct them to specific bills that they can pay rather than making contributions to the ABLE account.

Falcone points out that this keeps your money in your account as a long-term investment while keeping it out of your regular checking account where it would be counted in an asset test.

How should I invest with my ABLE account?

Wondering what you should do in your specific situation? Below you’ll find Falcone’s recommendations for some common circumstances individuals or families may find themselves in.

While this advice speaks to generic situations, it’s always advisable to talk with a professional about your own, unique set of circumstances before making any investment.

High-Yield Checking Account

  • Someone with no risk tolerance. They are not willing to put any of their funds at risk to earn even a small return.
  • Someone who needs the ability to withdraw funds immediately. Otherwise, withdrawal proceeds can take 3-10 days to reach the beneficiary in Pennsylvania, per the Program Disclosure Statement.
  • Someone who is already the beneficiary of a special needs trust or has some other fund/account/support to help pay for future expenses. They don’t need the benefit of the tax-free growth nature of an ABLE account, but want to shelter more funds from the asset test.
  • A disabled adult with current cash need, desire to shelter some assets from the asset test, and/or desire for some financial independence to purchase/pay for things on their own.

Conservative Investment Portfolio

  • Someone with very low risk tolerance.
  • Someone with no or insufficient emergency fund (i.e. low risk capacity.)
  • Someone with potentially large unexpected expenses.
  • Someone with a present need for cash (i.e. short investing horizon of less than 2 to 5 years.)
  • Someone whose primary goal is to shelter funds from the asset test, not earn a substantial return on those funds.

Moderately Conservative Investment Portfolio

This investor will display similar criteria to Conservative, but is willing to give up some principal protection for slightly more current income.

Moderate Investment Portfolio

  • Someone with moderate risk tolerance and moderate risk capacity.
  • Someone with high risk tolerance and low risk capacity. They’re comfortable with volatility, but can’t necessarily afford to lose money in the short-to-medium term.
  • Someone with low risk tolerance but high risk capacity. They’re not as comfortable with investment volatility, but can afford to take on some risk to earn a potential return.
  • Someone with infrequent but potentially large unexpected expenses.
  • Someone with a medium-length investing horizon of 5 to 20 years–perhaps a parent saving for their child’s future expenses, including education.
  • Someone who wants their money to earn a slightly higher return.
  • Someone who has access to other cash sources or temporary support in the event of a market downturn.

Growth Investment Portfolio

Will display similar criteria to Moderate, but is willing to take on slightly more risk for slightly more capital appreciation potential.

Moderately Aggressive Investment Portfolio

  • Someone with a high risk tolerance.
  • Someone with a high risk capacity (i.e. sufficient emergency funds or other cash/support sources.)
  • Someone with a long investing horizon and desire to benefit most from ABLE’s tax-advantaged growth. This could be parents who want to set aside funds for their child’s future needs and want those funds to earn a substantial return.
  • Someone who already has a special needs trust or is seeking an alternative to a special needs trust. One example is parents with a young disabled child or young adult.
  • Someone who has a low savings capacity now, but a large future capital or income need. One group that may fit this profile is parents wanting to establish a fund to pay for their child’s needs upon their death.

Aggressive Investment Portfolio

These investors will display similar criteria to Moderately Aggressive, but to a larger extent for each point. Even more comfortable with risk, even longer investing horizon, even greater future income or capital need, even more sources of additional support, etc.

Evaluate, but don’t mix and match.

Falcone advises against investing in multiple different portfolios at one time.

“Allocate 100% of your account balance and future contributions to whichever investment option you choose,” she says. “Mixing them changes the overall allocation and therefore the resulting investment strategy. For example, allocating half of your account to the Conservative option and half to the Aggressive option results in a combined portfolio similar to the Moderate investment option.”

She says the only exception would be if you needed some cash on hand in the high-yield checking account, but wanted to invest the surplus.

Falcone leaves us with these final words of wisdom:

“No matter which option you choose, make sure to re-evaluate your choice every year and make appropriate adjustments if your circumstances and/or goals have changed.”

6 Autistic Women Who Are Changing the World

In honor of Autism Acceptance Month, Femme Frugality is running a series of Monday articles focusing on the triumphs and challenges those diagnosed with autism face as related to their finances and careers. Today’s post is the second in the series.

These women aren't successful in spite of their autism--they're successful because of it. 6 Autisitc Women Who Are Changing the World.

 

Neurodiversity is a beautiful thing. When we think differently from each other, we each have the opportunity to do good in our own unique way.

Today we’ll look at six autistic women who are forging their own paths. They’re creating meaningful art. They’re creating jobs. They’re creating a better world.

Dani Bowman

At just eleven years old, Dani Bowman established an animation company called DaniMation Entertainment. Today that company is not only going strong, but also employs others on the spectrum. By recognizing and utilizing the talent in her own community, she has assembled a team that’s produced award-winning animated shorts for five consecutive years.

On top of building a successful company and tapping into the immense talent pool within the autistic community, Bowman works to develop that talent pool further by running summer camps focused on animation and empowerment.

Morénike Giwa Onaiwu

Morénike Giwa Onaiwu has a long history of working in advocacy and empowerment movements. She started her career in the nonprofit sector, and has since served in a various volunteer capacities, including positions within the Division of AIDS at NIH.

Within the autism community, she serves as the Autism and Race Committee Chair for the Autism Women’s Network. As a black woman, her voice is much needed as an advocate who can speak personally to the bias-centric hurdles autistic women of color face on a daily basis.

Jen Saunders

In 2011, Jen Saunders started an extremely successful magazine called Wild Sister. Birthed out of a trying time in Saunders’ life, the aim of the publication is to empower women to pursue their dreams rather than become victims of their circumstance.

In 2015, she received a diagnosis of Asperger’s Syndrome. These late diagnoses are becoming more and more common for adult women as we understand and identify autism not as a institutional disease, but as a sign of neurodiversity.

Women are socialized differently than men in our culture, leading some to argue that the symptoms of autism are not as visible with them. This difference in socialization and cultural expectations either creates the illusion of or is compounded by the assumed fact that the occurrence of autism is lower in females than it is in males.

As we’ve gotten better at identifying autism in women, more are being diagnosed later in life. Saunders used her diagnosis as an opportunity to reach out to women with a similar life experience and founded the Autistic Women’s Collective–a global social network for women on the spectrum and parents of daughters on the spectrum.

Kim Miller

Many of the women on this list are on a point of the spectrum where their communication isn’t necessarily limited by their autism. But just because verbal expression is not your preferred modality doesn’t mean you can’t contribute to the world in meaningful ways.

Kim Miller is a living example of that. She was non-verbal as a child, but was able to express herself through art. She would draw pictures to communicate her wants and needs to her family, and her comprehension to teachers at school.

Today she uses art as a powerful form of self-expression. She, and many others on the spectrum, are visual learners. This lends itself to pictorial processing rather than thinking in a string of sentential lexemes.

Her art, which has been featured in many different publications, portrays a full and rich interpretation of the world. She’s earning through her talents, and at the same time making the world a more beautiful and understanding place.

Currently, you can purchase works which have not had their copyright purchased by outside publishers through the Kimpressions online storefront.

Amy Gravino

In the US, we have a lot of supports for children with autism. But when it comes time to transition to adulthood, many states don’t have the proper systems in place to continue this support.

One place where this evidences itself is in the college experience. Not only do the intense and new social situations tend to be more difficult to navigate when you have autism, but the workload combined with an inclination towards completing tasks immediately rather than pacing make the entire experience extremely anxiety-inducing for those on the spectrum.

In an effort to up student retention rates in the autistic community, Amy Gravino started A.S.C.O.T. Coaching, LLC. On the spectrum herself, she is uniquely qualified to guide and support students through the transition to college life with concrete skills and true empathy.

Temple Grandin

Most readers will be familiar with Temple Grandin. Her name is known for her work in autism advocacy, and for good reason. But prior to this effort, she revolutionized slaughterhouses.

Her keen attention to detail, heightened sensory sensitivities and empathic compassion towards animals enabled her to design systems that kept cattle calmer as they were literally being led to the slaughter, and gave them kinder deaths.

Not only have her designs made our systems more humane, but they’ve also saved a ton of money in a massive industry.

Autism Empowers

All of these women are changing the world, and they’re doing it as career women and entrepreneurs.

At this point, it’s easy and common to feel stirred to a point of inspirational pity.

Let’s not do the common thing. You’ll note that every single one of these women isn’t successful in spite of her autism. They’re each successful because of it.

That’s what Autism Acceptance Month is about. It’s not about wiping out neurodiversity by finding a cure in order to eradicate the challenges of autism. Those challenges, which are real and sometimes large, do need to be addressed. But to cure autism itself would also remove many of these important contributions to society.

Rather, this month is about celebrating those differences, and recognizing that we, as a society, are better because they exist.

ABLE Accounts for People with Autism

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.

Great way to save money with tax-free growth. ABLE Accounts for adults with autism or families with children with autism.

If you are on the autism spectrum, or your child is on the spectrum, it’s likely that you incur some costs that neurotypical people simply don’t. There may be therapies, adaptive equipment, nutritional supplements or even legal fees related to autism that end up in your budget.

Fortunately, in recent years these financial burdens have been acknowledged. With the passage of the ABLE Act, people with qualified “disabilities” or their guardians now have the ability to open an account built specifically to deal with these added expenses.

I was incredibly psyched when an advisor let me know Pennsylvania was rolling out theirs recently. Since PA is the state I’m most familiar with, the PA ABLE account will be the one we dissect today, but other states have similar options. You can view them at the end of this article.

What is an ABLE account?

An ABLE account is a tax-advantaged investment account. It serves as a way for those with “disabilities” to save for expenses related to their condition–in this case, autism. Families are also able to save for their minor children in this way, or through a power of attorney if their child is an adult in need of assistance.

It’s a 529 account, which means the money you put in there is invested. If you’re familiar with these accounts for college savings, it’s a very similar thing except the scope of qualified expenses extends beyond just post-secondary education.

ABLE accounts are also advantageous because they don’t count against many state or federal programs that require asset tests, allowing people on the spectrum to save for future costs without worrying about losing their healthcare or other necessities.

How do you qualify for an ABLE account?

If you live in Pennsylvania, you’ve likely gone through the rigamarole of applying for SSI so you can get on Medicaid. If your income is low enough, you get SSI payments. If it’s too high, you don’t get the SSI payments, but SSI confirms that you have a disability so you can get state-sponsored insurance.

If your autism has been confirmed by SSI, you qualify. Other ways you can qualify are through entitlement to SSDI or a signed confirmation of disability from a physician. They must also certify that you had autism before age 26, which shouldn’t be difficult.

Invest in an ABLE account for your child's autism expenses and watch your savings grow tax-free.

What is a qualified expense for an ABLE account?

In Pennsylvania, qualified expenses are any expense related to the “disability.” That includes:

  • Tuition for school–Pre-K through post-secondary
  • Books and other supplies related to education
  • Mass transit expenses
  • Purchase of a vehicle
  • Modification of a vehicle
  • Moving expenses
  • Job training
  • Expenses related to gaining/maintaining employment
  • Health expenses across the realms of mental, physical, vision and dental
  • Health insurance premiums
  • Durable medical equipment
  • Respite care
  • Therapies
  • Communication services/devices
  • Personal assistance
  • Nutrition management
  • Financial management
  • Legal fees
  • Funeral and burial expenses

In addition, you can use it for these housing-related expenses tax free, though withdrawing money for any of the below may impact your SSI benefits:

  • Primary residence expenses
  • Rent
  • Mortgage payments
  • Property taxes
  • Home improvements or modifications
  • Utilities

This is by no means an exhaustive list. You can use the money for anything related to the associated “disability,” and it doesn’t necessarily have to be deemed medically necessary. Just remember to keep good documentation about what you’ve spent the money on. If the IRS ever audits you, they’re going to want to see receipts.

Check out other qualified expenses under PA ABLE.

How much can I save in an ABLE account?

You can save $14,000 per year. If you have family or friends that want to contribute, their generosity counts towards that $14,000.

The max amount you can have in an ABLE account at any given time is $511,758 in the state of Pennsylvania. This max number will vary from state to state. If you are a parent or guardian who is saving for a child, once you reach this point you may want to talk to a professional about a trust or even a special needs trust.

What are the tax advantages of saving in an ABLE account?

You contribute money after you’ve already paid taxes, so contributions won’t lower your AGI on your taxes. However, the money is allowed to grow tax-free, and as long as your withdrawals are made for qualified expenses, you won’t have to pay taxes when you take the money out.

If you spend the money on an unqualified expense, though, you will be hit with a penalty.

You don’t necessarily have to live in a state to purchase its plan. For example, PA ABLE is available to people in all 50 states–not just Pennsylvania. On this particular plan, you might end up paying state taxes on your gains if you’re from out of state. Pennsylvania residents are exempt, and also won’t pay state taxes upon a qualified withdrawal.

Pennsylvania residents also benefit from exemption from the PA inheritance tax. Check with your state to see what benefits may be available.

Stop worry about asset tests and start building savings with an ABLE account.

Will an ABLE account mess up my state or federal benefits?

ABLE accounts are not considered for SNAP benefits or any other federally-distributed benefits with means-based tests, save for SSI.

Typically, SSI limits your assets to $2,000, but ABLE accounts are a little different. They won’t count the first $100,000 in your ABLE account against you for SSI qualification or the determination of your dollar-amount benefits.

Separately, the state of Pennsylvania has passed legislation that prohibits your ABLE balance from being used in any asset tests related to health or disability. They’re also not allowed to use it for SNAP per the USDA’s issued guidelines.

What about financial aid for college?

In the state of Pennsylvania, PA ABLE savings will not count on applications for state-based financial aid.

Because ABLE accounts are not supposed to be counted on federal means-based tests, the general assumption is that these savings should not be included on the FAFSA. However, as far as can be told the US Department of Education has not issued any guidance on this to date. You may want to call the Federal Student Aid Information Center to get the most up-to-date information.

Do not count ABLE savings on other children’s FAFSA applications.

What are the fees?

You can avoid all administrative fees by getting your documents delivered electronically. Investment fees are between 0.34% and 0.38% depending on which option you pick.

Picking an option–from conservative to agressive–is something we’ll be tackling in a future post. Saving for college with a 529 is one thing, but saving for expenses related to autism that come up as a part of your daily life is quite another all together.

Rent isn’t something you’ll be paying in 30 years–it’s something that’s due now. If you need an iPad to communicate,  you’re not going to wait for 15 years of appreciation on your investment before you start to exchange information with the world.

But that isn’t to say the most conservative option is the best choice each and every time. It’s complex, and something we brought an expert in to cover.

functional fashion modern frugal mom

Are ABLE accounts worth it?

While the fees may not be the lowest, the account is tax-advantaged and allows you to use your money before retirement age. It also allows you to save for future expenses without disqualifying yourself from certain federal and state means-tested benefits.

If you’re a parent, you may not be sure if your child will go to college or not. An ABLE account gives them the flexibility to pursue whatever occupational or educational path they want and are able to when they get to that point in their life.

Or, if you come up against a financial emergency between now and then because of your child’s medical, communication or educational needs, you have the money there to save you from financial distress while still providing the best for your kid.

Overall, it’s a much-needed solution that many individuals and families will be able to use to their advantage. With so many frustrating lines of red tape around every corner, it’s good to see that this issue is getting some recognition and legislation.

Other states with ABLE accounts

Note that not all state plans are created equally. Don’t pick a plan simply because it is based in your state or think that because your state doesn’t offer a plan, you’re not eligible. Fees, residency requirements and state tax advantages are all going to vary. Do further research before opening any financial account.

Related Posts Plugin for WordPress, Blogger...