Medicaid 101: A Guide for People With Disabilities and Families

Medicaid is a health insurance program for many people with low incomes and people with disabilities.

For many people with disabilities, Medicaid is more than just health insurance. It can also help pay for services that support independence, such as personal care, employment supports, and assistive technology.

Millions of people across the United States use Medicaid to get healthcare and disability services.

What Is Medicaid?

Medicaid is funded and run by both the federal government and state governments. The federal government sets basic rules and helps pay for some of the program. States also help pay for Medicaid and make more decisions about:

  • Who can get Medicaid in their state
  • Which services are covered
  • How and where people can receive care

Because of this, Medicaid can look different from one state to another. Services, rules about who can get Medicaid, and the application process may be different depending on where you live.

Medicaid rules can also change over time. These changes may affect who can get Medicaid, what services they can get, and what information people need to share with Medicaid.

Learn how The Arc is working to protect Medicaid for people with disabilities.

Who Can Get Medicaid?

Medicaid is available to many people, including:

  • People and families with low incomes
  • People with disabilities
  • Children with disabilities or special healthcare needs
  • Some adults with low incomes, depending on their state’s rules

Some people qualify automatically for Medicaid. For example, in many states, people who receive Supplemental Security Income (SSI) also get Medicaid. Other people may need to apply and show that they meet their state’s rules about who can get Medicaid.

What Does Medicaid Cover?

What Medicaid covers changes by state, but Medicaid often pays for:

  • Doctor visits
  • Hospital care
  • Prescription medications
  • Mental health services
  • School-based therapies
  • Medical equipment
  • Long-term services and supports for people with disabilities
  • Home and community-based services

Home and Community-Based Services

One of the most important Medicaid benefits for many people with disabilities is home and community-based services (HCBS), which help people live and take part in their communities.

HCBS help people live in their homes instead of institutions or nursing facilities.

These services may include:

  • Help with bathing, dressing, or eating
  • Help preparing meals or managing medications
  • Transportation to work or other activities
  • Supported employment services
  • Day programs
  • Assistive technology
  • Home modifications, like ramps or grab bars

Some HCBS programs have waiting lists, so it is often best to apply as soon as possible and keep your contact information up to date.

Medicaid for Children With Disabilities

Medicaid also helps children get the care they need to grow, learn, and stay healthy.

Children may be able to receive:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Behavioral health services
  • Medical equipment and supplies
  • Other medically necessary services

Medicaid and Medicare: What’s the Difference?

People often confuse Medicaid and Medicare, but they are different programs.

Medicare:

  • Is usually for people age 65 or older
  • Also covers some younger people with disabilities
  • Is not based on income

Medicaid:

  • Is based on income and other eligibility rules
  • Covers many disability-related services and supports
  • May cover services that Medicare doesn’t cover, including many HCBS

Some people qualify for both Medicaid and Medicare.

How Do I Apply for Medicaid?

You can apply for Medicaid at any time of the year.

You can apply through:

  • Your state Medicaid agency
  • Healthcare.gov (in many states)

You may need:

  • Proof of your identity
  • Proof of your income
  • Information about your disability (if you have one)
  • Proof of where you live

If your application is denied, you have the right to appeal. An advocate or legal services organization may be able to help you.

How Do I Keep My Medicaid Coverage?

To avoid losing Medicaid:

  • Keep your contact information up to date with Medicaid
  • Open and read all mail from Medicaid
  • Check your email and text messages for updates
  • Complete renewal forms on time

If you move to another state, you must apply for Medicaid in your new state. Medicaid coverage does not automatically move with you.

Many people with disabilities can work and still keep Medicaid coverage. Some states offer special Medicaid Buy-In programs for workers with disabilities. Learn about new Medicaid work rules.

If you have private insurance or Medicare, Medicaid may help cover additional healthcare costs and services.

Where Can I Get Help With Medicaid?