Tag: medicaid

 Open Enrollment for Medicaid and Medicare Dual Eligibility 

Posted on by Nicol Walsh

Brief Overview  

  • Open enrollment ends January 15th, 2025.  
  • Go to healthcare.gov to get assistance if during the Covid Medicaid unwinding your coverage was dropped.  
  • If you are an immigrant or a part of the DACA program, a portal is now  available at Washington HealthPlan Finder to help with connecting you to coverage through a dedicated line in the Washington Health Plan Finder Immigrant Portal. 

Full Article  

Open enrollment for Medicaid and Medicare starts on November 1st, 2024 and ends on January 15th, 2025. The annual opportunity to sign up, renew, or change coverage to best suit your family’s situation. Washington Health Plan Finder has step-by-step instructions for applying and navigators to help with the application process. Help is available for those who are having trouble navigating the health insurance landscape. 

Medicaid, also known as Apple Health, is run by the state and can be accessed through the Washington Health Plan Finder.  Open Enrollment is the time for those enrolled in Medicaid to review your eligibility and renew your plan. To find out if you or a family member is eligible for Medicaid primarily based on income and age, visit the Apple Health Eligibility page.  For those enrolled in Medicaid Classic, go to Washington Health Plan Finder to renew coverage. Go to healthcare.gov to get assistance if your enrollment coverage was dropped during the unwinding from Covid. Many experienced challenges during this shift period, and healthcare.gov can support fixing any issues that may have occurred. 

If you are an immigrant or a part of the DACA program, using a dedicated  Immigrant portal in the Washington Health Plan Finder will connect you to coverage.  

 ¡Seguro médico para todos! 

Todos los habitantes del estado de Washington pueden contratar seguros médicos y dentales por medio de Washington Healthplanfinder™, sin importar su situación migratoria. 

If you have questions about the new ruling for those in DACA please download the PDF healthcare.gov  with this article that gives the full information available about the new ruling concerning DACA coverage. 

For individuals under 65 with disabilities, eligibility for Medicare A and B is completed automatically, and they will be enrolled after two years on SSI disability. However, the Open Enrollment period can be used to change coverage. Special circumstances will allow individuals to sign up for Medicaid or Medicare at other times of the year, but it is safest to do it now before the end of open enrollment. If you are an individual on SSI with Classic Medicaid and a Parent or guardian passes away you can become eligible for Dual Enrollment or DAC in Medicare A and B as well. 

Coverage options have grown in the marketplace over the last few years, especially for those who are just over the cap for Medicaid coverage. With options like the Cascade Care Savings Plan tool, finding options to fit budgets and healthcare needs is a little easier. ParentHelp123/HelpMeGrow Washington also has navigator support for finding coverage and other supports to help your family. Although choosing a plan can be daunting, the new tools and navigators have come a long way in helping choose new or updating an existing plan. 

Resources 

Washington State Health Care Authority 

626 8th Ave.  SE 

Olympia, WA 98501 

(844) 461- 4436 

www.hca.wa.gov 

Washington Health Plan Finder 

www.wahealthplanfinder.org 

Key search words: apple health, Medicaid renewal, Medicaid, renew coverage, immigrant, open enrollment 

Medicare 

www.medicare.gov 

Help Me Grow Washington 

www.resources.helpmegrowwa.org 

School Services That Can Be Billed to Medicaid

Posted on by Nicol Walsh

Brief Overview:

  • This information is good to know for families of students with Individualized Education Programs (IEPs) and Individualized Family Service Plans (IFSP) when those students have Apple Health (Medicaid/CHIP) for their health insurance.
  • Schools can bill Medicaid for many common IEP and IFSP services. When schools do this, they don’t have to spend special education funds on these services and can use that money to pay for other special education needs.
  • Medicaid billing can be complicated and difficult, and not all schools in WA State do it.
  • Parents can advocate for their student’s school to join the WA State Health Care Authority School-Based Services Program to bill Medicaid and free up money in the special education budget. Parents and caregivers can learn to advocate and resources for that are listed in the article.

Full Article

Individualized services that children receive through their IEP or IFSP may be covered by Medicaid. Medicaid will pay for health-related services in an Individual Education Program (IEP) or Individual Family Service Plan (IFSP) if they are already Medicaid-covered services, if the student qualifies for Medicaid for health insurance.

The Individuals with Disabilities Education Act (IDEA) requires that Medicaid be the primary payer to schools and providers of services included in an IEP or IFSP. (This means that if a school doesn’t use special education funds to pay for these services, Medicaid should be billed before any other insurance or individual.)

Which individualized services will Medicaid pay for?

  • An evaluation to see if a student is eligible for special education (if the student is found eligible)
  • Re-evaluations for special education
  • Nursing/health services
  • Physical Therapy
  • Occupational Therapy
  • Speech Pathology/Audiology
  • Mental Health Care
  • Other health services that schools provide, and Medicaid covers, as long as it’s included in an IEP or IFSP

Will Medicaid pay for services in a 504 plan?

If a student with a 504 plan needs medical services as part of their plan to receive a Free Appropriate Public Education (FAPE), Medicaid will not be the primary payer—but after a school bills any other potential payers (such as private health insurance), a school can bill Medicaid for any remaining costs.

If your student has Medicaid (Apple Health) or CHIP for health insurance, school health services like mental health care, substance use disorder services and monitoring medication can be covered by Medicaid, even if they are not included in a student’s IEP, IFSP, or 504 plan.

If a Local Education Agency (LEA, or school district) runs early childhood programs like Early Head Start, Head Start, or school-based preschool, schools can bill Medicaid for Medicaid-eligible Early and Periodic Screening, Diagnostic and Treatment benefits (EPSDT), even if they are not in a child’s IFSP. This ensures that children in these programs get these essential screening and well-child services.

Why is billing Medicaid important?

When Medicaid pays for services, schools do not have to use special education dollars for those services. Instead, special education dollars can be used for expenses like hiring adequate support staff, adaptive or communication technology, durable mobility supports, and enhanced accessibility supports for inclusive student activities.

How do schools get Medicaid to pay for these services?

Washington State public school districts, educational service districts (ESDs), public charter schools, and tribal schools are all eligible to participate in the School Based Health Services program at Washington State’s Health Care Authority (HCA).

Each school district that wants to bill Medicaid signs a contract with the state Medicaid agency and the Health Care Authority. School districts submit their costs for Medicaid-covered services to the state’s Health Care Authority (HCA), which reimburses their costs while billing Medicaid for those services. School or district staff are responsible to fill out the Medicaid claim forms with the proper billing codes. Staff need to take specific training to do this.

Some schools decide not to bill Medicaid and use special education funds for these services. Why?

Unlike healthcare providers, schools are not set up to bill programs like Medicaid. The billing process can be complicated and time-consuming (for example, the billing guide that HCA provides to schools who want to bill Medicaid is 57 pages long).

In 2023, a new federal law (the Bipartisan Safer Communities Act) required Medicaidto make the billing process easier for schools; in May 2023, the Centers for Medicare and Medicaid Services (CMS) announced new guidance on this topic, which was sent to all states.

The Network for Public Health Law says the law made “important and substantial changes to reimbursement for school-based Medicaid services”. The law requires updates to outdated Medicaid billing guides and gives more help to states and local education agencies (LEAs, or school districts) who want Medicaid to reimburse them for school-based healthcare services. The law also made grants available to states to “implement, enhance or expand school-based programs” for healthcare (HHS) and for programs run by the Department of Education.

One purpose of the new law was to make billing Medicaid simpler and less expensive for schools. A second purpose was to encourage states to allow schools to use Medicaid for more types of healthcare services. The law also provides grants and other funding for mental health services for students.

As of July 2024, the Health Care Authority is still examining the new guidance to see if they want to make changes to the School-Based Health Care Services program.

Parents may think it makes sense to use Medicaid funds rather than special education funds for IEP/IFSP services. This chart from the Health Care Authority lists the schools and districts who have contracted with HCA and get Medicaid reimbursement for school-based health services. (current as of June 2024).

If a school or district is not listed, what are some ways parents can advocate for a school to start billing Medicaid?

  • Ask the school principal or superintendent about the reasons for not billing Medicaid. Ask what would need to change for the district to start Medicaid billing. This information is useful for gathering support from other parents and school personnel, and for getting policymakers to make the change.
  • There are national and statewide organizations that want to expand the use of Medicaid to pay for school-based services for all Medicaid-eligible students, not only students with IFSPs/IEPs. Parents may wish to visit their websites, learn about what they want to change, and contact these organizations for information about advocacy and organizing other parents around this topic.
  • District-wide decisions and policies are often made locally by a district’s administration team, the School Board, or both together. Contact information for district administration will be on the district’s website (and possibly on the school’s website). Contact information for school boards is usually available on a town or city government’s website, and sometimes on the district’s website.
  • Does the school or district have a Special Education PTA? If so, this group of parents and educators may be a good way to find other people interested in this topic. If not, a school’s Parent Teacher Organization (PTO) is also a useful resource. List of WA State Special Education PTAs.
  • When parent advocate groups ask for change, it can be very helpful to offer assistance to help make their request a reality. Can parent volunteers be used in any way to make the change easier? What other creative assistance might be helpful? Discussions with district administration and school boards about “why this won’t work” will let you know where and what type of help is needed.
  • Many organizations which support families, including families whose child or children have disabilities can offer advice or training for parents who want to advocate about the need for services in schools. This list is a starting point—you may find other groups or organizations which are not on the list.

Apple Health for Kids: Medicaid and Children’s Health Insurance Program (CHiP) in Washington State

Posted on by Nicol Walsh

Overview

  • In Washington State, Medicaid, which includes the Children’s Health Insurance Program (CHiP) is called Apple Health. Medicaid and CHIP are medical insurance programs run by the state and funded by the federal government and the state.
  • Children can get free or low-cost health insurance from birth to age 19.
  • A child’s eligibility is based on living in Washington State, and the family level of income. Immigration status does not apply to Apple Health for Kids, and family information will not be shared with immigration officials.
  • There are links in this article to information on Apple Health insurance coverage for parents and caretakers, pregnant individuals, young adults, and children in foster care or who have been in foster care.

Where to apply or find more information about Apple Health for Kids:

Full Article

In Washington State, Medicaid, which includes the Children’s Health Insurance Program (CHiP) is called Apple Health. Medicaid and CHIP are medical insurance programs run by the state and funded by the federal government and the state.

The state agency that runs Apple Health programs is the Health Care Authority. This is the official website to get information about Apple Health programs. For some programs, such as Home and Community-Based Services Waivers (HCBS waivers) the Health Care Authority partners with the Department of Social and Health Services (DSHS). Find out more about HCBS waivers and similar programs at Informing Families.

Apple Health for Kids is free or low-cost health insurance for children from birth to age 19.

It covers the costs of medical, dental, vision (eye) care, hearing care, and behavioral (mental) health.

Medicaid programs, including CHiP, make sure that children get Early and Periodic Screening, Diagnostic, and Treatment services.

These services mean children get regular physical exams, are screened (checked) for any problems with physical and mental health, developmental delays, dental health, hearing, vision, and other tests to find any problems and treat them.

Are complex medical needs covered under Apple Health for Kids?

Yes, the Medically Intensive Children’s Program (MICP) is a Medicaid program for children who need a registered nurse to provide support.  Visit the MICP page at WA State’s Health Care Authority.

Who can get Apple Health for Kids?

  • The child must live in Washington State.
  • The family income must be below a certain amount. Based on the family income level, a child may qualify for either the free Apple Health for Kids (Medicaid), or for Apple Health for Kids with premiums (CHiP).

Important! Children and pregnant individuals may qualify for WA Apple Health coverage regardless of their immigration status.

Information from WashingtonLawHelp.org says:

“All children up to age 19 who have low income are eligible for free medical coverage (“Washington Apple Health”) in Washington State. There are no immigration status requirements for this coverage. Children from families with moderate income can also get coverage. They may have to pay a small monthly premium.

Your children may also be eligible for other programs, including Head Start and other education programs, school meals, and child nutrition programs

It’s generally very safe to apply.  State and federal laws protect the privacy of the information you put on your application. Your information should not be shared with immigration officials.

If you prefer, you can choose to apply for benefits for other family members, such as your children, and not for yourself. You won’t have to give information about your own immigration status, but you may have to give proof of your family’s income.”

Costs of Apple Health for Kids:

People on Apple Health (adults and children) do not pay cost-sharing, co-payments, or deductibles for any service.

There are three premium price levels for Apple Health for Kids:

  • Free (no monthly premiums)
  • Low monthly premium (payment to get the Apple Health Insurance plan)
  • Slightly higher monthly premium

Every year in April, WA State may adjust the amount of income a family can make to qualify for Apple Health for Kids. The premium amounts for Apple Health for Kids with premiums may also change. These changes take inflation and Apple Health program costs into account.

To check if  your family income meets the limits for Apple Health for Kids, go to the WA State Health Care Authority page for Children.

Exception: children of public and school employees who have access to, or are enrolled in health insurance coverage under PEBB or SEBB programs may be eligible for Apple Health for Kids with premiums.

Important to Know:

Apple Health for Kids includes “continuous coverage”. This means a child or youth can stay on Apple Health for Kids even if their family’s income goes above the Apple Health income limits during the continuous coverage period.

This rule applies to free Apple Health for Kids (Medicaid) and Apple Health for Kids with premiums (CHiP). The rule applies to both “with premium” plans.

  • For free Apple Health for Kids: Children birth to age 6 have continuous coverage from when they are enrolled until their 6th birthday.
  • For Apple Health for Kids with premiums, children from birth to age 6 have continuous coverage for 12 months at a time.
  • From age 6 to age 19, all three Apple Health for Kids programs have continuous coverage for 12 months at a time.  

If a child loses their coverage and needs to re-enroll, learn more on the HCA website or by emailing HCA at AskMAGI@hca.wa.gov.

Protections for children’s health insurance: New federal rules for Medicaid and CHiP

The new rules start as of June 1, 2024, but states have some time to make changes to their programs. WA State already follows these rules, but the new rules prevent WA State from doing any of these things in the future.

States will not be allowed to:

  • Require a waiting period before a child can be covered by Medicaid or CHiP health insurance
  • Stop a child’s Medicaid or CHiP health insurance if the family misses premium payments, during the continuous coverage period
  • Make a family pay back the unpaid premiums before a child can re-enroll after their continuous coverage period runs out, or charge an enrollment fee
  • States can’t put a dollar limit on benefits for CHiP. (Medicaid doesn’t allow dollar amount limits). Benefits can be limited in terms of what services are covered, or how often a service can be used. For instance, a state could decide CHiP will only cover a total of 12 visits for physical therapy in one benefit year

Health Coverage for Teens and Young Adults

Teens under age 18 who want or need to get health care coverage without their parents may be eligible for Apple Health under one or more of these conditions:

  • Live separately from parents or guardians and are not claimed by them as a tax dependent
  • Are pregnant
  • Need birth control or STI (sexually transmitted infection) care

To apply, follow these instructions on the Fact Sheet for Apple Health Teen Application Process.

Young adults aged 19 and up may be eligible for Apple Health if they meet income guidelines or have been in foster care. Apply online at Washington Healthplanfinder.

Other WA State Medicaid programs that may help people who care for children, or who are pregnant:

Parents and Caretakers

Pregnant Individuals

Foster Care

Resources:

The Family to Family Health Information Center (F2FHIC)

Helpline at PAVE

Informing Families

Medicaid Basics (article from PAVE)

WashingtonLawHelp.org

Washington State Health Care Authority

Washington State Healthplanfinder

WithinReach

Changes to improve monitoring for quality and improve oversight of HCBS Waiver Programs

New rules

The new rules will apply to § 1915(c) HCBS waivers and §§ 1915(i) state plan services, (j) personal assistance services, and (k) Community First Choice. The new rules will also apply under § 1115 demonstration projects unless specifically waived, and under FFS and managed care delivery systems.

  • Update functional assessments and person-centered plans at least once every 12 months;
  • Establish grievance procedures for Medicaid beneficiaries receiving certain HCBS services in FFS (there are already grievance procedures applicable to managed care);
  • Establish an incident management system to identify, investigate, and resolve critical incidents, including reports of abuse, neglect, and financial exploitation;
  • Provide assurances that payment rates are adequate to ensure a sufficient direct care workforce;
  • Collect and report data to monitor access (e.g., waiting lists, average amount of time between approval for and delivery of HCBS services, percent of authorized hours provided); and
  • Report on core measures in the HCBS Quality Measure Set.

Medicaid Basics

Posted on by Nicol Walsh

A Brief Overview 

  • Medicaid is state-run health care for those with limited income or individuals with chronic or complex health care needs with special circumstances. 
  • Medicaid is available to many families In Washington state who are not eligible for Medicare and are below certain income levels. 
  • Apple Health for children has broader eligibility requirements, meaning that more children in Washington state can be covered for low or no cost. 
  • You can apply for Medicaid through the Washington Health Plan Finder. 
     

Full Article 

Medicaid is a federal health care program that each state manages based on their own states legislative system. It is set up for individuals and families with limited income or special circumstances such as a genetic, medical, or job or accident-related disability. This health care covers physical and mental health and can be low to no-cost. To be eligible for fully subsidized (free) Medicaid you must meet the household income eligibility and not be eligible for Medicare. However, Medicaid for those with Medicare can help with some expenses not covered by Medicare for those with low income. It is available for an individual on classic Medicaid whose parent or guardian has died and whose benefits pass to their child. In the state of Washington, Medicaid is generally known as Apple Health and is administered by the Health Care Authority. 

There are two main types of Medicaid available in the state of Washington: Apple Health (income based), and Classic Medicaid. The day-to-day administration of Apple Health and Classic Medicaid is run by one of five Managed Care Organizations, or MCOs. Apple Health covers individuals up to the age of 6 and eligibility is based on household income. Apple Health has higher income limits for children than adults, meaning that many children in Washington State are eligible for free Apple Health, even when their parents or guardians are not..  If you have Apple Health, you will get healthcare from the providers at one of those MCOs. If you are found (determined) to have a disability or a disabling medical condition and are under the age of 65, you are eligible for Classic Medicaid if you are on Social Security Income or Supplemental Security Income (SSI). This is also considered Apple Health and under one of the 5 MCOs. If an infant, child, or youth through age 21 is in the foster care system they will be covered by Apple Health and will get their healthcare from one specific MCO no matter where they live in the state. 

Determining Eligibility for Apple Health 

Apple Health has different eligibility requirements for children and adults. These differences are listed below, including the maximum monthly household income requirements that families may have to obtain coverage. 

Eligibility for Apple Health for Children: 

  • Children of public employees with access to health insurance coverage under the PEBB or SEBB programs are not eligible for Apple Health for Kids with premiums. 
  • Low-cost coverage (Apple Health with premiums) is only available to children who are uninsured when household income is too high to qualify for free Apple Health (no premiums) 
  • Income requirements for free coverage: (2024) 
 Single Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Kids $2613 monthly $3534 monthly $4455 monthly $5375 monthly $6296 monthly $7217 monthly $8138 monthly 
  • Income requirements for Tier I subsidized coverage ($20 monthly per child; $40 family maximum): 
 Single Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Kids Tier I $3220 monthly $4355 monthly $5490 monthly $6625 monthly $7761 monthly $8896 monthly $10031 monthly 
  • Income requirements for Tier II subsidized coverage ($30 monthly per child; $60 family maximum): 
 Single Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Kids Tier II $3852 monthly $5210 monthly $6568 monthly $7925 monthly $9283 monthly $10641 monthly $11999 monthly 

Eligibility for Apple Health for Adults: 

  • For those aged 19 through 64. 
  • For U.S. citizens or those who meet Medicaid immigration requirements. (Including Washington residents from the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia) 
  • For those who are not entitled to Medicare.  
  • Have annual household income at or below the Medicaid standard: 
 Single Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Adults $1677 monthly $2268 monthly $2868 monthly $3450 monthly $4042 monthly $4633 monthly $5224 monthly 

How to Apply 

There are a couple of ways to start the process of getting Medicaid or other subsidized health care plans. The Health Insurance Marketplace Calculator provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges or “Marketplaces.” The Washington Health Benefit Exchange can help families and individuals find subsidized health care in their area.  

When ready to apply for coverage from Apple Health: 

  1. Review adult and/or child income eligibility requirements. 
  1. Read the Eligibility Overview to determine if Apple Health is the best fit for you and your family. 
  1. Create an account on Washington Health Plan Finder. 
  1. Collect and enter information into the Washington Health Plan Finder application, WAPlanfinder Mobile App, downloadable paper form, or call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633. 
  1. Review the five Integrated Health Care Plans responsible for Medicaid in Washington, not all of which may be available in your location. 
  1. If you need further help, contact a free Health Plan Navigator. 

To get signed up with Medicaid Classic, go online to Washington Connection and select “Apply Now,” or call 1-877-501-2233. For additional help signing up for Medicaid in Washington, help is available from Parent help 123, which can be contacted at 1-800-322-2588, or PAVE. If, in looking at the information above, you feel that you or the person you care for has lost Medicaid through a mistake or a problem with the system and going through the Washington Connection is not resolving the issue, the Federal Government is asking that you go through Healthcare.gov to get help with re-enrollment.  

Medicaid Waiver Benefits for Military Families 

Posted on by Barb Koumjian

When considering medical benefits for family members with special needs, military families often overlook Medicaid, a health benefits program established by federal law. Medicaid covers basic and long-term health care services for eligible children, pregnant women, parents with dependent children, adults aged 65 or older, and individuals with disabilities.

Eligible dependents of military families can benefit from BOTH TRICARE and Medicaid. Since TRICARE and Medicaid are both entitlement programs established by federal law, Congress has established a hierarchy of benefits between the two programs so eligible military family members receive the maximum range of benefits.  When a military family member is dually enrolled in TRICARE and Medicaid, TRICARE is the primary payee and Medicaid covers remaining costs.

Medicaid’s financial eligibility is determined by low-income limits and the number of members in a family. The income limits and coverage vary by the State administering the Medicaid program.  In most states, a person who is eligible for Medicaid is automatically eligible for Social Security Income (SSI). In some states, the application for SSI includes Medicaid, while in others there is a separate application process. Learn more about SSI.   The Division of Disability Determination Services (DDDS) in Washington State is responsible for assessing blindness and disability for SSI and Medicaid eligibility.

State waiver programs vary in eligibility criteria and coverage. The federal Medicaid website contains information Medicaid programs in each state, as well as state waiver programs. Waivers allow the state to decide how to spend federal Medicaid funding. For more information about mandatory benefits states must provide under Medicaid, read this Military OneSource article.

In many states, there are waiting lists for Medicaid waiver programs, and it may take years for an applicant to begin receiving services under the waiver. However, waiting lists are not always first-come, first-served. They can be based on the type and severity of disability, or on availability of providers and services. Each state runs its own Medicaid program, and benefits do not automatically transfer from one state to the next. Military families must reapply to get benefits anytime they PCS to another state.

Recognizing the challenge this presents for highly mobile military families, 37 states have developed policies specific to military families. Military waiver benefits in most of these states, including Washington, allow active duty military families to enroll in a waiver program and remain on the waitlist in their state of legal residence if they move but plan to return to that state. In Florida, there is no waitlist for Medicaid waivers if the active duty military family member was receiving waiver services in the previous state. Families are responsible for keeping their Case Manager informed as to their current location. Changes in status must be reported promptly to the Case Manager. This Military OneSource article provides more information about how to access military waiver benefits. 

When a service member leaves the military and TRICARE benefits change, Medicaid can provide services similar to those of TRICARE Extended Care Health Option (ECHO). Apply for Medicaid benefits for your child in the state in which you will be living after retirement or separation and apply before any transitional period for medical benefits starts. This will help prevent or minimize gaps in services and supports for the military family member with special needs.

Contact your regional TRICARE contractor to answer questions about receiving Medicaid benefits while on TRICARE.

Additional Resources

Supplemental Security Income (SSI)

Posted on by Nicol Walsh

A Brief Overview

  • Supplemental Security Income (SSI) is a monthly financial payment made to persons meeting specific eligibility requirements defined by the Social Security Administration (SSA).
  • A person may be eligible for SSI if they are aged, blind or disabled; have limited income and resources; and are a citizen or resident of the United States.
  • SSI is different from Social Security Disability Insurance (SSDI), which is an insurance that workers earn by paying into taxes on their earnings.
  • There is a special rule that allows dependent children of military families serving on overseas assignments to begin or continue receiving SSI benefits while outside of the United States.

Full Article

What Is SSI?

Supplemental Security Income (SSI) is a monthly financial benefit from the Social Security Administration (SSA) to people with limited income and resources who are age 65 or older, blind or disabled.  Blind or disabled children, as well as adults, can get SSI.

Eligibility Requirements

To be eligible for SSI, a person must meet specific eligibility criteria, including:

  • SSA definitions of aged, blind, or disabled
  • Having limited income and resources
  • Citizenship or residency status

Aged Determination

A person who is 65 years of age or older may qualify for SSI as “aged” if they also meet the financial determination.

Blind or Disabled Determination

SSA defines “blind” as seeing at a level of 20/200 or less in the better eye with glasses or contacts, or having a limited field of vision that can only see things at within a 20-degree angle or less in the better eye.  A person with a visual impairment that does not meet the criteria for blindness may still qualify for SSI based on the disability.

An adult or child may qualify for SSI as “disabled” if they have a physical or mental impairment that can be medically diagnosed through clinical and laboratory diagnostic techniques for anatomical, physiological, and psychological irregularities. The condition must cause marked and severe functional limitations, including emotional or learning challenges, that have lasted or are supposed to last for at least 12 months without interruption.

A person aged 18 or older must qualify as an adult, which includes proving they are unable to do substantial gainful activity.  Two (2) months before a child receiving SSI benefits turns 18, SSA will conduct a disability redetermination to determine whether the child meets the adult criteria to continue receiving SSI payments.

Eligibility for disability is determined by a team that includes a disability examiner and a medical or psychological consultant at a state agency known as the Disability Determination Service (DDS).  The team will review medical and financial documents, and determine eligibility based on the documents provided or request more documents be provided.

It is necessary to complete both disability and financial determinations when assessing eligibility. This is because SSI eligibility determination may be used in other programs within your state. 

Limited Income and Resources

SSI is a needs-based program. In order to receive SSI, the applicant must have limited income and resources.

If the applicant has too much income, their application will be denied, and they will be ineligible for SSI payments. A child does not earn income so part of their parent’s income will be attributed to the child. Different sources of income are treated differently and some have greater exclusions than others. When an adult applies on behalf of a child, the parent or guardian’s income is considered “deemed” income to the child. SSA will prorate the adult’s income among the family members to determine the amount applicable to the child.

If you received SSI in another state, be aware that some states have a higher income limit that allows an individual to receive SSI benefits despite being over the federally established income limits. Washington is not a state with a higher income limit and applications submitted in Washington state must meet the federal income limits.

Resources include both money (e.g., cash, bank accounts, Certificates of Deposit, stocks and bonds, investment accounts, life insurance) and property (e.g. vehicles, houses, real estate) that could be sold or converted to cash to pay for food or shelter. There are limits for how much an applicant may have in resources and maintain eligibility for SSI:

  • An individual may have up to $2,000
  • A couple may have up to $3,000
  • When applying on behalf of a child, an adult may have an additional $2,000 in resources and a portion of the adult’s resources may be applied to the child

Some resources are excluded from the eligibility determination, including:

  • Your house and the property you live on
  • The first vehicle (per household)
  • Most personal and household belongings
  • Property that can’t be used or sold for income
  • Up to $100,000 saved in an ABLE account
  • Properly distributed funds from a special needs trust (SNT) on behalf of the individual with a disability

Citizenship or Residency Status

SSI is only available to U.S. citizens and nations residing in the United States or the Northern Mariana Islands, and qualifying non-citizens with certain alien classifications granted by the Department of Homeland Security (DHS).  SSI benefits will stop if a person leaves the U.S. for a full calendar month or at least thirty (30) consecutive days, with the exception of dependent children of active duty servicemembers serving overseas.

Is SSI The Same As SSDI?

Supplemental Security Income (SSI) is not the same thing as Social Security Disability Insurance (SSDI).  SSI is a needs-based public assistance program for children and adults. The eligibility criteria include limited income and resources. SSI payments come from the general funds of the U.S. Treasury from tax revenues.

SSDI is an insurance that workers earn by paying into the Social Security through taxes on their work earnings. It is not affected by income or resources. In order to receive SSDI, the person must have worked and paid from their earnings into the Social Security trust funds in the U.S. Treasury.

How Do I Apply For SSI?

Family to Family Health Information Center (F2FHIC), a program of PAVE, provides technical assistance, information, and training to families of children, youth, and adults with special healthcare needs. The F2F website contains invaluable information and resources to help family members, self-advocates, and professionals navigate complex health systems and public benefits, including SSI. After reviewing F2F’s article about how to apply for SSI, if you have questions and would like to speak with an F2F team member, please submit a Help Request.

Special Consideration For Military Families Overseas

A special rule allows dependent children of military families serving on overseas assignments to begin or continue receiving SSI benefits while outside of the United States. The child must be:

  • is a U.S. citizen
  • living with a parent who is a member of the U.S. Armed Forces assigned to permanent duty ashore outside the United States
  • listed in the Command sponsorship orders.

If the child is receiving SSI benefits before moving overseas with the active duty service member, the benefits will continue based on the rate of the state in which they applied. If the child is born overseas or becomes eligible for SSI while overseas, you can apply for SSI by contacting the Federal Benefits Unit at the nearest U.S. Embassy or Consular Office, or by applying online. For additional support with your application, call SSA at 1-800-772-1213 (TTY 1-800-325-0778).

Once the child turns 18, they will no longer be eligible for SSI until they have been living within the United States for thirty (30) consecutive days and will be subject to the disability redetermination process.

When relocating on military orders overseas, you must report:

  • the servicemember’s expected report date to the duty station overseas
  • the child’s expected date of arrival at the overseas location
  • the mailing address at your new duty station
  • changes in military allowances at your new duty station

Additional Resources

WISe Provides Team-Based Services for Washington Youth with Severe Behavioral Health Disorders

Posted on by Nicol Walsh

A Brief Overview

  • WISe behavioral healthcare teams serve children and youth 20 or younger whose conditions are too severe to benefit appropriately from regular visits to a community clinician and/or therapist.
  • To qualify for WISe, the young person must be eligible for Apple Health, which is the public health program for Washington State. WAC 182-505-0210 describes Apple Health eligibility standards.
  • WISe was created as a response to the T.R. et al. lawsuit, settled in 2013.
  • Different agencies manage WISe programs in various regions of the state. The Health Care Authority manages a downloadable list of WISe agencies, organized by county. Families can contact their area agency by calling the phone number on this referral list.
  • Read on for various places families might seek solidarity and support. One option is Family, Youth, and System Partner Round Table (FYSPRT), which is a network of groups that meet to discuss what’s working/not working in behavioral healthcare systems in their communities.

Full Article

Children and youth with intensive needs related to behavioral health may be eligible for services from a statewide program called WISe–Wraparound with Intensive Services. A WISe team includes various clinical and professional staff and certified peers, who may support the emotional needs of family members.  

WISe services are provided in the community—outpatient—for children and youth 20 or younger who are eligible for public insurance, called Apple Health in Washington State. To be assigned to a WISe team, the young person must demonstrate a need for services that are more intensive than what is provided from regular visits to a community clinician and/or therapist.

What does behavioral health mean?

Behavioral health is a broad term describing services for people with conditions based in the brain that impact their behavior. Bipolar disorder, schizophrenia, and substance use disorder (SUD) are examples of severe behavioral health conditions impacting some adults and young people.

Other childhood conditions are many and varied, and not everyone uses the same terms for the same symptoms. The Child Mind Institute is a place for information about childhood symptoms, diagnoses, and options for treatment and support.

Some developmental conditions, such as autism, are considered behavioral health conditions when symptoms have a significant impact on behavior. A person with a complicated behavioral health condition may have impacts in multiple areas and may be given a “dual diagnosis.”

Who is eligible for WISe services?

WISe services are for children and youth until their 21st birthday. WISe is only approved if the patient has used other, less intensive therapies, with little to no improvement.  Once approved for services, a young person may spend time on an “interest list,” receiving limited support, before a full team is formed to serve them.

The young person is evaluated with a Child and Adolescent Needs and Strengths (CANS) intensive mental health screening tool, called the CANS-SCREEN.

Five core areas are evaluated:

  1. Life functioning
  2. Behavioral and emotional needs
  3. Risk behaviors
  4. Caregiver resources and needs
  5. Diagnosis and prognosis

According to the CANS-SCREEN, “The care provider, along with the child/youth and family as well as other stakeholders, gives a number rating to each of these items. These ratings help the provider, child/youth and family understand where intensive or immediate action is most needed, and also where a child/youth has assets that could be a major part of the treatment or service plan.”

WISe requires public health insurance eligibility

In addition to meeting criteria based on their symptoms, a young person must be eligible for Apple Health, which is the name for public health insurance in Washington State. The Washington Administrative Code (WAC 182-505-0210) describes Apple Health eligibility standards for children.

Apple Health is most often administered by Managed Care Organizations (MCOs). In 2022, plans are provided by Amerigroup, Community Health Plan of Washington (CHPW), Coordinated Care, Molina, and United Healthcare. Families can request case management from their MCO to help them navigate and understand healthcare options available to them.

An MCO care coordinator/case manager commonly is the person who refers a young person into WISe, although referrals also can be made by the family, a provider, a county health agency, or someone else with knowledge of the circumstances.

Different agencies manage WISe programs in various regions of the state. The Health Care Authority manages a downloadable list of WISe agencies, organized by county. Families can contact their area agency by calling the phone number on this referral list.

Who is on the WISe team?

Team members include:

  • Natural supports (family, friends, religious leaders…)
  • A Care Coordinator (who oversees clinical aspects of the case)
  • Therapist
  • Professionals (clinicians/prescriber if needed, Child Protective Services, probation officers and others who are relevant)
  • Certified peer support specialist
  • Others upon request (youth peer, school staff…)

The clinical group creates a Team Vision Statement, explaining what they plan to achieve and how they will accomplish it through collaborative work. The family also creates a Vision Statement, showing what strengths they would like to build in their family and what tools they need to make their goals possible.

WISe requires family engagement

The time commitment for WISe is significant. Clinicians engage with the whole household on topics related to school, health, work, relationships, home organization, and more.

WISe publishes data about its service delivery. According to January 2021 Service Intensity Estimates, an average family spends 10 or more hours per week engaged with WISe services. This could be much higher, especially in the beginning. Parents/Caregivers are offered therapy sessions and opportunities to engage with parent peers. 

WISe clinicians are responsible to integrate their work to fit with a family’s schedule, often seeking creative ways to tuck sessions into already busy days. For example, a clinician describes a day when they picked up a child at school and conducted a session in the car while driving the child to their next activity. After work, parent met with the clinician while the adults watched the child swim.

Family experiences with WISe are varied. Some say WISe created a critical turning point that enabled family survival. Others cite high staff turnover as a barrier to ideal therapeutic outcomes. The program is most effective with buy-in from the young person and their caregivers and when services are provided to match family needs and schedules.

Does my child have to agree to WISe services?

WISe is a voluntary program. Families may be able to motivate their child to participate by getting services started through Family Initiated Treatment (FIT). FIT was established as a pathway to treatment for youth 13-17 when Washington passed the Adolescent Behavioral Health Care Access Act in 2019. A parent/caregiver can initiate outpatient services to attempt to get the youth to engage. If after 12 visits (within 3 months) the youth is still unwilling to engage with the treatment, the family must end services. They have the option to engage a different provider to try FIT again.

What if WISe isn’t enough?

The WISe program is the most intensive outpatient program that the state offers. If services don’t seem to be working, the family might check the WISe Service Delivery, Policy, Procedure and Resource Manual to see whether there is more the program could be doing. The family also might check if the child could get additional services from another agency to complement the work with WISe. For example, service providers from a special education program at school or from the Developmental Disabilities Administration (DDA) can collaborate with a WISe team.

If a child needs inpatient services, they may be eligible for a referral into the Children’s Long-term Inpatient Program (CLIP). Children placed on a waiting list for CLIP often receive ongoing services from WISe. PAVE provides an article: Children’s Long-Term Inpatient Program (CLIP) Provides Residential Psychiatric Treatment.

History, Advocacy, and Family Support

WISe was created as a response to the T.R. et al. lawsuit, settled in 2013. The class-action lawsuit named ten plaintiffs who were denied treatment for schizophrenia, depression, bipolar disorder, and other serious psychiatric conditions. Most were institutionalized repeatedly and for extended periods, despite recommendations by therapists and case workers that they return home and receive services in their homes and local communities.

Disability Rights Washington (DRW) provided attorney support for the settlement of the T.R. et al. lawsuit. DRW is monitoring current issues related to children being underserved through WISe and encourages families with concerns to contact attorney Susan Kas: susank@dr-wa.org.

Another result of the legal settlement was a statewide network of stakeholders who meet regularly to discuss what works/doesn’t work within the behavioral health system for youth. That network is called Family, Youth, and System Partner Round Table (FYSPRT). Regional FYSPRTs report to a statewide FYSPRT to share input for system improvement. Regional groups are a hub for family networking and emotional support in addition to serving as a place to engage with community health providers, insurance case managers, and other professionals. Some FYSPRTs have distinct groups for young people to meet and support one another. Many FYSPRT groups use online meeting platforms due to the pandemic.

Another place for families engaged in behavioral health services to network is Washington State Community Connections (WSCC), which sponsors an annual family training weekend, manages an SUD Family Navigator training, and offers a variety of ways for families to share their experiences and support one another. WSCC in 2022 is engaged in work to help build a statewide website to help families navigate behavioral health services across systems. Stay tuned!

Families can get direct support from A Common Voice, a statewide non-profit staffed with Parent Support Specialists who have lived experience parenting a child with challenging behavioral health conditions. The program offers virtual support groups and 1:1 help. A Common Voice is part of the Center of Parent Excellence (COPE), managed by the state’s Health Care Authority. The COPE project website provides a schedule of support group meetings and contact information for regional lead parent support specialists.

An informal place to connect with other families is a Facebook group called Healthy Minds Healthy Futures. Advocates in this group initiated work for an interactive website for parents and are engaged in a push for HB 1800 to expand behavioral health services for minors statewide.

Families wanting to advocate for system change can participate in meetings of the Children and Youth Behavioral Health Work Group (CYBHWG). The work group was created in 2016 by the Legislature (HB 2439) to promote system improvement. CYBHWG supports several advisory groups, including one for Student Behavioral Health and Suicide Prevention. The work groups include representatives from the Legislature, state agencies, health care providers, tribal governments, community health services, and other organizations, as well as parents of children and youth who have received services. Meetings include opportunities for public comment. Meeting schedules and reports are posted on the Health Care Authority (HCA) website.

Parity laws, thoughtful language, stopping stigma

Keep in mind that a healthy mind is part of a healthy body, and U.S. laws protect parity for all illness conditions. Despite those protections, discrimination and stigma are commonly discussed within behavioral healthcare systems. Here are a few tips and considerations to help reduce stigma:

  • All behaviors start in the brain, so an impairment that impacts the brain is going to affect behavior. Some behaviors are not a person’s fault; that’s why they need treatment, support, and services.
  • Specific person-first language can help reduce stigma. For example, instead of calling someone bipolar or schizophrenic, say they are a person with bipolar disorder or schizophrenia.
  • An exception to person-first language is in the autism community, which has collectively agreed to use the term “autistic” to describe someone on the spectrum.
  • Saying that someone has “behavioral health,” or “mental health” does not describe their condition or what they need help with. Everyone has mental health! A better choice is to describe the condition/concern and the need for help: “This youth’s schizophrenia is impacting every aspect of life, and they need a range of services and treatments to recover and move forward with their life plans.”
  • A person who dies from suicide did not commit a crime, so the word “commit” is inappropriate to use when discussing suicide.

For additional information on related topics, including areas where behavioral health impacts school, see PAVE’s article: Mental Health Education and Support at School can be Critical

Children’s Long-Term Inpatient Program (CLIP) Provides Residential Psychiatric Treatment

Posted on by Nicol Walsh

A Brief Overview

  • CLIP serves children ages 5-17 by providing mental-health treatment and school in a secure, residential facility. Read on for more information about CLIP eligibility and how to initiate a referral.
  • Young people placed in CLIP could not recover adequately with the most intensive outpatient services available, which in Washington are provided through Wraparound with Intensive Services (WISe).
  • Family caregivers of young people with intensive behavioral health needs can request support from A Common Voice, staffed by lead parent support specialists. Find their contact information on the Center of Parent Excellence (COPE) page of the Health Care Authority’s website.

Full Article

Families have few options to help a child with a psychiatric illness that makes in-home, community-based care unworkable. Local hospitals are designed to provide crisis care and generally do not keep a patient for mental health treatment and recovery beyond a few days or weeks. Sometimes those short hospitalizations are not long enough for lasting stability.

One choice for children 5-17 is the Children’s Long-Term Inpatient Program (CLIP), which provides intensive mental health services and school in a secure residential setting. A CLIP stay is usually about 6 months long. Eligibility for CLIP ends on the child’s 18th birthday.

Most CLIP referrals are for children with Medicaid—public health insurance, which is called Apple Health in Washington State. Families with private health insurance have access to CLIP but may be referred first to private facilities for long-term, inpatient care. Medicaid is the payer of last resort.

Who is Eligible for CLIP?

  • Youth ages 5 to 18
  • Legal residents of Washington State
  • Youth diagnosed with a severe psychiatric disorder
  • Youth at risk to themselves or others or gravely disabled due to a psychiatric condition
  • Youth who are not successfully treated through community-based mental health resources

Families are involved and children get school at CLIP

Parents/legal guardians engage with the treatment team while a child is at CLIP. The goal is to help the child stabilize and provide the family with skills and tools for a successful return to the home, school and community.

Children attend school while at CLIP. Teachers at the residential facility manage the student’s Individualized Education Program (IEP), or Section 504 plan, and help with transitions from and back into the student’s local school.

CLIP referrals may be voluntary or involuntary

Parents and legal guardians can refer children to CLIP. The first step is to know whether the referral is voluntary or involuntary. Parents can volunteer their children younger than 13 for residential treatment. Youth 13 and older must voluntarily go to CLIP unless they meet criteria for involuntary commitment.

The Revised Code of Washington (RCW 71.34.010) establishes that an adolescent 13-18 may be committed for up to 180 days of involuntary inpatient psychiatric treatment if commitment criteria are met. Residential placement at CLIP is one way to carry out a commitment order, which may be based on a standard of imminent threat (to self or others) or grave disability/severe psychiatric deterioration. Seattle Children’s Hospital provides a Guide to the Involuntary Treatment Act (ITA).

To refer a child or youth to CLIP for voluntary admission, the parent, legal guardian, or youth may get help by following a CLIP administration menu that starts with the name of the child’s heath plan. A child’s mental health provider or social worker also can support a CLIP application.

The family can request a hearing with a regional committee, which may then refer the case to the CLIP Administration for final approval. Sometimes a child is put on a waiting list for an available bed.

CLIP is a step up from WISe

Young people placed in CLIP have a record of being unable to access an appropriate level of care within their community. That usually means failure to recover with services from our state’s most intensive outpatient option for children and youth, which is Wraparound with Intensive Services (WISe).

The WISe program was begun as part of the settlement of a class-action lawsuit, TR v Dreyfus, in which a federal court found that Washington wasn’t providing adequate mental-health services to youth. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital.

Families engaged in WISe and/or CLIP services are encouraged to participate in their regional Family, Youth, and System Partner Roundtable (FYSPRT), which provides a place to share resources, solidarity, and feedback about the behavioral health system. See PAVE’s article: Families and Youth Have a Voice on Mental Health Matters Through FYSPRT.

Organize and prepare for a CLIP application process

Families need an organized set of medical and school paperwork to complete CLIP applications. Refer to PAVE’s article about document management for guidance about how to create a care notebook or other filing system for this and other purposes.

The regional CLIP committee includes care providers from managed care organizations and other agencies that may provide additional support and resources to the family, regardless of whether a CLIP referral is recommended. Generally, the committee determines that all community-care options have been exhausted before recommending a more restrictive placement through CLIP. The team will also make a recommendation based on whether the child is likely to benefit from the therapeutic program, which is mental health based and may not be a good fit for an individual with a severe form of developmental or intellectual disability.

Where is CLIP located?

The largest CLIP facility is the Child Study and Treatment Center (CSTC) in Lakewood, adjacent to Western State Hospital. CSTC provides about 60 beds in cottages that house children in groups by age and other factors. Additional options with fewer beds include:

  • Tacoma, The Pearl Street Center
  • Spokane, the Tamarack Center
  • Yakima, Two Rivers Landing

Further Resources

Washington’s Health Care Authority (HCA) has additional information about WISe, CLIP, early signs of psychosis, and Family Initiated Treatment (FIT).  If a person 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys (website link includes access to a referral form).

Help for Understanding Health Insurance

Posted on by Nicol Walsh

Healthcare insurance includes words and abbreviations that can be confusing and hard to remember. This article describes a few key terms to demystify the health insurance world for Washington State families. Washington Healthplanfinder.org is a place to research insurance options statewide, with English and Spanish options.

Managed Care Organization (MCO)

A Managed Care Organization (MCO) is an agency that coordinates medical services and reimburses providers.

State medical insurance in Washington is called Apple Health. Apple Health pays a monthly premium to an MCO that an individual or family chooses to manage preventive, primary, specialty, and other health services. Apple Health also pays for some services directly, through Fee for Service (FFS).

The term “provider” describes any health care professional or facility that provides treatment. Doctors, nurses, mental health professionals, physician assistants, dentists, therapists, behavior specialists, and many other professionals are considered providers.

Clients enrolled in managed care must seek providers who are part of their plan’s network unless there is an emergency or prior authorization is arranged. Prior authorization means the insurance company agrees to pay for a service, treatment, prescription drug, medical equipment, or something else because it is determined to be medically necessary.

The Apple Health system includes five MCOs. Not all plans are available in all areas of Washington State. ​

  • Amerigroup (AMG)
  • Community Health Plan of Washington (CHPW)
  • Coordinated Care of Washington (CCW)
  • Molina Healthcare of Washington, Inc (MHW)
  • United Healthcare Community Plan (UHC)

For complicated circumstances, an MCO may recommend a case manager be assigned to support an individual’s care. Families also have the option to request case management, especially if locating providers is difficult to meet unique or substantial needs.

Health Maintenance Organization (HMO)

A Health Maintenance Organization (HMO) is a type of MCO.  An HMO is an independent system that requires enrollees to seek care within a specific network of hospitals and providers. An HMO plan is based on a network of providers who agree to coordinate care in return for a certain payment rate for their services. 

Preferred Provider Organization (PPO)

A Preferred Provider Organization (PPO) is another type of MCO. A PPO generally will allow individuals to choose their providers and does not limit reimbursement to providers in a specific network. Because of that, a PPO tends to be more expensive than an HMO.

What is the difference between Medicaid and Medicare?

Medicaid is income dependent, and Medicare is not. Both provide government-funded healthcare.

Medicaid is state-managed to provide free or low-cost medical coverage for individuals or families who qualify based on income. Washington’s Medicaid program is Apple Health.

Medicare is a federal health insurance program for individuals age 65 and older and for those with qualifying disabilities. Medicare is not dependent on income.

Copayments, Premiums, and Deductibles

When healthcare is not free, the cost to the family adds up through the copayments, premiums, and deductibles. Here’s what that means:

  • Copayment: a specific fee for a visit or procedure.
  • Premium: payment for the insurance. An individual might have premiums withheld from a paycheck, or an employer might agree to pay all or part of the premium.
  • Deductible: the amount of money an individual must pay each year before insurance payments “kick in.” After a deductible is met, the patient may still make copayments or pay a percentage of the cost, depending on the plan. Supplemental insurance through Medicare is sometimes an option to cover deductible expenses.

What is a Medicaid Waiver?

A Medicaid waiver allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to reimburse for services that would not otherwise be covered by Medicaid. Waivers generally provide local, non-institutional solutions for individuals with disabilities. For example, in-home care paid for through a waiver might support someone to live in the community.

Medicaid.gov provides a Washington Waiver Fact Sheet that outlines waiver programs available in Washington State.

An Illustration of the insurance terms described in this document

Download the illustration as a PDF – Health Illustrative

New Immigration Rules: Public Services May Impact Eligibility for U.S. Residency

Posted on by Nicol Walsh

On Feb. 24, 2020, U.S. Citizenship and Immigration Services (USCIS) implemented new rules nationwide that impact immigrants who wish to become permanent or long-term residents. Since the policy change, some benefits that families receive may count against them if they apply for residency.

Called Inadmissibility on Public Charge Grounds, the new rule prohibits permanent residency if an individual relies on or is likely to rely on public resources for housing, food or healthcare assistance. The changes were implemented in response to a Supreme Court ruling.

Previously, persons may have been eligible for residency if they did not primarily depend on government funds. According to the USCIS, the new rule requires that a potential resident will not depend on government funds at all.  A person applying for residency must demonstrate current and potential income. Non-residents already in the United States may be impacted if they continue to access government resources and wish to stay or make their residency status permanent.

What programs are included?

  • Medicaid for adults over 21 (expectations are made for emergencies, pregnant women, and those who have given birth in the last 60 days)
  • Supplemental Security Income (SSI)
  • General Assistance programs from government agencies that give cash support or income maintenance
  • Supplemental Nutrition Assistance Program (SNAP or Food Stamps)
  • Housing Assistance, including public housing, Section 8, and Temporary Assistance for Needy Families (TANF) cash benefits

Benefits Excluded from Public Charge

  • Emergency medical assistance
  • Children’s Health Insurance Program (CHIP)
  • Medicaid for children under 21
  • Disaster relief
  • State, local, or tribal programs (other than cash assistance)
  • Community-based programs, such as soup kitchens, crisis counseling and intervention, and short-term shelter
  • Temporary Assistance for Needy Families (TANF) non-cash benefits
  • Supplemental Nutrition for Women Infants and Children (WIC)
  • School Breakfast and Lunch programs
  • Low Income Home Energy Assistance Program (LIHEAP)
  • Transportation vouchers or services
  • Pell Grants and student loans
  • Childcare services
  • Head Start
  • Job training programs

Who is Affected?

Most individuals seeking permanent residency with a Green Card are affected.  Use of public benefits may also damage a non-resident’s attempt to extend temporary residency in the U.S.

Individuals who may be exempt or eligible for a waiver

  • Refugees
  • Asylum applicants
  • Refugees and asylees applying for adjustment to permanent resident status
  • Amerasian Immigrants
  • Individuals granted relief under the Cuban Adjustment Act (CAA), Nicaraguan and Central American Relief Act (NACARA), or Haitian Refugee Immigration Fairness Act (HRIFA)
  • Individuals applying for a T or U Visa
  • Individuals with a T or U Visa who are trying to become a permanent resident with a Green Card
  • Applicants for Temporary Protected Status (TPS)
  • Certain applicants under the LIFE Act Provisions

Are there any exceptions?

The USCIS has announced that “inadmissibility based on the public charge ground is determined by the totality of the circumstances.” While use of public charge funds will count against individuals applying for residency, they are not the sole factor in the government’s decision to approve or deny residency requests. Here are additional resources:

American Immigration Lawyers Association: Public Charge Changes at USCIS, DOJ, and DOS

Public Charge Fact Sheet

Reuters: “U.S. Supreme Court lets hardline Trump immigration policy take effect”

U.S. Citizenship and Immigration Services: Public Charge