Medicaid Waiver Benefits for Military Families 

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

Person Centered Planning and Aging Families

At the age of 56, a single parent from the baby boom age, my youngest son is now 26, and at this time in my life I need to plan for my retirement.

In a few years I will be heading toward the twilight of my life, so I need to take into account how that affects the life of my son, Kyle, who experiences Down Syndrome. Just like many families who live with and care for their adult sons and daughters for most of their life, it is my responsibility to share vital information that I might be the only one who knows, such as how, what, when, and where services are to be received. This way all the hard planning that has made his routine and the quality of life possible can continue even when I’m no longer able to care for him or myself as I age.

Up to this point most families don’t plan for such events, thinking that they will outlive their loved one with a developmental disability, brushing aside thoughts of what the future might hold for them. If I don’t think about it won’t happen. So usually what happens is when the parent or care giver has a medical emergency there is no plan of care or support for themselves or for their adult son or daughter with a disability, leaving both in need of a plan of care. It will be important to identify who it is left to sort through the maze of services, or lack of services, to help during this very vulnerable time.

Person Centered Planning is a tool that is used to help people plan for the future. Just as you plan along awaited trip you use a simple guide to help you make the journey comfortable to enjoy your precious time you have set aside. When it is time to plan, bring together the people who will be in the family’s life at that critical time. Usually, it is left up to siblings who have not been very involved in their sibling’s day-to-day care. Their parents did a really good job of caring for their sibling, but most find out the hard way what the daily routine looks like for their sibling.

By using the Person Centered Planning method, you have a document on hand so that you are able to have input into a plan of care before a crises.

Aging parents must start thinking about drafting a will and learning about trusts for your peace of mind. Think about the use of Person Centered Planning as a tool, as it can help relay your wishes and concerns. Share information about their care, like who their doctors are, what their care plan is, and other things like a living will. This is in case the parent loses their ability to share vital information to the people who care and to service providers who need to plan action steps.  What history of care has been provided, what are the needs, who can help, what is the plan of care when you or I are not able to communicate the needs of our adult sons and daughters?  As we age, the plan becomes the family plan, not just for the individual but for the whole family, including the network of support and those who will be left to sort things out.

The process helps pull together all their important information so that people who come in and out of the person’s life have something with which to help plan a positive quietly of life for the  individual and their family.

Pierce County Parent to Parent has also put together a care notebook that helps families keep important information together for when the parent is no longer able to speak for themselves or share information that is important, not just for the individual with the disability, but for the family itself.

Learn more about Person Centered Planning

Reunited photo courtesy Jenn Durfey via flickr