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.