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Medical Assistance after age 18

Last week's blog addressed the importance of Medical Assistance after diagnosis but what happens when they are no longer a child (defined as under the age of 18).


Here are our key notes for this week.

The benefit that changes after the age of 18 is the SSI (Supplemental Security Income). You now need to apply for your child as an adult and it is so important to do so before they turn 21. The best time to apply is the first month after their 18th birthday. If you apply before they are actually 18 then they will look at the family income but if it is after 18 years old, then it is only the applicants income that is considered. More details can be found here


One of the things they ask for when applying is all of the doctors and providers that are treating your child. They then reach out to all of those providers to get the therapy notes which you can imagine takes a lot of time and effort on their part. Michael Walling M.Ed is an expert in the field of benefits and I have attended his seminar several times (that’s how complicated the system is to understand).

Michael Walling M.Ed., is the owner of Benefits Training and Consulting.

He provides workshops, internet-based training, and technical assistance

throughout the United States.


He travels the nation sharing his knowledge and resources. While traveling he takes some amazing pictures. These can also be found on his website if you need a break from all the paperwork!


He suggested at one of his seminars that along with providing all of those names and contact information include the after visit summaries from the providers essentially doing the work for them. I scanned all of the documents that I had and put them on a CD which I included with my application.


The next thing they will need to be sure is that your child's diagnosis still qualifies as a diagnosis as an adult. I went to the Blue Book, to be sure we were looking at the adult disability requirements.

This handbook describes what disabilities make someone eligible for Medical Assistance and what the criteria looks like for each diagnosis.


I gathered as much information as I could that I felt supported Ben’s disabilities and provided that to his physician to make a letter from her easier to write. I copied and pasted right from the document anything that I felt supported Ben's disability so the exact wording was used in the supporting physician letter. Many people are denied the first time they apply so don’t be discouraged if this occurs and keep pursuing the benefit.

We were fortunate to be approved with the first application and I believe it was because we provided all the information scanned and saved on a disc and sent in with our application.


It is also important that your child pays you rent/room and board so that they will receive the maximum benefit allowed. You can have your adult child sign monthly IOU’s for the amount if they don’t have any income to show that you are charging them rent as well as a simple rental agreement. You may feel that you can continue to support your adult child, but consider if they were on their own or someone else's care, would the monthly benefit be enough to cover expenses.


The last helpful hint is that if your adult child is working, there is a limit each month on how much they can earn to maintain the benefit. This changes year to year but if you are over 18 and as an adult still in school, there is a student exclusion and they are allowed to earn any amount of income and it does not affect their benefit. Once they take their diploma, this exclusion is no longer available.

One last thought is to know the rules for how long your child can stay in school. It is always so sad to me when I hear of a family that did not know that their child could stay in school until the age of 21. Ben graduated with his class, all of the students he came to know over the years at the high school, and we had the big graduation party for him after 12th grade. He then attended what was known at the post 12 program in our district so they actually banked his real diploma for 2 years of additional school where he spent a half day with academic instructions and the other half in job exploration. Every district calls it something different but it is the law in Pennsylvania that your child can stay through the year the turn 21. We knew that what we call the “adult cliff” was coming and that we would need to deal with employment issues in the future but we were grateful for 2 additional years of structured services provided by the school to meet Ben’s needs including the extended school year summer program. Here is a link for some information based on your state. Each state is a bit different.


I am by no means an expert in the complicated system of benefits but would encourage anyone to keep asking the questions so that your adult child will maximize their benefits.

Love you more,


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