Applying for Medical Waivers and Medicaid Based on Medical Necessity
Walking Through the Process
Step by Step
The first step is to apply for Social Security Disability for your child through your local Social Security office.
If they qualify, Social Security will help you obtain Medicaid. This is income and asset based. However, even if you know you will be denied, you have to apply to be able to move onto the next step.
If denied, keep denial letter and proceed to step 2.
Social Security Administration
To find a local office and for more information, go to:
Call to schedule an interview 1-800-772-1213
Louisville local office: 10503 Timberwood Cir, Louisville · (888) 280-5851
At the interview, if you qualify financially, you will need to provide:
- Information about your child’s medical condition(s)
- Dates of visits to doctors or hospitals, the patient account numbers for any doctors or hospitals, and contact information for each doctor
- Copies of any medical reports or information you have in your possession
Social Security will contact the doctors directly for additional information, you don’t need to have the doctors write letters. Just bring what you already have. Copies of your child’s Medical Summary and List of Doctors from their Medical Binder will be helpful for this. Take the Medical Binder into the interview in case they need to make copies of anything else. To learn more, visit: https://www.ssa.gov/pubs/EN-05-10026.pdf
If you would like the help of a lawyer to apply for Disability, you can contact Sam Schad at Schad & Schad Law Firm http://www.schadlaw.com/sam-schad/ 800-730-4555
Once your child reaches 18 years old, you can apply for Social Security Disability again if they didn’t qualify financially before. It will no longer be dependent on parent’s income even if they still live at home. If they qualify, they can receive Medicaid as well as disability income (about $700/month). Adults can apply themselves (or with someone’s help) online at: https://www.ssa.gov/disabilityssi/
Even if your child does not qualify financially for Social Security Disability, they still may qualify for Medicaid based on financial need. If you know you will not qualify based on financial need, skip this step and go on to step 3.
To apply go online to https://www.healthcare.gov/. This is only based on current income, not past income or assets. Follow up by visiting with your local Cabinet for Health and Family Services. If you don’t qualify financially, proceed to step 3.
To be eligible to receive straight Medicaid, your child has to be receiving Waiver Services (these help cover care giver costs and supplies). You can apply for Waiver Services and Medicaid based on medical necessity for your child at your local Department for Community Based Services by going in person and scheduling an appointment.
To find a local office in Kentucky, visit https://prdweb.chfs.ky.gov/Office_Phone/index.aspx . Another way to start the application process is to apply online at benefind.ky.gov or call 855-306-8959. However, if you apply in person or with assistance from an agency, you may be more likely to gain approval.
If you do not live in Kentucky, Click here to get information on how to apply in your state.
You will need your Social Security denial letter for this appointment.
Waiver Services and straight Medicaid is not income based. However, you will need to provide your financial information. For a complete list of information you will need, download Social Security Disability requirement list for interview
*Helpful tip – at your appointment, request your case be reviewed by a Medical Review Team.
If you live in Kentucky and you would like assistance applying for Waiver Services and Medicaid, check this CDO_Brochure for a listing of agencies.
In the Greater Louisville, KY area, call KIPDA at 502-266-5571 and ask for the Aging and Disability Resource Center or visit KIPDA’s website .
For outside of Kentucky, contact your local Department for Community Based Services to find out more information on waiver programs available in your area.
- If you have Medicaid based on financial need, you can still use agencies listed in the brochure above, to apply for waiver programs.
This information is subject to change and may not be up to date.
Please check with your local Social Security office and Department for Community Based Services for accurate information.
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We are in this together
“Providing education and resources to support parents of chronically and critically ill children.”
“Love always protects, always trusts, always hopes, always perseveres.”
1 Corinthians 13:7