Parenting is a beautiful journey. Still, when you’re a parent of a neurodivergent kid, you may find yourself in a maze of healthcare programs and services. One such program is Pennsylvania Medicaid. It can seem like a complex puzzle, but don’t worry; we’re here to help you assemble the pieces. This guide will walk you through the Pennsylvania Medicaid system, giving you the knowledge and tools to make informed decisions for your child.
Let’s start by demystifying what Pennsylvania Medicaid is. It’s a joint state and federal program providing health coverage to low-income people. This includes some low-income adults, children, pregnant women, elderly adults, and people with disabilities. But how does this relate to your neurodivergent kid? This program can be a lifeline, offering access to vital services and support.
You might wonder, “Is my child eligible?” Eligibility for Pennsylvania Medicaid is determined by several factors, including income, family size, and disability status. For example, kids with severe disabilities may qualify regardless of their parent’s income. So, checking the specific eligibility criteria to see if your child qualifies is crucial.
Applying for Pennsylvania Medicaid can feel like climbing a mountain. But, with the proper guidance, it can be a manageable hike. Here’s a step-by-step guide to help you navigate the application process:
During this process, remember to stay patient and persistent. It may take some time, but securing Pennsylvania Medicaid for your child can open doors to essential services and support.
| Goally Waiver Scorecard | Score |
|---|---|
| Website clarity and ease of navigation | 3/5 |
| Access and requirements of qualification | 0/5 |
| Healthcare coverage | 5/5 |
For neurodivergent kids, Pennsylvania Medicaid offers several waiver programs. These programs provide additional services and support not typically covered by Medicaid. This includes things like respite care, home modifications, and therapeutic services. These programs can be a game-changer for your child’s care.
But how do you access these programs? That’s where Goally comes in. We can help you navigate these programs, ensuring your child gets the needed services. Remember, each child is unique, and what works for one may not work for another. So, stay flexible, stay informed, and most importantly, stay strong. You’ve got this!
ASERT resource specialists: 877-231-4244
Most importantly, remember you’re not alone. Resources and support are available to help you navigate the Pennsylvania Medicaid system. It may seem overwhelming initially, but with the right information and guidance, you can successfully navigate this system and secure the services your child needs.
And remember, your child’s needs are unique. What works for one child may not work for another. So, stay flexible, stay informed, and most importantly, stay strong. You’ve got this!
Waivers: Consolidated Waiver and Personal/Family Directed Support Waiver (PFDS)
Does your child need some extra guidance on building essential life skills? Goally’s skill building tablet for kids includes a TV app that has the most robust video library of skills training videos for kids. Ranging from content like “How to Brush Your Teeth” to “How to Make Friends at School,” we have dozens of interactive video lessons for kids with thinking and learning differences.
HERE’s a video explaining how to works.
Circumstance/Diagnosis: Any child or adult who is diagnosed with either an intellectual and/or developmental disability (this includes autism). The state requires that individuals need an intermediate care facility level of care to qualify. There is a technical definition for this, but it really just means that the individual is unable to get through their day without a lot of supervision.
Income:These waivers only account for your child’s income, so unless they are making any money they will qualify for these programs.
You can view a full list and comparison of services between waivers on page 5 of this document. A key thing to note is that the Consolidated Waiver has no cap on the amount of money that can be spent on services while PFDS has a $33,000 cap.
Call your county’s Mental Health/ Intellectual Disabilities Office to get more information on these waivers and other resources that may be available to you.
No parent should have to wait 5 years to get the services they need. Once you are on one of these waivers though, you will have enough funds to cover just about every service you can possibly think of. Additionally, since the waiver is all ages, your child will receive support until they have good enough employment that makes them ineligible. What’s missing in Pennsylvania is an option for a smaller amount of funds for less pressing needs. Many states have county resources that fulfill this purpose, but we could not find anything definitive on the web.
This post was originally published on 02/16/2021. It was updated on 09/14/2023.
