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Typically, insurance of some sort is required to access or pay for services and treatment for ASD. It is helpful to understand the different insurance options that are available for individuals with ASD and their families, as well as information to consider when planning financially for individuals with special needs.

What Insurance is Available to Individuals with ASD?

In Indiana, there are two primary types of insurance that typically provide access to ASD-related services: private insurance (generally provided through an employer) and government supported insurance. Private insurance companies generally have their own regulations related to ASD-related service coverage, so families should contact their insurance agencies directly to determine which services are covered. The Arc of Indiana Insurance Advocacy Resource Center is a very helpful resource that can also assist families with determining what is covered by their current insurance.

Government supported insurance options include, but are not limited to:

Supplemental Security Income (SSI)

Supplemental Security Income, or SSI, is an initiative by the Social Security Administration offering monthly benefits to eligible applicants, including individuals with disabilities, and may also guarantee eligibility for Medicaid and SNAP (Supplemental Nutrition Assistance Program) assistance. SSI will provide limited funds for basic necessities, such as food, shelter, and medical care for families with assets lower than $2,000. Upon turning 18, an individual with ASD is considered an adult, and the asset requirement to maintain SSI rests solely on the individual and not on the family. For specific information about SSI, visit the United States Social Security Administration Supplemental Security Income website.

Medicaid

Medicaid is a federally-funded health insurance program for people with low income, including individuals with disabilities. In order to receive Medicaid benefits, individuals must apply and qualify for both disability and income guidelines through the Indiana Family and Social Services Administration (FSSA). To receive Medicaid coverage, family assets must be below $1,500. Visit the FSSA Medicaid Policy website for additional information about eligibility and to apply.

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What is a Medicaid Waiver?

Medicaid Waiver Programs in Indiana are extremely helpful means to obtain the most services possible without having to pay for those services out of pocket. To receive a Medicaid Waiver, an individual must first qualify for Medicaid and have no more than $1,500 in assets and an income no more than 300% of the amount paid by SSI. Additional eligibility requirements can be found by contacting the FSSA Division of Developmental Disabilities Services (DDRS). Indiana currently offers two Medicaid Waivers:

Family Supports Waiver (FSW)

The Family Supports Waiver provides Medicaid Home and Community-Based Services (HCBS) to individuals with developmental disabilities so that they may access services within a community setting rather than residential care facilities. The FSW provides annual funding of $16,250 (with $1,500 of that funding designated for paying for case manager support). Because the FSW is the first point of entry for waiver services, the FSW is issued on a first come-first served basis, and, as a result, there is a waitlist for services.

Community Integration and Habilitation Waiver (CIH)

The Community Integration and Habilitation Waiver also provides access to services and supports to individuals with disabilities, but the services are needs-based and require a more specific set of eligibility criteria compared to the FSW. the CIH Waiver does not have one set monetary allowance, and there is no current waitlist to receive CIH Waiver services.

For more information on waiver eligibility and applications, visit the DDRS website. The Arc of Indiana Insurance Advocacy Resource Center may also be able to assist with questions related to Medicaid Waivers in Indiana.

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What is SSI?

Supplemental Security Income, or SSI, is an initiative by the Social Security Administration offering monthly benefits to eligible applicants, including individuals with disabilities, and may also guarantee eligibility for Medicaid and SNAP (Supplemental Nutrition Assistance Program) assistance. SSI will provide limited funds for basic necessities, such as food, shelter, and medical care for families with assets lower than $2,000. Upon turning 18, an individual with ASD is considered an adult, and the asset requirement to maintain SSI rests solely on the individual and not on the family. For specific information about SSI, visit the United States Social Security Administration Supplemental Security Income website.

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What is a Special Needs Trust Fund?

A trust fund can hold money for the benefit of an individual with disabilities, allowing for the use of those funds to provide items and services to improve the individual’s quality of life without jeopardizing eligibility for public benefits such as Medicaid and SSI. While SSI and Medicaid funds are limited to supporting basic needs, a trust fund allows the beneficiary to pay for items or services beyond simple necessities. Families may set up trust funds through private agencies and financial planners or state-supported groups such as the Arc Master Trust.

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What Should I Consider when Planning for a Dependent with Special Needs?

Some government support programs, such as SSI and Medicaid (as outlined above), place limits on the assets that a family may possess to qualify or maintain that support. Any inheritance or future investments exceeding $2,000 may disqualify an individual from receiving most federal assistance, so it is important that families discuss such stipulations with a financial expert when planning for an individual’s future.

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What is the ABLE Act?

The Achieving a Better Life Experience Act of 2014, (ABLE ACT) allows families/caregivers of individuals with disabilities arrange a special saving account for disability-related costs.  Any savings incurred on an ABLE account is not taxed and funds are not generally considered for SSI or Medicaid.  This act was built upon the current law that makes saving for a child with disabilities difficult.  Individuals eligible for an ABLE account include a person who becomes difficult before age 26 and (1) has SSDI or SSI or (2) submits a disability certification under rules written by the IRS.

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Additional Resources

References

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