Your family may face many financial challenges as you support and care for your child with special health care needs. Following are programs and resources that might help pay for things your child may need in their daily life.
Medicaid is a health insurance program that provides medical services to specific groups of people in Iowa, when they meet certain eligibility requirements.
These specific groups include:
- A child under the age of 21
- A parent living with a child under the age of 18
- A woman who is pregnant
- A woman in need of treatment for breast or cervical cancer
- A person who is elderly (age 65 or older)
- A person who is disabled according to Social Security standards
In addition to being a member of one of the groups listed above, to be eligible for Medicaid programs in Iowa, individuals must:
- Live in Iowa
- Be a United States citizen or have acceptable immigration status
- Provide a Social Security number or proof that you have applied for one
- Provide other information (such as household income or size of family)
How Do I Apply for Medicaid for My Child?
In Iowa, Medicaid (Title 19) funding is administered by managed care organizations; however the Department of Human Services (DHS) determines eligibility and manages applications. You can apply for any program for your child by visiting your local DHS office. You can find the nearest office by visiting the DHS website.
If you have any questions while you are completing the Medicaid application, you can call the DHS Help Center at 855-889-7985.
Medicaid for Kids with Special Needs
Medicaid for Kids with Special Needs (MKSN) is a special kind of Medicaid for children with special needs due to a disability (determined by the Social Security Administration or the Department of Human Services). A child may often qualify for MKSN while they are on the waiting list for a waiver; however a child does not have to be on a waiver waiting list to qualify. It is based on the number of people who live in your home and your monthly income.
To qualify for MKSN you child must be:
- Under the age of 19
- Disabled (the disability must meet the standards of the Social Security Administration).
- Income Eligible. Your family income must be no more than 300 percent of the federal poverty level of your family size.
- A U.S. citizen.
Medicaid for Kids with Special Needs (MKSN) gives the same Medicaid insurance coverage you will have while on a waiver. You can apply at your local DHS office or by calling 877-937-3663.
Children at Home Program
The Children at Home Program is a program that can help you and your family receive services and supports you think are necessary in helping your child remain at home. It also can help you receive the services and supports that are not available in other programs.
Eligibility for the Children at Home Program is for families who meet all of the following conditions:
- The family resides in Iowa
- The family includes an individual with a disability, which is defined as an individual who is less than 22 years of age and meets the definition of a developmental disability
- The family expresses an intent for the individual with a disability to remain living in the family’s home
- The family’s net taxable income is the most recently completed tax year is less than $60,000
Autism Support Program (ASP)
In 2013, the Iowa Legislature created the statewide Autism Support Program. This program provides funding for applied behavioral analysis (ABA) therapy for some Iowa children and youth with a diagnosis of autism spectrum disorder (ASD).
Eligible children may receive up to $36,000 per year for ABA therapy services over a 24-month period of time, not to exceed $72,000 total.
General eligibility guidelines for the Autism Support Program:
- The child is under the age of 14 years at the time of application
- A diagnosis of ASD has been provided by a child psychiatrist, developmental pediatrician, or clinical psychologist
- Diagnosis was provided within 24 months of the date of application
- The child does not qualify for Medicaid or coverage under a commercial insurance plan
- Individual and group insurance policies vary. Iowa Regional Autism Assistance Program (RAP) teams are available to help families apply for the Autism Support Program and to explore their insurance coverage options
- The family meets specified Federal Poverty Level (FPL) income guidelines; family income must be under 500 percent of FPL
- A completed application
Supplemental Security Income (SSI)
The Supplemental Security Income (SSI) program is a government program that is based on financial need. This program offers monthly cash assistance to help pay for personal and medical needs for children with disabilities and special health care needs.
Part of the application process for this program involves the completion of a Child Disability Report. This report collects information about the child’s disability or condition and how it affects his or her ability to function. More information about this program and application instructions can be found on the Social Security website.
Medicare is a federal health insurance program for individuals age 65 and older. However, there are two ways that children can also get Medicare coverage. Children with chronic renal disease who need a kidney transplant or maintenance dialysis, or children with Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) are eligible to receive Medicare benefits. More information about Medicare can be found at Medicare.gov.