In particular, I through IV, we discussed in detail all the problems that a low-income child with special needs might face in trying to cover medical expenses when they grow old from the rather comprehensive Medicaid program, called the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT). But what we did not discuss is that these costs may actually look as if they should fail, as many do, in order to find the necessary coverage. In short, because of the pocket expenses of many relatively common disabilities, you can completely spoil the ability of a young adult to make ends meet.
Costs increase even with coverage
To begin with, people with disabilities pay more to get through an average day than a fully wealthy person, even with health care coverage. One study showed that approximately half of all families supporting an insured adult with mental or intellectual disabilities in development pay more than $ 5,000 annually for expenses not covered by their health insurance. There is a huge amount of minor expenses that insurance does not cover, from obvious (co-payments and deductibles) to a minority (transportation to and from the therapy, hired housewife to assist in daily activities, such as cooking).
Problem of use
The simple fact is that people with special needs simply use medical services more than those who do not. How much more? According to a brief summary of several studies conducted over the past decade, insured low-income families with no children and no adults with disabilities spend approximately 2.2% of their household income on medical expenses. Insured low-income families with no children and adults with one or more disabilities, on average, accounted for 5.6% of their income spent on medical needs — more than 2.5 times more than the first group.
(And if 5.6% of your income does not seem like a huge deal to you, remember that these families usually live with almost zero room for maneuver in their budgets - when your excess income after the necessities and expenses in tens of dollars a month is the difference $ 1500 / year and $ 3750 / year is huge!)
No coverage? You can pay the maximum price: Institutionalization
Perhaps the most terrible risk that newborn adults with special needs face is the risk of losing all home and community services (HCBS) that EPSDT offers. For many of these people, if they cannot find the means to pay for their homeless caregivers from their own pockets, their only remaining option is institutionalization — giving up everything they know and is going to live in full-time employment for people with disabilities. It is so frightening that many young people prefer to live on their own instead, knowing that their medical needs are unmet.
Yes, Medicaid offers a waiver allowing states to provide HCBS coverage, but the HCBS system is currently undergoing radical changes because, while states like to cut costs, the federal government has not even noted that these reduced costs are stunningly high. We will talk about the details of this situation in the next post.
