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Eligibility for Home Care Services for Children

Parents caring for a child with a disability or debilitating illness can find themselves emotionally and financially strained. The intensive costs and requirements of medical care can go beyond a family's means. That's when they turn to private and public health insurance resources. The federal government gives special consideration to children needing intensive medical care. Parents must understand their options and work through the sometimes complex applications and processes needed to secure help.

  1. Private Insurance

    • Children covered by their parents' private group health insurance can usually receive home health care. Private plans normally have home health care provisions although they can vary widely. Typically, if a physician orders home health care for a child -- particularly if the child has a debilitating or terminal illness or disability -- an insurer will pay for the services per plan rules. In many cases, insurance pays for only a percentage of the total home care costs, and parents are responsible for sometimes large remaining amounts.

    Medicaid

    • The federal Medicaid program provides medical coverage to those with low income, the disabled and families in financial hardship. The Centers for Medicare & Medicaid Services (CMS) contracts screening and many administrative duties to state agencies. As a result, parents who want to verify their children's eligibility and apply must contact their state department of health. Guidelines are national although each state conducts its eligibility process in its own way.

    Basic Qualifications

    • Low income is a primary requirement for Medicaid. For example, Medi-Cal -- California's Medicaid agency -- used an annual per household income of $40,000 or less as a rough qualifying estimate. However, the Centers for Medicare & Medicaid Services require each case to receive individual evaluation to take into account a family's assets and financial resources. The number of people in a household and the total financial picture play a large part in agency determinations. CMS gives special consideration to disabled and sick children in danger of being taken out of the home for lack of home care services. The agency encourages anyone who thinks they might qualify to visit their state Medicaid office for a consultation. There are also online eligibility checking tools at Benefits.gov.

    Social Security

    • Children who qualify for Supplemental Security Income (SSI) from the Social Security Administration (SSA) are automatically eligible for Medicaid. The SSA issues benefits if "the child has a medically determinable physical or mental impairment or impairments which result in marked and severe functional limitations." SSI determinations result from an in-depth examination of a child's condition and family finances. Families do not necessarily have to be low income to receive SSI but need to demonstrate financial hardship as a result of the child's disability. A successful application for SSI will entitle the child to Medicaid which will, in turn, pay for home care.

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