Navigating the complex landscape of government benefits and resources is critical for families caring for loved ones with special needs. The path can be overwhelming, but support, services, and financial assistance are available to help you along the way.
In this blog, we’ll explore the diverse array of government programs and resources available to families with special needs and offer guidance on how to access these services, what each program includes, and how to maximize the assistance provided.
Whether you’re seeking information about Social Security Benefits, Medicaid, educational services, housing assistance, food assistance, etc., this comprehensive guide will help you chart a course toward a more accessible and fulfilling future for your family.
Social Security Disability Insurance (SSDI)
Social Security Disability Insurance (SSDI) is a federal government program that provides financial assistance to individuals who have a disability and can no longer work due to their medical condition. It’s part of the broader Social Security program and is designed to offer financial support to disabled workers and their eligible family members.
Let’s break down the qualification requirements and application process for SSDI.
Qualification for SSDI
To qualify for Social Security Disability Insurance, you must meet several criteria. First, the person applying must have a severe, long-term disability that prevents them from engaging in substantial gainful activity (SGA). The disability also must be expected to last for at least 12 months or result in death.
In addition, the applicant must have a sufficient work history and earn enough “work credits” through Social Security payroll taxes to be eligible. The number of required work credits varies based on an individual’s age when they became disabled.
Children who apply for SSDI do not need work credits to be eligible for benefits. SSDI is primarily intended for disabled individuals with a work history who have earned work credits by paying into the Social Security System through payroll taxes. Since children don’t have a work history or earnings record, they are not subject to this requirement.
To apply for SSDI, you will need the following information/documentation:
- Medical records, doctor’s reports, and test results that document your disability and its severity.
- Social Security number and proof of age.
- Work history, such as W-2 forms, tax returns, or pay stubs.
- Information about any workers’ compensation or other disability benefits you receive.
- Documentation of any other income sources.
It’s important to note that the application process for SSDI can be complex and time-consuming, and many initial applications are denied. You can appeal and provide additional evidence to support your claim.
Getting denied for SSDI is a common occurrence, so it can be easy to get discouraged. Know that you’re not alone! Some applicants seek legal assistance or representation to help them navigate the process. In addition, don’t let the fear of getting denied keep you from applying in the first place. SSDI can be a significant asset for individuals and families with special needs, so the process is worth it.
If approved for SSDI benefits, you’ll receive monthly financial support based on lifetime earnings before your disability begins. In addition, in some cases, family members of the approved individuals (spouse, dependent children, etc.) may also be eligible for auxiliary benefits.
Individuals who qualify for SSDI benefits may also qualify for Medicare. We’ve covered Medicare on our blog before, but let’s quickly run through an overview.
Medicare is a federal health insurance program that covers hospitalization (Part A) and medical services (Part B). Most people become eligible for Medicare after receiving SSDI for 24 months, regardless of age. Some states also offer Medicaid to SSDI recipients, providing additional coverage.
Supplemental Security Income (SSI)
Let’s switch gears and dive into Supplemental Security Income (SSI). SSI is a federal needs-based program that provides financial assistance to low-income individuals aged, blind, or disabled. The main goal behind financial assistance is to help individuals and their families meet their basic needs like food, shelter, and clothing and, of course, have access to the medical care they need.
The program is also administered through the Social Security Administration (SSA). It is designed to provide a safety net for people with limited income and resources meeting specific disability or age-related criteria.
To be eligible for SSI, an individual must be aged 65 or older, blind, or disabled. The SSA defines disability as a physical or mental impairment expected to last at least 12 months or result in death.
Applicants for SSI must have limited income, which includes any earned income, unearned income (Social Security benefits, pensions, and financial support from others), and in-kind support and maintenance. The income limits can change annually and vary by state.
Another requirement that those who receive SSI must be aware of is the “resource threshold.” SSA identifies resources as things that you own, like:
- Bank accounts
- Stocks, mutual funds, or savings bonds
- Life insurance
- Personal property
- Anything that could be changed to cash and used for food or shelter.
Also included is something called “deemed resources.” In some situations, SSA will “deem” a portion of the resources of a parent, spouse, parent’s spouse, etc., belonging to the person who applies for SSI. The maximum resources allowed are $2,000 for an individual or $3,000 for a couple.
For example, if a child under 18 lives with a parent, $2,000 of the parent’s total countable resources does not count, if the child lives with two parents, $3,000 does not. SSA counts any amount over the parents’ limit as part of the child’s $2,000 resource limit.
It’s important to note that things like the home the individual lives in, household goods, personal effects (such as wedding rings), burial spaces, life insurance policies, values under $1,500, and others do not count as resources and cannot be counted towards the limit.
An individual’s SSI payment depends on living situation, income, and resources. Since payments are meant to supplement the individual’s income to ensure they have a minimum level of support, the amounts received will vary from person to person. The maximum monthly SSI payment in 2023 is $914 for an individual and $1,371 for a couple (please note that these amounts tend to follow inflation rates).
Most SSI recipients automatically qualify for Medicaid. This program provides comprehensive medical coverage for doctor’s visits, hospital stays, prescription drugs, and other essential healthcare services.
Medicaid is often critical for individuals with disabilities because it helps cover the often significant healthcare and long-term care costs.
Medicaid Waiver Program
A lesser-known program, the Medicaid Waiver Program, is a set of programs within the United States that allows individual states to provide additional and specialized services to specific populations of Medicaid beneficiaries. The programs offer flexibility within the Medicaid system to address the unique needs of specific groups of people who may not otherwise qualify for Medicaid.
Here’s a quick rundown of how this program works:
- Targeted Services: Waivers are designed to target specific individuals’ needs, such as people with disabilities, seniors, children with special healthcare needs, or those requiring long-term care.
- State Flexibility: States are given flexibility to design their own Medicaid waiver programs to address the unique needs of their state’s population.
- Additional Services: The waiver program allows states to offer services beyond what is covered under the standard Medicaid benefits package. This often includes home and community-based services, personal care assistance, assistive technology, transportation, etc.
Ultimately, the goal of the Medicaid waiver program is to help keep people with disabilities or specialized healthcare needs within their homes and community (least restrictive setting) rather than an institutional setting (like a nursing home or other long-term care facility).
To apply for the waiver program, a person must meet the following criteria:
- Have a qualifying condition or disability (developmental disabilities, traumatic brain injuries, AIDS, substance abuse disorders, etc.)
- Demonstrate a need for the specialized services provided by the waiver
There are a few other things you should be aware of about the Medicaid waiver program:
- Waitlists: Some states have limited funding, so there may be waitlists for services. This means you would have to wait until funding becomes available before receiving services through the waiver program.
- Application process: Typically, the application for Medicaid waiver services is done through your state’s Medicaid agency. The application process may also involve providing medical documentation demonstrating the need for waiver services. You can also get help from your state development disability administration (the actual name of the agency varies by state).
- Renewal and assessment: Waiver beneficiaries are periodically re-evaluated to determine whether they meet the service requirements. This ensures that the limited funds are directed to individuals who continue to have the most significant level of need.
Various benefits are available to families with special needs that don’t fall under the Social Security Administration umbrella. Let’s take a look through a few of them.
Children’s Health Insurance Program (CHIP)
The children’s health insurance program (CHIP), also known as the State Children’s Health Insurance Program (SCHIP), was created to help bridge the gap in healthcare coverage for children whose families have income that is too high to qualify for Medicaid, but may not be able to afford private health insurance.
CHIP provides comprehensive coverage (doctor’s visits, immunizations, hospital care, medications, etc.) for children under 19 who meet specific eligibility requirements. Since CHIP is structured for low-income families, premiums and cost-sharing are generally based on the family’s income level. Many states provide coverage for little to no cost for eligible families.
CHIP is a state-managed program that often works closely with Medicaid. Each state can vary in eligibility rules, benefits, and the application process. CHIP and Medicaid also work closely together because children can transition between the two programs as the family’s financial situation changes to ensure they maintain consistent healthcare coverage. That said, CHIP coverage needs to be renewed annually in case of eligibility changes.
Children with disabilities can also receive coverage through CHIP as long as they meet the other program requirements. A child eligible for CHIP and Medicaid (“dual-eligible”) may receive a combination of benefits from both programs to ensure they receive the services they need.
Supplemental Nutrition Assistance Program (SNAP)
The Supplemental Nutrition Assistance Program (SNAP) provides eligible low-income individuals and families with funds to purchase food. SNAP is administered through the federal government and is designed to help provide equal access to an adequate and nutritious diet regardless of financial circumstances.
The eligibility requirements for SNAP include:
- Income: Household income must be at or below a specific percentage of the federal poverty level. This can vary by the size of your household.
- Resources: Similar to other programs, households must also meet resource limits (bank accounts, real estate property, etc.)
Families with special needs children may have unique circumstances that impact their SNAP eligibility:
- Higher Expenses: The additional costs associated with caring for a child with special needs can be considered when determining household expenses, affecting your eligibility.
- Medical Expenses: Out-of-pocket medical expenses related to the child’s condition may be deducted from income when determining eligibility, potentially increasing your benefits.
- Caregiver Costs: If a parent or guardian of a special needs child has to pay for child care or other services due to the child’s disability, these expenses can be considered when determining eligibility and benefits.
Because these factors influence eligibility, families with special needs children need to provide thorough information throughout the SNAP application process.
Federal housing assistance includes various programs to help low-income individuals and families secure safe and affordable housing. These programs include a housing choice voucher, public housing, project-based rental assistance, and more. But let’s look closer at the housing assistance program tailored for individuals with disabilities.
- Section 811 Supportive Housing for Persons with Disabilities: Offers rental assistance and supportive services to help individuals live independently. It does this in a few different ways.
- Capital Advances: Grants provided to nonprofit organizations to fund the construction, rehabilitation, or acquisition of housing units specifically designed for people with disabilities.
- Project Rental Assistance: Covers the difference between the residents’ contribution toward rent and the HUD-approved payment standard. This ensures that eligible individuals will only have to pay the portion of the housing they can afford.
- Supportive Services: These can include assistance with activities of daily living (bathing or dressing), case management, access to transportation, and coordination of medical and mental health services. These services are typically provided on-site or near the housing location.
To be eligible, applicants must be low-income and have a disability. While this program is typically tailored for adults with disabilities, some programs can serve individuals transitioning from institutions or youth aging out of foster care.
Applications for housing assistance are processed through the local housing authority, nonprofit organizations, or service agencies that receive funding through Section 811. In addition, a referral from a social worker, healthcare provider, or other service provider is required.
This resource is crucial for individuals with disabilities who need affordable and accessible housing combined with supportive services to maintain their independence and well-being. The program is designed to foster a sense of inclusion and self-sufficiency essential for individuals with disabilities.
Individuals with Disabilities Education Act (IDEA)
Every child deserves a well-structured, supported, and engaging education, no matter their circumstances. The Individuals with Disabilities Education Act (IDEA) is a federal law within the United States that ensures all students with disabilities receive a free and appropriate public education (FAPE) tailored to their needs.
Before IDEA was passed in 1975, many children were denied education and learning opportunities. It’s reported that in the 1970s, U.S. schools educated only one in five children with disabilities, and many states had outright laws excluding students with disabilities.
Significant progress has been made toward developing and implementing programs and services for early intervention, special education, and related services. Rather than excluding children with disabilities, U.S. public schools in 2021 provided more than 7.5 million children with disabilities with special education and other related services. Further, in 2021, 66% of those children were in their general education classrooms for most of their school day, allowing them a stable environment and connection to familiar teachers and friends.
To further understand the impacts of IDEA in our schools, lets explore several key provisions it includes that are vital for students with disabilities.
- Individualized Education Programs (IEPs): Every disabled child must have an IEP. This written plan outlines their educational goals and the services and support they need to achieve them.
- Appropriate evaluation: Schools are required to conduct thorough evaluations to determine a student’s disability and educational needs. These evaluations are essential in developing a thorough IEP.
- Least restrictive environment: Students with disabilities are ensured the right to be educated to the maximum extent possible with their typically developing peers. This encourages inclusion inside of their regular classroom.
- Procedural safeguards: IDEA has a range of legal protections and dispute resolution processes to ensure that the rights of students with disabilities and their parents are upheld.
- Transition planning: The transition from school to adulthood is a significant focus within IDEA. It addresses the importance of preparing students for post-secondary education, employment, and independent living.
Even with these safeguards, advocating for your child’s education and needs is essential. We’ve compiled a list of ways you can be involved in your child’s educational process to help ensure their needs are met.
- Understanding your child’s needs: It’s critical to deeply understand your child’s specific needs, strengths, and potential weaknesses. This will help guide the development of their IEP and further inform your advocacy efforts.
- Requesting an evaluation: If you suspect your child may have a disability, you can request an evaluation from your school district to determine your child’s eligibility for special education services. Typically, this is the first step for students with disabilities in the public school system.
- Participate in the IEP creation process: If/once your child is eligible for special education services, be sure to actively help create their IEP. You can attend IEP meetings and collaborate with school personnel and administration. Ultimately, to ensure that the IEP addresses your child’s needs.
- Know your rights: Familiarize yourself with the rights and protections provided to you and your child under IDEA. They can provide valuable insights and support while implementing your child’s IEP.
- Collaborate with school staff: Teachers and administrators want the best for your child. Since you have the same goal, establish open, honest, and collaborative communication with your child’s teachers and other school personnel.
- Advocate for your child: If your school is not adequately meeting your child’s needs, don’t hesitate to voice your concerns or seek additional support or legal guidance.
IDEA is the piece of the puzzle that helps ensure students with disabilities can receive an education tailored to their unique needs. To ensure your child’s rights are upheld, and their education is benefiting them in the best way possible, effective advocacy and collaboration with your child’s school are essential.
Temporary Assistance for Needy Families (TANF)
This federal program provides temporary financial assistance to low-income families and individuals facing financial hardship. TANF is designed to help families meet their basic food, housing, and childcare needs and promotes self-sufficiency.
Let’s walk through how TANF works, eligibility requirements, the application process, highlight the potential benefits for families with special needs, and how to maximize its resources.
It’s important to note that while TANF is a federal program, it’s state-administered, meaning the operation can somewhat vary from state to state, but some features should remain standard.
- Eligibility: TANF eligibility is primarily based on financial need (depending on your income and family size). To qualify, families must have low income and assets (exact amounts depend on your state).
- Work requirements: Recipients are generally required to engage in work-related activities like job training, education, or employment as a condition of receiving the benefits. The reason for this is the goal of TANF is to help families become self-sufficient.
- Time limits: As the name implies, TANF benefits are generally time-limited. After reaching the maximum time limit (typically 60 months), you may become ineligible.
Specifically, for special needs families, the following TANF resources can be highly beneficial:
- Cash assistance: Caring for a child with special needs can be expensive. To help with that, TANF can provide cash assistance to cover any additional costs incurred from your child’s disability.
- Child care assistance: TANF can help families access affordable childcare services, which are essential for parents with additional caregiving responsibilities.
- Job training and education: Job training and educational programs can be valuable for parents seeking to improve their employment prospects and better support their families.
- Support Services: Some states offer direct support services for special needs families, like case management and referrals to disability-specific resources.
To apply for TANF, you’ll first need to contact your state’s TANF office. From there, you will complete the application, provide the required documentation (proof of identity, income, assets, residency, medical information, etc.), and potentially participate in an interview to review your application.
You can do a few things to maximize your TANF resources if you are deemed eligible. First, be sure to engage in the job training and educational programs available. These can help improve your employment prospects and, ultimately, your financial stability. Second, use childcare assistance to ensure you have the support you need to attend work or training or care for your loved one with special needs.
Next, don’t be afraid to seek assistance for housing, utilities, or other basic needs to free up your budget for other expenses related to caring for your special needs child. And lastly, be sure to stay informed about changes in TANF rules and eligibility requirements to ensure you remain compliant.
The Developmental Disabilities Administration (DDA)
This state agency exists in various U.S. states to provide services and support to individuals with disabilities and their families. While the specific structure and function of DDA may vary from one state to another, their primary mission is to help individuals with developmental disabilities lead fulfilling lives and access the support and services they need.
Here are a few things that DDA does:
- Eligibility determination: Responsible for assessing an individual’s eligibility for services and supports based on their disability.
- Individualized service planning: Work with individuals and their families to develop person-centered plans that outline the services and supports they need to achieve their goals and improve their quality of life. Typically, these plans include specific interventions, therapies, and other resources tailored to the person’s unique needs.
- Access to services: DDA often plays a significant role in helping families access a wide range of services. This can include healthcare, behavior therapy, educational support, vocational training, etc. They might be able to help you find resources that you don’t even know exist!
- Residential supports: They facilitate and coordinate residential services for individuals with disabilities like group homes, supported living arrangements, and other community-based options.
- Family support: They recognize the importance of family support and can provide resources to families caring for individuals with developmental disabilities.
- Advocacy and community integration: They promote the inclusion and integration of individuals with developmental disabilities in their communities. This can involve advocacy for rights and initiatives to reduce stigma and discrimination.
- Quality assurance: They typically monitor the quality of services of agencies and providers in their area and ensure compliance with regulations and standards.
- Resource coordination: They are a central point of contact for individuals with disabilities and their families. They are here to help navigate the complex network of services and resources in your state.
Pro Tip: For information on DDA in Washington, please visit this website.
Tips for Maximizing Government Resources
Now that you’re aware of all of the resources available to you, it’s time to explore how you can best maximize your benefits. This is essential for ensuring the well-being and support of your loved ones with special needs.
Let’s explore practical steps to help you navigate the system, stay informed about policy changes, and determine when to seek professional guidance.
Understand The Benefits Available To You
Research (just like you’re doing now!) the various government benefits that are available and relevant to your family’s needs. In addition, be familiar with the eligibility requirements and benefits provided by each different program.
Connect With Local Resources
Contact local disability advocacy organizations, support groups, and community centers. They can be a vault of valuable information. For example, Ben’s fund in the state of Washington helps children and young adults with Autism by funding grants
Maintain Accurate Records
Keep detailed records of medical and educational documentation and all finance and benefit-related paperwork. These help you substantiate your needs, eligibility, and resources, and you will save yourself stress and time if you maintain their updates.
Attend Workshops and Training
Consider attending workshops or sessions offered by DDAs in your area. These can provide further in-depth information on government benefits and the application process.
Review Eligibility Regularly
Changes in income, assets, or the disability status of your child can impact your eligibility. Notify the relevant agencies if you experience any changes, and periodically review your eligibility status.
Know Your Rights
Familiarize yourself with your rights as a parent and advocate for your child with special needs. This is crucial for ensuring your child gets the services they need.
Plan For The Future
Stay Informed About Policy Changes
Subscribe to government agency newsletter, follow reputable advocacy organizations, and read policy updates and any official publications from government agencies.
Build a Support Network
This is one of the best things you can do for your child and your family. Connect with other families that have special needs to exchange information and experiences. They can offer insights into their journey to accessing government benefits or simply be an understanding friend or ally.
Seek Professional Guidance
If you encounter challenges or have complex questions about government benefits, don’t hesitate to seek professional guidance. For example, if you’re unsure about eligibility criteria, need to appeal a denied application, or need help with estate planning or financial management.
Bringing It All Together
Navigating the system for government benefits can be challenging, but with the right resources, information, and support, you can maximize access to the assistance your family with special needs requires. Being proactive, staying informed, and seeking professional help if necessary are key steps in this process.
At TFS Advisors, we know first-hand how difficult it can be to navigate the world of government benefits and financial planning for special needs. No family should have to choose between their financial stability, the well-being of their child, and the needs of their family. A solid financial plan can help relieve stress so you can focus more on your loved ones.
It can be easy to feel alone on this journey, but that’s far from true!
Please reach out to us today if you have questions regarding government benefits, inclusive financial planning, or special needs trusts. We’re here to help you and your family meet your goals and live a happy, fulfilling life.