Ask the Expert: What are the benefits for a disabled child?
My 19-year-old child is special needs disabled. My wife and I are her legal guardians. We are awaiting final determination on her Supplemental Security Income payments. Two questions that no seems to be able to answer: (1) With SSI, will enrollment in Medicare be automatic, or will we need to apply separately? (2) Once we have Medicare, which health insurance is primary? My child is still covered under my wife's insurance until age 26.
When she starts receiving SSI, your child will automatically be enrolled in Medicaid, not Medicare. Medicaid is the payer of last resort, so her mother's insurance will still be her primary coverage.
But after you and/or your wife retire, you should reevaluate the situation. The reason: An adult disabled child whose parents are retired, disabled or deceased is entitled to Social Security Disability Insurance, says Vincent Russo, a Garden City elder law attorney. And 24 months after she starts receiving an SSDI benefit (or sooner, depending on her disability), she’ll qualify for Medicare.
The difference: SSI and Medicaid are based on financial need. SSDI benefits and Medicare coverage for a disabled adult child are based on her parent's Social Security work record.
An SSDI benefit may financially disqualify her for SSI and Medicaid, says Russo. But you should reapply for them to find out. She might still be eligible. If it turns out that she qualifies for both Medicaid and Medicare, her mother's workplace insurance would still be primary if it covers 20 or more employees. If the workplace policy covers fewer than 20 people, Medicare would be primary, followed by the workplace coverage, and then by Medicaid.
The bottom line
An elder law attorney can help you navigate the complex rules that govern potential benefits for a special-needs child.
