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    • Navigating government benefits: A checklist for supporting individuals with special needs

    A mother and child siting at a desk covered with papers, a water bottle and a fidget.

    Government benefits can be complex, especially for individuals with special needs and their caregivers. By understanding these programs, you can help your clients maximize their financial resources, maintain eligibility for necessary services and build a more secure future.

    Key government benefits

    Medicaid

    • Provides health care coverage for low-income individuals and includes services such as doctor visits, hospital stays, prescription medications and home health care
    • Working adults with disabilities may still qualify for Medicaid through special programs such as Medicaid Buy-In, depending on the state
    • Medicaid eligibility criteria and covered services can vary by state

    Eligibility: Eligibility is based on income, assets and disability status and can vary significantly by state. 

    For more information visit Medicaid’s website.

    Medicare and Medicaid offer dual eligibility

    Dual eligibility for Medicare and Medicaid is when an individual qualifies for both federal insurance programs, often due to low income and disability. 

    Who qualifies:

    • Individuals who are enrolled in Medicare and also meet their state’s requirements for Medicaid eligibility, which often includes those with low income and limited assets
    • Those who receive Supplemental Security Income (SSI) are also typically eligible for Medicaid 
    • Those who are 65 or older qualify for Medicare, as do younger people with qualifying disabilities
    • States may have their own unique criteria for Medicaid eligibility

    Medicare

    • Provides health care coverage for people 65 and older
    • Provides coverage to younger people with certain disabilities or conditions

    Eligibility: Individuals age 65 or older are eligible. It also covers individuals under 65 with certain disabilities who qualify for Social Security Disability Insurance (SSDI) benefits, but only after they have received SSDI benefits for 24 months. Those first 24 months act as a waiting period before Medicare coverage begins.

    For more information visit Medicare’s website.

    Supplemental Security Income (SSI)

    • Offers financial assistance for basic needs such as food, clothing and shelter
    • SSI eligibility is very sensitive to income; even part-time work can disqualify someone

    Eligibility: Individuals with disabilities and limited income/resources are eligible, but they must have less than $2,000 in countable assets. Note: The SSI definition of “disabled” is different for children1 and adults.2

    To learn how to apply for SSI, visit the Social Security Administration's website or call 1-800-772-1213.

    Social Security Disability Insurance (SSDI)

    • SSDI provides benefits to individuals who have worked and paid into Social Security but are now disabled or those who are the disabled beneficiaries of eligible workers 
    • SSDI benefits are not affected by how much money an individual makes, as long as they’re not earning more than the limit for what’s considered substantial work under Substantial Gainful Activity (SGA)
    • When someone who’s been getting SSDI moves into a nursing home or assisted living, they usually stop receiving the SSDI money directly; instead, that money is typically used to help cover the cost of their care, and it goes to the facility providing the services

    Eligibility: Eligibility is based on work history and/or disability status.3

    Learn how to apply for SSDI by by visiting the Social Security Administration's website.

    Disabled Adult Child (DAC) benefits

    • A unique benefit that allows adults disabled before age 22 to receive benefits based on a parent’s Social Security earnings; DAC benefits are a critical option for adults with lifelong disabilities
    • These benefits are often higher than SSI and include Medicare, while allowing continued Medicaid coverage if previously enrolled

    Eligibility: The parent must be deceased, retired or disabled.

    Access the Benefits for Children with Disabilities (PDF) brochure for more information.

    Supplemental Nutrition Assistance Program (SNAP)

    • SSDI provides funds for food purchases
    • There are some special eligibility rules for households with older adult or disabled members.

    Eligibility: Similar to SSI, eligibility is based on income and resources and can vary significantly by state.

    You must apply for SNAP in the state where you currently live.

    Housing

    • Assisted living: Residential communities designed for individuals who need some help with daily activities but do not require the intensive medical care provided in nursing homes
    • Nursing homes: Skilled nursing facilities are residential care facilities that provide a high level of medical care and assistance with daily activities for individuals who are unable to manage independently due to age, illness or disability
    • Institutional facilities: These include state-run or Medicaid-funded facilities that provide long-term care for individuals with significant disabilities or medical needs; examples include Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) and developmental centers
    • Personal residence or private living arrangements 

    Eligibility: Eligibility is based on financial means, medical qualifications and disability status. Access to assisted living, nursing homes and institutional facilities is subject to availability, and placement may involve long waitlists or limited geographic options, even for those who qualify under Medicaid.

    A quick glance at eligibility considerations for government benefits
    Government benefit Eligibility Child
    (under 18)    		 Adult (18-64) not working Adult (18-62) working Senior (65+) Notes
    Medicaid Based on income, assets and disability status YES
    If family income qualifies or through SSI    		 YES
    If income qualifies or through SSI/SSDI    		 YES
    If income qualifies (some states allow working disabled)    		 YES
    With SSI or income-based    		 Can vary by state; working adults may qualify under “Medicaid Buy-In”
    Medicare Primarily for individuals age 65 or older NO YES
    After 24 months on SSDI    		 YES
    After 24 months on SSDI    		 YES
    Automatically at 65    		 Individuals under 65 with certain disabilities who qualified for SSDI benefits — but only after they have received SSDI benefits for 24 months
    SSI Individuals with disabilities and limited income/ resources; must have less than $2,000 in countable assets YES
    Must meet Social Security definition of disability for children1

    Limited income/ resources are low    		 YES
    Must meet disability or age criteria2

    Limited income and resources    		 YES
    Must meet SSI income and resource tests    		 YES
    Limited income and resources    		 Strict income limits; working may disqualify
    SSDI Based on work history and/or disability status3 NO YES
    If sufficient work history and disabled    		 YES
    If sufficient work history and disabled    		 YES
    If disabled before 65 and had work history    		 Based on work credits
    DAC The parent must be deceased, retired or disabled NO YES
    If disabled before 22 and parent is retired, disabled or deceased    		 YES
    If disabled before 22 and parent is retired, disabled or deceased    		 YES
    If disabled before 22 and parent is retired, disabled or deceased    		 Not income-based; based on parent’s record
    SNAP Similar to SSI, based on income and resources; can vary by state YES
    If household qualifies    		 YES
    If income/ resource qualifies    		 YES
    If income/ resource qualifies    		 YES
    If income/ resource qualifies    		 State rules vary; SSI recipients often qualify
    Housing Based on financial eligibility, medical and disability status YES
    If family qualifies    		 YES
    If income qualifies and disability is verified    		 YES
    If income qualifies and disability is verified    		 YES
    If income qualifies and disability is verified    		 Long waitlists; local housing authorities manage programs

    Help your clients make the most of available government benefits

    A mom kneels beside her child seated at a desk in front of a window.
    Your clients count on you to make sure they’re planning their finances appropriately and taking advantage of any available resources. By connecting caregivers and individuals with special needs to the right government agencies, you can help them explore the benefits available and guide them through the steps needed to access these resources.

    Download the client checklist (PDF)


    [1] For children: To qualify for SSI, a child must have a physical or mental health condition that significantly limits their ability to function; this condition must either have lasted or be expected to last for at least 1 year or be life-threatening.
    [2] For adults: To qualify for SSI, an adult must have a physical or mental condition(s) that prevents them from engaging in meaningful work; the condition has lasted, or can be expected to last, for a continuous period of 12 months or more.
    [3] Disability status for SSDI is determined based on work status and living arrangements, such as living alone vs. in nursing homes or assisted living.