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Overview:
One of the most frustrating situations for parents of children with
disabilities is the income limit imposed for qualification of Supplemental
Security Income (SSI). The Deeming Waiver is a way for parents to get
Medicaid for their child with a disability when their income is too high to
qualify for SSI. This federal waiver takes the family income out of the
picture and looks at the income/assets of the child. Even if a child has
private insurance coverage, parents can apply for this waiver. Most private
insurance policies have service limitations, out of pocket expenses, and
lifetime caps. In cases where private insurance exists, the Deeming Waiver
will be beneficial as secondary insurance to cover out of pocket expenses
and will be helpful to have before a lifetime cap is met. As secondary
coverage, Medicaid will pay for 20% of covered expenses that primary
insurance does not pay.
Eligibility Criteria:
In order to apply for the Deeming Waiver the child must meet the following
guidelines.
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Child must be
under 18 years old.
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Child must meet
Social Security disability criteria.
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Caring for child
at home must be cost effective (less than nursing home cost).
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Child must be
ineligible for Supplemental Security Income (SSI) due to income and/or
assets of the parents.
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Child must meet
the criteria for nursing home placement as established by the Georgia
Medical Care Foundation (GMCF) for Medicaid recipients.
*NOTE:
This does not mean the child should be placed in a nursing home, simply that
he/she meets the nursing home criteria for care.
How To Apply:
I. Contact your county Department of Family and Children Services (DFCS).
Ask to speak with the Adult Medicaid worker, even though you are getting the
waiver for a child. The Adult Medicaid worker is the one who handles the
Deeming Waiver (General DFCS personnel are not usually familiar with the
Deeming Waiver). The Medicaid worker will schedule an appointment for you,
which will be long and in-depth. The Medicaid worker should tell you ahead
of time what you will need to bring with you to the appointment. (If not,
make sure to ask so you do not waste your valuable time). The first step in
the process is to determine ineligibility for SSI. Most of the time, the
county DFCS office can make this determination, but occasionally this is not
possible. If they cannot, they will refer you to the Social Security office
to apply for SSI for your child.
II. You will need to gather information and fill out forms in order to
document your child’s disability. The DFCS worker will tell you about this
information, give you the appropriate forms, and tell you where you can get
assistance in completing the documents.
These documents include:
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Social History:
a detailed family history.
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Psychological
Evaluation: for children with a mental retardation or developmental delay
diagnosis. This must be completed by a Psychologist (PhD.)
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Plan of Care:
service plan that states the child’s strengths, needs and recommendations.
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DMA- 6 Form:
physician’s recommendation for nursing home placement. Although the form can
be filled out by the parent it must be signed by the doctor. This form is
very important. Be sure to ask the DFCS worker to mark the areas that
require the signature of the doctor. Form should be taken to the doctor that
knows your child best. Do not have the Dr. date the form when it is signed
because it is only good for 30 days from the time it is dated. It should be
dated at the time all of the paperwork is completed and the application is
ready to be submitted.
III. When all
paperwork is complete, the DFCS worker will submit the completed packet to
the Georgia Medical Care Foundation (GMCF) for approval.
* Once a child is approved for the Deeming Waiver, a review of the child’s
continued eligibility must be completed annually.
For More Information:
If you would like to talk with another parent that has already gone through
the Deeming Waiver process, contact Parent to Parent of Georgia by phone to
request a parent match or fill out the
Peer Support Request now (be sure and
note on the form that you want a match on the deeming waiver process).
Atlanta and local calling area: 770-451-5484
Macon calling area: 478-934-3694
Statesboro calling area: 912-489-1904
Toll-Free Statewide: 800-229-2038
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A special needs
trust is the only estate planning option that protects assets, enables the
beneficiary to receive goods and services from the estate, and still
preserves eligibility for government benefits. |
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