Developmental and Intellectual disabilities are typically present at birth, and are life-long, incurable disabilities impacting individuals’ language, cognitive and behavioral development. Sometimes, Developmental Disabilities can affect fine/gross motor, executive functioning and other adaptive functions, at times, having negative effects on other body parts, too. Typically, individuals with developmental or intellectual disabilities need long-term support in the areas of life skills, self-care, self-direction, health, safety, mobility and many other areas. The support services individuals require are in the form of nursing assistance, medical and therapeutic services (services that are covered by Medicaid).
Autism, Behavioral disorders, some Brain Injuries, Cerebral Palsy, Down Syndrome, Epilepsy, Hearing Loss, Intellectual Disability, Muscular Dystrophy, Spina Bifida, Vision Impairment and others. Individuals that do not have a developmental disability, but are deemed medically fragile, also require long-term services and may be eligible for either Katie Beckett, or the NOW/COMP waiver programs. You are considered medically fragile if you are quadriplegic, paraplegic, require a PICC line, suffer from a spinal cord injury, had a massive stroke, require ostomy care, tube fed or are ventilator dependent. As a result of the complexity of their medical conditions, many medically fragile pediatric patients are eligible for the Georgia Pediatric Program for Children (GAPP) Medicaid waiver which families can apply for with the assistance of many in home nursing support providers.
No. It is not the individual's disability that makes them eligible for a waiver. Having Autism Spectrum Disorder or Downs Syndrome, for example, is not enough to be eligible for a Medicaid waiver. It is whether the individual's disability rises to an institutional level of care that makes them eligible for a waiver. This means that the care and treatment your child would receive in the community must be comparable to that provided in a hospital, nursing home or intermediate skilled nursing facility. Individuals eligible for the Katie Beckett and NOW/COMP waivers must have been diagnosed with a developmental or intellectual disability by qualified medical professionals before the ages of 18 and 22, respectively.
If an individual is approved for a waiver which allows them to remain in the comfort and security of their home while receiving medical and therapeutic support in their community, they must receive a minimum amount of care equivalent to what they would receive, if they were in fact institutionalized in a hospital, nursing home or skilled intermediate nursing facility. If your child receives services in school such as speech, occupational or physical therapy, school-based therapy counts toward your child's minimum of 5 weekly sessions, as long as your Pediatrician requests school-based therapy in their order (script) for total weekly sessions. In some circumstances a child may not be required to participate in 5 weekly therapy sessions based on the results from a Psychological Evaluation using intelligence and behavioral testing.
A Pediatrician is the primary provider responsible for managing the overall medical care your child receives. Depending on your insurance provider, your Pediatrician is often required to make referrals to other healthcare providers to insure any additional services may be covered. But, in areas where a child's development, or behavior is a concern, it may be necessary that you and your child's Pediatrician work together to seek the services of a more specialized physician such as a Developmental Pediatrician. Developmental Pediatricians have attained more advanced training in all areas of child development. Depending on your child's disability, you may also need the services of even more specialized physicians or researchers such as an Endocrinologist, Neurologist, Cardiologist, Physiatrist, Geneticist or Gastroenterologist. Regardless of your child's healthcare needs, it is always best to consult first with their Primary Pediatrician, regarding any medical services performed by other providers. This ensures that continuity of care is properly managed, and that you, along with the counsel of your child's doctor, will make the best informed decisions regarding your child's care. Additionally, your child's pediatrician will be necessary in attesting to their level of care when applying, or reapplying for a Medicaid disability waiver.
Yes! Easterseals of North Georgia's Champion for Children Program is an excellent option for children who are medically fragile, have developmental disabilities and are not eligible for Katie Beckett. The program provides financial assistance and support to families needing medical or therapeutic services for their children.
If your child is approved for a waiver, Medicaid will go back 90 days from the date of the application to pay medical bills. The way that works is you have to let those providers know to bill Medicaid for those costs. If you've paid out of pocket for those predated medical expenses, the providers will reimburse you after their claims have been paid by Medicaid. Medicaid does not reimburse individuals. Medicaid only pays providers that accept Medicaid. Medicaid can serve as a child's secondary form of insurance while their parents' insurance can remain as primary coverage. Medicaid could also serve as a child's primary insurance if there is no other form of primary insurance.
Absolutely! Depending on your loved ones' medical condition, there may be other waiver programs offering more specialized services suitable to their healthcare needs. To find the right Medicaid waiver for your disabled loved one, please click below.
Shortly before your chlld turns 18, you'll receive notification from the Katie Beckett Centralized Office that their Medicaid will terminate on the last day of the month they turn 18. It is critical that you contact the Centralized office to request that your child's Katie Beckett Medicaid is changed to Transitional Adult Medicaid to prevent a gap, or loss in coverage. By this time, your child should have also been placed on the Long Term Planning List for the NOW/COMP Waiver, which we recommend families immediately apply for upon your child's initial approval for Katie Beckett. You would then need to apply for SSI for your child as early as the day after they turn 18. In order to maintain your child's Transitional Adult Medicaid you will have to provide evidence to the Centralized office that you've applied for SSI for your child. After being interviewed by a SSI worker, you will receive a determination letter if benefits are approved. If benefits are not approved, you may need to seek the services of an experienced SSI Disability attorney.
Like Hospital In-Patient and Marketplace Exchanges, Medicaid has a Drug Formulary of approved drugs it may cover the cost for patients whose medical providers prescribe for them.
If it is suspected that your child is exhibiting learning and developmental delays, psychological testing will be required to determine a proper diagnosis so that medical, therapeutic and educational supports can be ordered for the child. As part of the Katie Beckett and NOW/COMP application requirements, a current psychological evaluation (one that is not more than 3 years old) must be done and submitted along with the child's application. Psychological testing may be done by a private psychologist, or one that works for your local school system. Psychological evaluations can even be performed by developmental pediatricians. Make sure that the clinician performing the tests have the proper credentials as required by the state they're licensed in. It is very important that before ANY other assessments are performed on your child that their pediatrician make their own physical examination to rule out any other diagnoses that may be negatively impacting the child's learning or development.
There are several tests that are used to evaluate a child's development. It will be determined by the clinician performing the evaluation which tests are necessary to use based on some of the initial feedback they obtain from parents, medical providers or even educators who are able to provide their personal assessments of the child's development. Typically, the evaluating clinician will test a child's intelligence, adaptive and executive functioning, information processing, social and emotional development and even use interviews and questionnaires completed by parents and teachers. The psychological evaluation is a required component of the disability review process as it helps to determine, along with other required documents, if a child's disability meets an institutional level of care.
Parenting is truly the toughest job you'll ever love! But, when it involves parenting a child with disabilities, it can be a bit more challenging. Parents of Special Needs kids need to know there are highly trained professionals available to support parents and their children to lessen, or prevent crisis situations.
As disabled children experience transitions throughout their primary and secondary education the same will be the case for their healthcare needs . Families are often stressed and left wondering what doctors will care for their disabled children when they become older. Typically children stop receiving medical services from their pediatricians and pediatric therapists around 18 to 20 years old. At that time, It will be necessary to transition them to medical providers who treat, and understand the substantial medical needs of developmentally or intellectually disabled adults. Sometimes families and caregivers begin their child's transition to adult healthcare as early as 12 years old. The Adult Disability Medical Healthcare (ADMH) is a service provider for disabled teens and adults providing primary and some speciality healthcare. There are 4 physicians on staff at the ADMH. The ADMH also partners with hospitals and private practitioners who offer more specialized medical services when such treatments are necessary. The ADMH is on the cutting edge of advances in medical technology as it uses Telehealth to offer not only convenience to its patients, but the same high quality services patients and their families have become accustomed to for many years. The ADMH accepts Medicaid and insurance, and has provided care to disabled individuals from all over Georgia and other states. C.A.M.P's Founder and Executive Director also proudly serves as a member of ADMH's Board of Directors. To learn more about how the ADMH assists teens and adults with developmental disabilities, please visit their website at www.theadmh.org
Telemedicine, more commonly referred to as "telehealth" has been around for several decades. It's become more popular in the last decade as a way to diagnose, analyze and treat patients. During the COVID-19 Pandemic, it became an efficient way to maintain healthcare while preventing the spread of the Coronavirus. Telehealth became a household word in the disability community as healthcare providers in clinical and educational settings used it to provide health, therapeutic and even Special Education services to students with intellectual and developmental disabilities during the state mandated "Shelter-in-Place" order.
Community Service Boards provide a wealth of healthcare services for individuals affected by mental illness, behavioral health issues and those with intellectual disabilities. These boards receive funding and oversight by the Georgia Department of Behavioral Health and Developmental Disabilities. Georgia has at least 26 recognized community service boards; many serving multiple counties around the state. So, not every county has its own service board. Additionally, service boards assist in the treatment and recovery of those affected by substance abuse. Community service boards are also the "safety nets" for eligible uninsured or under insured individuals who, without the support of their local service board, would not have access to the necessary healthcare, peer support, residential treatment, crisis intervention and even job training opportunities these agencies provide. To learn where your nearest community service board is, and to learn if you or someone you're caring for may benefit from them go to: https://dbhdd.georgia.gov/locations/community-service-board
The Georgia Crisis and Access Line has professional counselors working 24/7 to listen and get you the help you need
The Georgia Crisis and Access Line also supports families, advocates and healthcare providers of developmentally disabled individuals needing critical and emergency resources