The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program requires states to extend Medicaid coverage to low-income children for almost all medical services, but adults are a different story. There are genuinely consequential restrictions on Medicaid benefits offered to adults, as many, if not most, of the services that allow a person with disabilities to maintain function within their community have very limited coverage options. These include prescription drugs (Adderall for ADHD), respiratory care (inhalers for severe asthma), and therapy services (speech therapy for autism spectrum disorders), as some common examples.

While all states offer some degree of these optional services, no state offers coverage for all optional services used by people with disabilities. For example, as of 2012:

• Only 23 states offered private duty nursing benefits (used by anyone with a disability that prevents them from grooming themselves),

• Only 26 states fully cover speech, hearing, and language disorders,

• Only 32 states fully cover glasses,

• Only 25 states fully cover psychiatric services, and

• There are still 3 states that offer absolutely no mental health coverage!

Restricted access

The other side of this horrible coin is that there is no guarantee that a disabled young adult will be able to get coverage, even if the state offers a Medicaid program relevant to their needs. That’s because states are given broad permission to limit the scope, duration, and number of benefits offered to adults. For example, some states’ prescription drug coverage restricts any individual to receiving only 3 different prescriptions per month. Any parent of a child with severe ADHD can tell you that 3 prescriptions will only cover someone who needs a daily dose, an hour of school, and a “booster” dose of Concerta to be able to function effectively throughout the day. God forbid that same child is also diabetic and requires insulin!

Likewise, many states that offer therapy services, such as occupational, speech, or physical therapy, only cover a specific number of sessions each year, which is totally acceptable if you have an injury you’re trying to recover from. For someone with ongoing special needs for whom therapy acts as maintenance rather than recovery, who needs a therapy session every week or more for the foreseeable future, it’s a complete disaster.

waiver of support

Finally, many states are trying to reduce health care burdens by offering less expensive home and community-based services (HCBS), by obtaining a special waiver from Medicaid that allows them to create a location-based program. These HCBS waivers are good in a way, because many states wouldn’t offer any services without them, but they’re also very bad, because anyone who can’t qualify under a waiver is placed on a waiting list and receives no Medicaid services. unless they have a genuine medical emergency.

How bad is it really?

Genuinely Bad: A recent study showed that of the approximately three million Americans who need daily assistance to perform the most basic activities (to the bathroom, eat, get dressed, etc.), one million of them were unable to get assistance. they needed regularly. Specifically:

• 80% said that they regularly go one or more days a month without clothes.

• 30% said they had gotten dirty at least once in the last month because they had no other choice.

• 10% said they had gone to bed hungry at least once in the last month because they had received the help they needed to eat.

You may be thinking of seniors right now, but remember: About 10% of those three million people are between the ages of 19 and 35. That means that, in the last month, there are thirty thousand American adults who went to bed hungry because they couldn’t feed themselves, and the programs that got them to age 19 disappeared beneath them.