Understanding Medicaid and Medicare

When you are raising a child with a disability, understanding health insurance options can make a big difference. Two public programs, Medicaid and Medicare, may help cover your child’s medical and care needs—even if you already have private insurance.

This page will help you understand:

• The differences between Medicaid and Medicare.
• Who might qualify
• How these programs can support your child

What Is Medicaid?

Medicaid is a health insurance program funded by both the federal and state government. It helps people with limited income and certain needs, including many children with disabilities.

In Ohio, Medicaid may cover:

• Doctor visits and hospital care.
• Therapies (speech, audiology, occupational).
• Hearing aids, glasses, wheelchairs, and other equipment.
• Mental health services.
• Home health care and personal care support.

Some children with disabilities may qualify for Medicaid even if their parents earn too much to qualify based on income alone. This may happen through:

• SSI (Supplemental Security Income): SSI is a needs based program. The income and resource limit must be met to qualify for both SSI and Medicaid. Therefore, if your child gets SSI, they automatically qualify for Medicaid.
• Waiver programs: Ohio offers Medicaid waivers that allow children with significant medical or developmental needs to get services at home or in the community. These waivers look specifically at your child’s needs and income, not yours or your whole family’s income. For example, for a child receiving child support, that money would count towards the child, but not the parent.

Learn more about waivers: Ohio Waiver Programs.

What Is Medicare?

Medicare is a federal health insurance program mainly for people age 65 and older. But some younger people with disabilities also qualify.

A child may get Medicare if:

• They have been receiving Social Security Disability Insurance (SSDI) for at least two years (this is rare for young children but more common in adults with disabilities).
• They have a qualifying medical condition, like kidney failure requiring dialysis or a transplant.

Most children with disabilities will use Medicaid, not Medicare—but both can be important as your child grows older.

Can a Child Have Medicaid and Private Insurance?

Yes! Medicaid can work as secondary insurance. That means if your child has private insurance (like through a parent’s job), Medicaid can help cover:

• Copays and deductibles.
• Services not covered by the private plan.

This can save your family money and make sure your child gets the care they need.

Having the right kind of insurance can give your child access to:

• Medical care and therapy.
• Equipment and supplies.
• In-home support.
• Case management or care coordination.

Madeline’s Law

Families should be aware of a recent legislation in Ohio called “Madeline’s Law.” Madeline's Law,  requires health insurance plans to cover hearing aids and related services for individuals 21 and younger. To use this coverage, ensure your child is verified as deaf or hard of hearing by a licensed audiologist, otolaryngologist, or other licensed physician. The plan must cover the cost of one hearing aid per hearing-impaired ear, up to $2,500 every four years, and related services like fittings. If a more expensive hearing aid is chosen, the plan will cover up to the $2,500 limit, and there are no penalties for choosing a more expensive model. Please note, Madeline’s law does not include cochlear implants. To explore other funding sources, view the Financial Aid, section of this guide.

What Can I Do Next?

• Check if your child might qualify for SSI or a Medicaid waiver.
• Talk to your county’s Job and Family Services office or a benefits specialist.
• Apply for Medicaid online at ohio.gov

Get more familiar with Medicaid and other benefits by reviewing resources like this booklet, “Planning for Bright Tomorrows: Estate and Future Planning for Ohioans with Disabilities and Their Loved Ones.”