Aging Out of EPSDT – Part IX: More Strategies

In the last post, we talked about how families with disabled children aging out of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program in a non-Medicare-expanded state might deal with the likely failure of the system to provide for their loved one’s health care. We’re doing the same thing here, but looking at a handful of smaller programs.

Military Benefits

If you are a veteran and the parent of a disabled adult child, you can ask the military to designate your child an Incapacitated Dependent, which will qualify them for limited TRICARE benefits. Like most such benefits, those offered by SSI and Medicare are more comprehensive, but should they not qualify, TRICARE can at least contribute something.

Start a Charity

There are a startling number of ways to ask for charitable donations in today’s connected world, from old-school options like putting coin banks on the counters of local stores to social-media-friendly options like GoFundMe. These can be highly successful short-term options, but they tend to not last over an extended period of time. Also, in most states, the only wise way to deal with the proceeds of such a charity is by setting up a Special Needs Trust — any other disbursement might end up counting as income for the person with special needs, and thus quite accidentally get them kicked off of Medicaid or SSI. Ask a lawyer before you go this route.

Apply for a Grant

Not that many grants exist in the United States for families — most of them are by organizations, for organizations — but a few do. The list available at is a good place to start for nationwide resources; for more local opportunities, inquire at your Area Agency on Aging. Finally, consider looking up resources specific to your loved one’s disability, such as this list for people on the autism spectrum.

Seek a Tax Break

For certain extremely poor families who spend an extraordinary amount taking care of a disabled loved one, the tax break for medical expenses might be worth their while. Essentially, everything you pay for your family’s medical expenses over 10% of your adjusted gross income is deducted from that taxable income. It’s really not much, but for families in such desperate straits that 11% or more of their gross income is going to medical bills, it could literally be a lifesaver.

Leveraging Existing Resources

Many families, while poor in income due to economic circumstances and burdened by staggering amounts of debt, nevertheless have some surprising resources at their disposal. If you know for certain that your disabled loved one is going to be able to get coverage by a certain time, you could consider getting a reverse mortgage and pulling some money out of your home’s equity to help you make it that far.

Bridge Loans

Similarly, several lending institutions (particularly credit unions and other local banks) offer ‘bridge loans’ to families who can show that they have a defined waiting period they need to cover in order to ‘bridge’ successfully onto Medicaid or a similar comprehensive program. These loans will need to be paid back, but they are a tool that shouldn’t be discarded out-of-hand.

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Aging Out of EPSDT – Part VII: Taking Responsibility

For the last six posts, we’ve talked a lot about all of the factors that go into making the transition from child with special needs (covered by the Early and Periodic Screening, Diagnosis, and Treatment — EPSDT — program) to adult with special needs a particularly traumatic event for low-income families. We’ve talked about the states that declined the Medicaid Expansion offered by Obamacare, and about the failures within Medicaid that make the non-expanded version fail so many low-income adults with disabilities. We’ve talked about the costs this can have on the families who have to pay for their newly-adult children with disabilities out-of-pocket.

What we haven’t talked is how much these failures are costing all of us. Not just in some sort of moral-outrage kind of way, either, but in terms of actual tax money out of our pockets.

Emergency Treatment is a Right…

Treatment for medical emergencies became a universal right in the United States in 1986 — if anyone, insured or not, shows up at a hospital ER with a life-threatening emergency, the ER is legally obligated to treat them until their lives are no longer in danger. If that person is uninsured, has no money, and the hospital cannot convince Medicaid that they should be covered, the hospital uses a perfectly valid and legitimate technique called ‘price shifting’ to essentially bill Medicaid anyway, by charging slightly more for all of the other Medicaid-covered services they offer.

… That We All Pay For

That sounds like it might be a no-loss situation for the taxpayer, but that couldn’t be further from the truth, and here’s why: medical emergencies cost an unbelievably greater amount than medical maintenance. The cost to keep someone with severe asthma on a potent inhaler might run several thousand dollars every year, plus another twelve thousand for a couple of interventions. The cost to resuscitate, medicate, observe, and finally release someone whose untreated severe asthma led their sister to call 911 and get the paramedics will easily top $100,000.

And that’s for just one such event. Many relatively common forms of disability, severe asthma among them, commonly put their sufferers in the hospital several times every year when they go untreated. So the cost of covering one of these families under Medicaid would run perhaps $20,000, and the cost of not covering one of these families can easily exceed $520,000. When you multiply the half-million dollar difference by rough estimate of 25,000 Americans who have severe disabilities and aren’t covered by Medicaid or any other insurance, you’re suddenly looking at $12.5 billion that the American taxpayers are paying so that some states can pat themselves on the back for ‘reducing costs’ by cutting coverage to young adults aging out of the EPDST program.

The Fiscally Responsible Thing to Do

A decade or so ago, ‘renegade researcher’ Malcolm Gladwell authored an article in the New York Times called Million Dollar Murray, describing how one specific homeless man cost the city of Las Vegas over a million dollars in hospital costs over a 10-year period. Since that article, several entities have recognized the value of simply paying for people who can’t pay for themselves. The state of Utah’s Housing First program, for example, simply gives small-but-complete houses to the chronically homeless, charging them a meager $50/month in rent. Why? Because a study showed that one chronically homeless person cost the state an average of $19,000/year in jail, hospital, and other services — but it cost only $8000/year to give them a house and assign them a case worker.

There are hundreds of similar examples all over the country — cities, counties, and occasionally entire states that realize that simply giving service to the people who need it most is the genuinely fiscally responsible option in the long run. And while you might be able to make a pretty solid-seeming argument about bootstraps and pulling-up when it comes to homelessness or drug use, it’s a pretty rock-solid bet that you can’t really ask someone with a chronic disability to ‘man up’ and deal with it on their own, making it not just fiscally responsible, but morally responsible as well.

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