Medicaid

Almost everything an autistic adult receives comes through Medicaid, and almost none of it is guaranteed.

This category covers the waiver programs that pay for community-based support: who is eligible, what services each one includes, how the waiting lists work, and what happens when a service is removed from the array. It also tracks federal rule changes, because a decision made at CMS reaches a kitchen table in Michigan a year or two later. Written for families, not for billing departments.

Appealing Denials Without Losing What You Still Have

Documentation Strategies How-To Guides Medicaid

Appealing denials without losing what you still have A denial notice has a clock hidden inside it. Miss it and you lose the service while you fight. Catch it and...

Documentation Strategies How-To Guides Medicaid

Budget methodologies and ‘medical necessity’ language Two phrases do most of the damage: “more cost-effective option available” and “not medically necessary.” Neither one is a medical judgment. Both are budget...

Advocacy Resources Documentation Strategies How-To Guides Medicaid

AAC and Insurance: Getting Device Coverage The documentation that gets AAC devices funded, the medical necessity letter that does most of the work, the trial period that demonstrates use, and...

Advocacy Resources How-To Guides Medicaid Waiting Lists

Understanding Long Waitlists and What to Do While You Wait The HCBS waiver waitlist is rationing dressed in administrative language. The wait is real, the wait is long, and the...

Advocacy Resources How-To Guides Medicaid Waiting Lists

Medicaid Waivers and HCBS Basics What a waiver actually is, what “level of care” really means, why waiting lists exist, and the questions every caregiver should walk into the first...

Adult Transition Advocacy Resources How-To Guides Medicaid

The “Benefits Cliff”: Work, Medicaid, and Keeping Supports How part-time work actually affects SSI and Medicaid, why the cliff is mostly a wall built by misinformation, and the federal work...

Advocacy Resources Comparison Tools How-To Guides Medicaid

ABLE Accounts vs Special Needs Trusts (and the $2,000 SSI Asset Limit) Two saving instruments, one cliff. SSI’s $2,000 asset limit has not moved since 1989. ABLE accounts and SNTs...

Advocacy Resources Comparison Tools How-To Guides Medicaid

Special Needs Trusts: First-Party, Third-Party, and Pooled Three trust structures, one critical rule about Medicaid payback, and the most common mistake families make: putting the inheritance directly into the autistic...

Adult Transition Advocacy Resources How-To Guides Medicaid

SSI at 18 and the Age-18 Redetermination Why eligibility shifts the day a young adult turns eighteen, why initial denial rates are brutally high, and how to start documentation at...