Health care, Medicaid & EPSDT
All people, including people with intellectual and/or developmental disabilities (I/DD), should have timely access to high quality, comprehensive, accessible, affordable, appropriate health care that meets their individual needs, maximizes health, well-being and function, and increases independence and community participation.
Affordable Care Act
Enactment of health care reform, known as the Affordable Care Act (ACA), is the most significant law for people with disabilities since the enactment of the Americans with Disabilities Act (ADA) in 1990. It brings about comprehensive reforms that will benefit Americans with disabilities by prohibiting discrimination based on health status and improving access to care.
Virginia Medicaid offers several low-cost and no-cost health coverage programs for eligible children, pregnant women and adults, including individuals with disabilities.
Medicaid for individuals with disabilities
Individuals who are age 65 or older, and/or who are disabled, may be eligible for full-Medicaid health coverage. This, however, is dependent on income and the assets your loved one may have. Certain requirements may be waived if he or she is eligible for a Medicaid Waiver.
More information on Medicaid for individuals with disabilities may be found by downloading the manual to the right.
Resources & links
Early & Periodic Screening, Detection and Treatment (EPSDT) is a federally mandated Medicaid program for children from birth to 21 years of age who qualify for Medicaid. It is sometimes referred to as a "safety net", covering services that are not paid for by Medicaid. EPSDT is a federally-mandated program that is available through all states.
What services are available?
Some, but not all, services covered by EPSDT include:
EPSDT covers treatments that are typically not available to certain disability groups as well as services that are not covered by the state Medicaid plan. Examples include:
Hearing & audiology;
Private duty nursing;
Behavioral therapies and treatments;
Specialized inpatient services; and
How to request services & supports through EPSDT
To access EPSDT Specialized Services, the medical provider sends an order to an enrolled service provider chosen by the family. The service provider then obtains a service authorization if necessary.