Developmental Pediatrics and Autism

Financial Resources for Medical Services

Understanding your options

Availability of financial resources is greatly dependent on your child’s diagnosis and, in some cases, family income. The social workers at the Meyer Center for Developmental Pediatrics and Autism can provide you with guidance about financial resources that may be available to you.

Medicaid and Children’s Health Insurance Program (CHIP)

Medicaid and CHIP are state and federally funded programs that provide medical coverage for families in need. A family’s eligibility for either program is greatly dependent on their income and number of people within their home. While your child does not have to have a disability to qualify for Medicaid or CHIP, your family does have to meet the financial eligibility criteria.

CHIP and Medicaid both cover services such as:

  • Dentist visits
  • Diagnostic testing and lab work
  • Eye exams and glasses
  • Hospital care and emergency services
  • Medical visits
  • Prescription medications
  • Treatment of special health needs and/or pre-existing conditions

If your family qualifies for Medicaid, there is no cost for these services. However, if your family qualifies for CHIP, you’ll pay an enrollment fee of $50 or less; copays for services will be assessed based on your family income. Copays typically range anywhere from $3–$35.

Supplemental Security Income (SSI)

SSI for children with disabilities is a federal program that offers monthly cash assistance to help caregivers cover the expenses of their children’s personal and medical needs.

To qualify for SSI, your child must meet the Social Security Administration’s disability criteria and income guidelines. Children who qualify to receive SSI benefits will also qualify to receive STAR Kids Medicaid coverage.

For more information on signing up for SSI, you can print an SSI Child Disability Starter Kit (for children under 18).

You can also visit Navigate Life Texas for more information about SSI and the eligibility criteria for children with special health care needs.

Medicaid waiver programs

These programs are called “waivers” because they waive certain Medicaid requirements so that even if your child would not normally qualify for Medicaid, he or she may still qualify for the Medicaid waiver programs.

The waiver programs offer services such as behavioral support, respite care, occupational therapy, physical therapy, speech therapy, minor home modifications, pre-vocational training, supported employment, transition assistance, prescription medications, residential services, day habilitation and more. They provide coverage for services that traditional insurances typically do not cover. Most waivers also provide Medicaid funding to children with disabilities regardless of family income.

Call now to apply for a waiver program because the waitlist for approval can take multiple years. Although it may be hard to know what your child may need in the future, you can always decline services later if you feel that this assistance is no longer needed. When you call, you’ll need to provide your child’s Social Security number, Medicaid insurance number (if applicable) and basic information regarding your child’s diagnosis.

Below are some specific Medicaid waiver programs that may apply to children seen at the Meyer Center. To be placed on the interest list for the waivers below, call 1-877-438-5658. Tell the operator “I’m calling to register my child on the waiver interest list for …”

  • Community Living Assistance Support Services (CLASS): for individuals with an intellectual disability or related medical condition that originated before age 22 and affects a person’s ability to function in daily life.
  • Medically Dependent Children’s Program (MCDP): for children and young adults who are medically dependent.
  • There are other interest lists your child may qualify for as well; however, you must call your Local Intellectual and Developmental Disability Authority (LIDDA) to be placed on the additional interest lists below. Call the LIDDA for your county and tell the operator “I am calling to register my child on the following waiver interest lists …”
  • Home and community-based services (HCS): for persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes.
  • Texas Home Living (TxHml): This program provides selected essential services and supports to people with intellectual and developmental disabilities who live with their families or in their own homes.
  • Youth Empowerment Services (YES): Provides community-based services and support for families caring for children with a serious emotional disturbance.
  • Locate your county LIDDA below:
    • Harris County: The Harris Center: 713-970-7000 
    • Fort Bend County: Texana Center: 281-239-1300
    • Brazoria County: Gulf Coast Center (Select IDD services and intake): 800-643-0967 
    • Liberty, Montgomery and Walker Counties: Tri-County Services: 936-521-6100 
    • Contact information for these and all other county LIDDA services can be found online.

Medicaid Buy-In for Children

Medicaid Buy-In for Children is a program that allows families to buy Medicaid coverage for children ages 18 or younger with disabilities or special health care needs.

If your income is over the limit for Medicaid or CHIP, you may still qualify for this program. If you’re approved for this program, you’ll pay a monthly premium to Medicaid and your child will receive all the benefits of traditional Medicaid, including no copays for doctor visits. The premium is based your family’s income and the number of people living in your home.

To apply for Medicaid Buy-In, you must first apply for Medicaid. Once you receive the denial letter for Medicaid, call the number on the letter and tell them that you’re interested in applying for the Medicaid Buy-In program.

For more information about this program, visit Navigate Life Texas