Children over the age of 18 with disabilities that began before age 22 or children of any age with end-stage renal disease (ESRD) may qualify for Medicare based on:
- Social Security’s disability requirements
- Parents’ Social Security work credits
Supplemental Security Income (SSI) pays benefits to adults and children with disabilities who have limited income and resources. Social Security Disability Insurance (SSDI) pays benefits to adult children with disabilities if you or your spouse worked long enough and paid Social Security taxes. Both programs have the same medical requirements for disability.
Read on to access detailed information about eligibility requirements, how to apply for disability programs, and other health insurance options for children.
Can a Child Qualify for Medicare?
Children can qualify for Medicare, though most Medicare recipients are 65 and older.
Medicare is our nation’s federal health insurance for United States citizens and legal permanent residents who are 65 years and older and for younger people with disabilities. It’s individual health insurance, so it offers no opportunity for a family plan. Every person who has Medicare due to disability must qualify based on disability eligibility requirements and work credits defined by Social Security. Most people who qualify for Medicare due to disability are covered after they have been receiving SSDI payments for 24 months.
Medicare is available for people of any age, including children, who have ESRD. ESRD means that the kidneys no longer work and require regular dialysis or a transplant. Children who qualify for Medicare due to ESRD do so under parental work record and payment of Medicare taxes.
An SSDI Disabled Adult Child (DAC) is over 18 years old, becomes disabled before the age of 22, and draws disability benefits as a survivor or dependent under your work record. Your DAC can get Medicare immediately if they have ESRD or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). If your child is between 20 and 22 years of age and receives SSDI under your work record, they are eligible for Medicare.
When do children with ESRD qualify for Medicare?
A child can qualify for ESRD Medicare based on kidney function and if you or your spouse have earned at least six Social Security work credits within the last three years or are getting or eligible for Social Security or Railroad Retirement Board (RRB) benefits.
ESRD Medicare defines a child as
- An unmarried person younger than 22
- A person between the ages of 22 and 26 who remains unmarried and continues to meet the requirements for ESRD
A child can be your biological or legally adopted child, grandchild, or stepchild for at least one year.
You must enroll your child in Medicare through Social Security and may be asked to complete CMS Form 2728 (“End-Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration” demonstrating proof of ESRD. Medicare coverage will end 12 months after the completion of dialysis or three years after a kidney transplant.
When do children receiving SSDI qualify for Medicare?
Children between 20 and 22 years old receiving SSDI for at least two years can qualify for Medicare.
When Do Children With Disabilities Qualify for SSI Payments?
Children younger than 18 qualify for SSI payments when their disability meets Social Security’s definition of disability and their income and resources fall within eligibility limits set by the state in which they live. According to Social Security rules, income and resources from the child and those living in their household count toward the total limit allowed.
To be considered medically eligible for SSI in 2022, a child must have a medical condition or a combination of conditions that result in “marked and severe functional limitations” that very seriously limit the child’s activities.
As with disability benefits for a person of any age, the condition(s) must last, or be expected to last, at least 12 months or result in death. A child who is not blind must not be working or earning more than $1,350 a month. A child who is blind must not be working or earning more than $2,260.
Do Adults With Disabilities Since Childhood Qualify for SSDI Benefits?
Adults with disabilities since childhood qualify for SSDI benefits based on a parent’s Social Security earnings record. According to Social Security, SSDI benefits apply to children who have a disability that began before age 22. The parent must be receiving Social Security retirement or disability benefits or have worked long enough to earn Social Security retirement benefits if the parent is deceased.
A disabled child is a minor until age 18, then is considered an adult child. Adult children must meet the same eligibility criteria as adults to continue receiving SSDI benefits based on a parent’s earning record.
How Do You Apply for Medicare With a Disability?
To qualify for Medicare with a disability, you need to get disability benefits from Social Security or the RRB. To apply for disability benefits online, create a My Social Security account and complete the disability application. If you cannot apply online, you can apply on the phone or in person at a Social Security office near you.
Do you meet the eligibility requirements for Medicare with disabilities?
To be eligible for Medicare due to disability, you need to meet Social Security’s definition of a total disability and have worked and paid Medicare taxes. The Social Security website outlines the application for disabilities process which includes these steps:
- Review the adult disability checklist to find out what you need to complete the application. Work history and medical records with proof of disability are included on this checklist.
- Social Security checks your application to ensure you meet disability and whether you have enough work credits.
- Your state’s Disability Determination Services makes the final determination about whether you qualify for disability benefits.
You must receive disability benefits for 24 months before you are eligible for Medicare due to disability.
What do you need to apply for Medicare with disabilities?
The Social Security Administration (SSA) considers you to be disabled if you can’t do the work you used to do because of your medical condition, you can’t perform other work due to your medical condition, and your disability is expected to last for at least 12 months or result in your death.
You will be automatically enrolled in Medicare Parts A and B if:
- You’ve received SSDI benefits for 24 months
- You’ve received RRB disability benefits for 24 months and don’t have a disability freeze
- You have ALS and you’ve received one SSDI payment or one RRB disability payment
If you have ESRD, you must complete a Medicare application through Social Security. You or your spouse must have worked long enough under Social Security, the RRB or as a government employee to be eligible for retirement benefits.
How Do You Apply for SSI Payments for Your Child?
To apply for SSI benefits for your child, you must complete an application for SSI payments and a Child Disability Report. This report collects information about your child’s condition and how it affects their ability to function. You will sign an authorization form that gives your child’s doctor permission to share information about your child’s disability with Social Security. You will need your child’s social security number and birth certificate.
You can apply online or in person at a local Social Security office.
Do you meet the eligibility requirements for SSI payments?
SSI payments are based on income and resources in the household.
| Income | Resources |
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There are many sources of income and resources that do not count toward your income and resource limit. Click here for an exhaustive list.
What do you need to apply for SSI payments?
You can apply for SSI payments by contacting your local Social Security office or by calling (800) 772-1213 for an appointment. Social Security agents can help you determine what you need to apply. Parents or guardians can apply for a child under age 18 with the following:
- Social Security card or number
- Proof of age, such as a birth certificate
- Home information, such as mortgage receipts or lease
- Payroll slips, bank books, insurance policies, car registration, and burial fund records
- Information about income and resources
- Names and contact information for health care providers and facilities if applying due to disability or blindness
- Proof of U.S. citizenship or lawful noncitizen status
You can apply for SSI payments online at www.ssa.gov/benefits/ssi if you:
- Are between the ages of 18 and 65
- Have never been married
- Are a U.S. citizen residing in one of the 50 states, the District of Columbia, or the Northern Mariana Islands
- Haven’t applied for or received SSI payments in the past
- Are applying for SSDI benefits at the same time as an SSI claim.
How Do You Apply for SSDI Benefits for an Adult With Disabilities Since Childhood?
You should apply as soon as your DAC becomes disabled. You can apply online or through an in-person interview at your local Social Security office.
Do you meet the eligibility requirements for SSDI benefits?
Eligibility requirements for SSDI benefits for a DAC include:
- A qualified disability that began before age 22
- Parent is deceased or starts receiving retirement or disability benefits
- Must be a biological or adopted child, and in some cases, a stepchild, grandchild, or step-grandchild
- Must be unmarried
- Age 18 or older
It is not necessary that your DAC ever worked. Benefits are paid based on the parent’s earnings record. But if the DAC does work, earnings cannot be substantial. In 2022, this means working and earning more than $1,350 ― or $2,260 if the DAC blind ― a month.
What do you need to apply for SSDI benefits?
Social Security provides a Disability Starter Kit, which outlines what you need for your online application or in person interview. Each kit includes a fact sheet of frequently asked questions (FAQs), a checklist of required documents and information, and a worksheet to help you gather everything you need.
Your DAC must meet Social Security’s definition of total disability for adults, but benefits are based on your Social Security earnings record.
How Much Does Medicare Cost for Kids With Disabilities?
Medicare costs are the same for kids with disabilities as they are for adults.
| Medicare Costs for Kids With Disabilities | |
| In 2022, costs without financial assistance from Medicaid or a Medicare Savings Program include: | |
Part A (hospital insurance):
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Part B (medical insurance):
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Part C (Medicare Advantage):
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Part D (Prescription Drug Coverage):
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Employment Support Programs for Young People With Disabilities
Young people with disabilities can still receive SSI and SSDI and work if they want to. Generally, if a young person with a disability wants to work, some income and resources are excluded from the SSI or SSDI payment calculation.
What are your employment options under SSI?
- If a student and under the age of 22, Social Security may exclude $2,040 of a young person’s monthly earnings, up to $8,230 a year when calculating their SSI payment.
- The Plan to Achieve Self-Support (PASS) program allows children 15 and older to save income and resources needed to pay for education or other expenses that allow them to work. These savings are not included in the SSI payment calculation.
- Payments for items, services, and rehabilitation needed to work and support a child’s medical condition may be deducted from a child’s earnings.
Medicaid coverage may continue as long as earnings are below a certain amount, even if SSI payments stop.
What are your employment options under SSDI?
DAC are entitled to the same help with work expenses as young people with disabilities who receive SSI. Benefit payments may continue as long as your child is not engaging in substantial work. For 2022, that is if their monthly earnings are under $1,350 for nonblind beneficiaries and $2,260 if they are blind.
Do You or Your Child Qualify for Medicaid and Medicare?
Medicaid is a joint federal and state program that provides financial assistance for health care to people with low income and resources. Medicare is health insurance.
What are the qualifications for Medicaid?
- Financial eligibility is determined based on your modified adjusted gross income (MAGI). Your or your disabled child may be exempt from the MAGI requirements. To be dual-eligible for Medicare and Medicaid, you must meet the basic Medicare requirements and the income and resource requirements for Medicaid.
- The Department of Health and Human Services (HHS) establishes federal poverty guidelines each year to help determine financial eligibility for certain programs, including Medicaid and Medicare Savings Programs. Federal Poverty Guidelines ― also known as Federal Poverty Limit (FPL) ― are published each January. The 2022 guidelines are listed here and are about a 5% increase over 2021.
What are the qualifications for Medicare?
The basic qualifications that make you eligible for health insurance through Medicare are:
- You are a U.S. citizen or a legal resident who has lived in the U.S. for at least five years, and:
- Are 65 years of age
- Have a disability based on the Social Security’s definition of total disability
- Have ALS
- Have ESRD (permanent kidney failure requiring dialysis or transplant)
- You worked and paid Medicare taxes for at least 10 years (to be eligible for premium-free Part A, but you may be able to buy it if you haven’t worked the required number of years and meet other qualifications).
Do You or Your Child Qualify for Children's Health Insurance Program?
Children’s Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to purchase private insurance. Each state’s CHIP program works closely with the Medicaid program and has its own rules about who qualifies.
If you apply for Medicaid coverage to your state agency, you’ll also find out if your children qualify for CHIP. If they qualify, you won’t have to buy a private insurance plan to cover them.
To qualify for CHIP in your state, your child must be uninsured, under 19 years of age, and a U.S. citizen. Like Medicaid, CHIP eligibility requirements are based on Federal Poverty Guidelines.
FAQs
Can you work if you’re on Medicare disability?
What is the SSDI trial work period?
How long can children with disabilities have Medicare coverage?
What Medicare benefits are available for people with disabilities?
What is Social Security’s definition of disability?
How does Social Security decide if I have a qualifying disability?
How Do You Find Alternative Health Care Services for Children With Disabilities in Each State?
A good place to start to find alternative health care services for children with disabilities in your state is to visit InsureKidsNow.gov, a website operated by the Centers for Medicare and Medicaid Services (CMS). Click on your state to find information about free or low-cost health care for your child or teen through Medicaid or CHIP. You can also search HealthCare.gov to see if you qualify for insurance through the Health Insurance Marketplace.
What Are Common Alternative Health Care Options for Children?
- Parent’s employer coverage or other private health care plans: Most employer-sponsored and private health care plans offer family plans with coverage for spouses and children.
- Health insurance marketplace plans: Health insurance exchanges were established in 2010 by the Affordable Care Act (ACA). You can search for plans in your state here or speak with a trusted insurance agent in your area to find the most affordable plan for you if you don’t qualify for CHIP or Medicaid.
- CHIP: CHIP provides health insurance for uninsured children under 19. You must meet income and resource requirements established by your state. Each state’s CHIP provides comprehensive free or low-cost coverage for your child.
- Medicaid: Provides free or low-cost health care if you meet income and resource limits. Medicaid is a joint state and federal program. Learn how to apply for Medicaid or CHIP through the Health Insurance Marketplace or directly through your state Medicaid office.
State Health Care Services for Children with Disabilities
Every state offers Medicaid, CHIP, and other insurance options and assistance for children with disabilities. Find coverage for your family at InsureKidsNow.gov. Click on the map or use the drop-down menu to find your state. You will be taken to the home page with contact information for available programs.
| Alabama | ||
| Health Care Option | Description | Contact/Website |
| Alabama Medicaid | Medicaid covers low income children, disabled adults, nursing home residents and low income people who also have Medicare. Alabama Medicaid is a very limited program. The requirements vary from program to program. In many cases, Medicaid must consider resources (assets) as well as income. Some women are covered only if they are pregnant. Most Medicaid eligibles, however, are children. | Phone: (334) 242-5000 |
| ALL Kids | ALL Kids is a low-cost, comprehensive healthcare coverage program for children under age 19. Benefits include regular checkups and immunizations, sick child doctor visits, prescriptions, vision and dental care, hospitalization, mental health and substance abuse services, and much more. | Phone: (888) 373-5437 |
| Alaska | ||
| Health Care Option | Description | Contact/Website |
| Alaska Medicaid | Medicaid provides health coverage and long-term care services for low-income Alaskans. The Division of Public Assistance determines eligibility for this program. | Phone: (800) 478-7778 |
| Denali KidCare | Denali KidCare is Medicaid coverage for children from birth through age 18 and Pregnant Women who meet income eligibility standards. | Phone: (800) 478-7778 |
| Arizona | ||
| Health Care Option | Description | Contact/Website |
| Arizona Health Care Cost Containment System | The Arizona Health Care Cost Containment System (written as AHCCCS and pronounced ‘access’) is Arizona’s Medicaid program, a federal health care program jointly funded by the federal and state governments for individuals and families who qualify based on income level. | Phone: (602) 417-4000 |
| KidsCare | AHCCCS offers health insurance through KidsCare for eligible children (under age 19) who are not eligible for other AHCCCS health insurance. For those who qualify, there are monthly premiums. | Phone: (855) 432-7587 |
| Arkansas | ||
| Health Care Option | Description | Contact/Website |
| ARKids First | ARKids First is a health insurance program that provides coverage for thousands of children across the state. It covers well-child checkups, eye exams, dental checkups and more. It’s insurance that is growing healthy kids in Arkansas and it might be the answer for health coverage for your children. | Phone: (888) 474-8275 |
| California | ||
| Health Care Option | Description | Contact/Website |
| Medi-Cal | Medi-Cal is California’s Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS. Medi-Cal is financed equally by the state and federal government. | Phone: (800) 541-5555 |
| Colorado | ||
| Health Care Option | Description | Contact/Website |
| CHP+ Program | Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado (Colorado’s Medicaid program), but not enough to pay for private health insurance. | Phone: (800) 359-1991 |
| Health First Colorado | Health First Colorado is public health insurance for Coloradans who qualify. Medicaid is funded jointly by the federal government and Colorado state government, and is administered by the Department of Health Care Policy & Financing. | Phone: (800) 250-7741 |
| Connecticut | ||
| Health Care Option | Description | Contact/Website |
| State of Connecticut Department of Social Services | Both Medicaid and CHIP are administered by Connecticut’s Department of Social Services, whose website acts as a one-stop destination to match you with the programs and services that you’re eligible for. | Phone: (855) 805-4325 |
| Delaware | ||
| Health Care Option | Description | Contact/Website |
| Delaware Medicaid Program | Medicaid in Delaware is run by the Delaware Division of Medicaid & Medical Assistance (DMMA) and pays medical bills with State and Federal tax money. It pays medical bills for eligible low-income families and for eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. | Phone: (302) 255-9500 |
| Delaware Healthy Children Program | The Delaware Healthy Children Program is a low cost health insurance program for Delaware’s uninsured children. The Delaware Healthy Children Program features the same high-quality coverage you’d get with some of the best private insurance plans. | Phone: (800) 996-9969 Website |
| Florida | ||
| Health Care Option | Description | Contact/Website |
| Children’s Medical Services | Children’s Medical Services (CMS) is a collection of programs for eligible children with special needs. Each program and service they offer is family-centered and designed to help children with a variety of conditions and needs. | Phone: (850) 245-4200 |
| Florida Agency for Health Care Administration | In Florida, the Agency for Health Care Administration (Agency) is responsible for Medicaid. Medicaid is the medical assistance program that provides access to health care for low-income families and individuals. | Phone: (888) 419-3456 |
| Florida Healthy Kids | Florida Healthy Kids offers health and dental insurance for children ages 5 through 18. Healthy Kids coverage includes doctor visits, immunizations, dental care, emergency care, hospital stays and much more. Most families pay just $15 or $20. | Phone: (800) 540-5437 |
| Georgia | ||
| Health Care Option | Description | Contact/Website |
| Georgia Medicaid | Medicaid is a medical assistance program that helps many people who can’t afford medical care pay for some or all of their medical bills. Medicaid is administered by the Georgia Department of Community Health (DCH) and pays medical bills with State and Federal tax money. | Phone: (404) 657-5468 Website |
| PeachCare for Kids | PeachCare for Kids is a comprehensive health care program for uninsured children living in Georgia. | Phone: (877) 427-3224 |
| Hawaii | ||
| Health Care Option | Description | Contact/Website |
| Quest Program | Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain categories of individuals, including children, pregnant women, parents of eligible children, low income adults, former foster care children, aged, blind and disabled individuals. Med-QUEST administers Hawaii’s state Medicaid program. | Phone: (877) 628-5076 |
| Idaho | ||
| Health Care Option | Description | Contact/Website |
| Idaho Medicaid Program | Medicaid offers healthcare coverage that addresses a variety of health needs, including coverage for low-income adults, pregnant women, the elderly, and people with disabilities who meet certain income criteria. | Phone: (877) 456-1233 |
| Idaho CHIP Program | Children with household income over 138 percent of the federal poverty line (FPL) may qualify for the Children Health Insurance Plan (CHIP), which provides health coverage for children who don’t otherwise qualify for Medicaid. | Phone: (800) 926-2588 |
| Illinois | ||
| Health Care Option | Description | Contact/Website |
| All Kids | All Kids is Illinois’ program for children who need comprehensive, affordable, health insurance, regardless of immigration status or health condition. | Phone: (866) 255-5437 |
| Application for Benefits Eligibility (ABE) | You can use ABE to apply on-line for healthcare, SNAP, CHIP, cash assistance and the Medicare Savings programs with the State of Illinois. | Phone: (800) 843-6154 Website |
| GetCovered Illinois | Medicaid eligibility is determined through the State of Illinois’ Affordable Care Act portal, GetCovered Illinois. | Phone: (866) 311-1119 |
| Indiana | ||
| Health Care Option | Description | Contact/Website |
| Healthy Indiana Plan | The Healthy Indiana Plan is a health-insurance program offered by the State of Indiana which pays for medical costs for members and could even provide vision and dental coverage. | Phone: (877) 438-4479 |
| Hoosier Healthwise | Hoosier Healthwise is a health care program for children up to age 19 and pregnant women. The program covers medical care such as doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost to the member or the member’s family. The Children’s Health Insurance Program (CHIP) falls under the Hoosier Healthwise program. | Phone: (800) 457-4584 |
| Iowa | ||
| Health Care Option | Description | Contact/Website |
| Hawki | The Children’s Health Insurance Program (CHIP) is offered through the Healthy and Well Kids in Iowa program, also known as Hawki. Iowa offers Hawki health coverage for uninsured children of working families. | Phone: (800) 257-8563 |
| IA Health Link | The IA Health Link program (Medicaid) is administered by contracted Managed Care Organizations (MCOs) which provide members with comprehensive health care services, including physical, behavioral and long-term care services and support. | Phone: (855) 889-7985 |
| Kansas | ||
| Health Care Option | Description | Contact/Website |
| KanCare | KanCare is the program through which the State of Kansas administers both Medicaid and CHIP Kansas, a health insurance program that provides coverage benefits to children who are not eligible to Medicaid due to family income, but are otherwise uninsured. | Phone: (800) 792-4884 |
| Kentucky | ||
| Health Care Option | Description | Contact/Website |
| KCHIP | The Kentucky Children’s Health Insurance Program (KCHIP) is free health insurance for children younger than 19 without health insurance. Children in families with incomes less than 213 percent of the federal poverty level are eligible. | Phone: (877) 524-4718 |
| Kentucky Medicaid | Kentucky Medicaid is a state and federal program authorized by Title XIX of the Social Security Act to provide healthcare for eligible, low income populations. These populations include children, low-income families, pregnant women, the aged and disabled. | Phone: (855) 306-8959 |
| Louisiana | ||
| Health Care Option | Description | Contact/Website |
| LaCHIP | The Louisiana Children’s Health Insurance Program (LaCHIP) provides health coverage to uninsured children up to age 19. It is a no-cost health program that pays for hospital care, doctor visits, prescription drugs, shots and more. | Phone: (877) 252-2447 |
| Louisiana Medicaid | Medicaid provides medical benefits to low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. | Phone: (888) 342-6207 |
| Maine | ||
| Health Care Option | Description | Contact/Website |
| Cub Care | Cub Care is another name for Maine’s Children’s Health Insurance Program (CHIP). Cub Care is a program that provides health coverage for children aged 0-19. If your child meets eligibility rules, they will be able to receive full Cub Care benefits which are the same as those a child with full MaineCare coverage would receive. | Phone: (855) 797-4357 |
| MaineCare | MaineCare provides free and low-cost health insurance to Mainers who meet certain requirements, based on household composition and income. | Phone: (855) 797-4357 |
| Maryland | ||
| Health Care Option | Description | Contact/Website |
| Maryland Medicaid Administration | Medicaid provides medical benefits to low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. | Phone: (855) 642-8572 |
| Maryland Children’s Health Program | The Maryland Children’s Health Program offers free or low-cost health coverage to children whose household incomes are below certain income limits. There are higher household income limits for children than for adults. Your child may be eligible for Medicaid or MCHP even if you’re not. | Phone: (855) 642-8572 |
| Massachusetts | ||
| Health Care Option | Description | Contact/Website |
| MassHealth | In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members may be able to get doctors visits, prescription drugs, hospital stays, and many other important services. | Phone: (800) 841-2900 |
| Michigan | ||
| Health Care Option | Description | Contact/Website |
| Healthy Kids Program | Healthy Kids is a program that provides a wide range of health care coverage and support services for qualifying pregnant women, babies and children under age 19. | Phone: (844) 799-9876 |
| MIchild | MIChild is a health insurance program for uninsured children of Michigan’s working families. MIChild services are provided by many HMOs and other health care plans throughout Michigan. | Phone: (877) 789-5610 |
| Minnesota | ||
| Health Care Option | Description | Contact/Website |
| MinnesotaCare | MinnesotaCare is a health care program for Minnesotans with low incomes. MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding and enrollee premiums and cost sharing. | Phone: (651) 431-2670 |
| Minnesota CHIP | The Children’s Health Insurance Program (CHIP) supplements existing federal Medicaid funds that provide
health care coverage for low-income Minnesota families. While it is a separate program from Medicaid, it is also administered by MinnesotaCare. |
Phone: (651) 431-2670 |
| Mississippi | ||
| Health Care Option | Description | Contact/Website |
| Mississippi Medicaid | Medicaid provides medical benefits to low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. | Phone: (800) 421-2408 |
| Mississippi CHIP | CHIP provides health coverage for uninsured children up to age 19 years old. To be eligible for CHIP, a child cannot be eligible for Medicaid. | Phone: (800) 884-3222 |
| Missouri | ||
| Health Care Option | Description | Contact/Website |
| MO HealthNet for Kids | MO Healthnet is Missouri’s Medicaid program, which provides health care benefits to low-income individuals and families.
MO HealthNet for Kids is the state’s version of CHIP. |
Phone: (855) 373-9994 |
| Montana | ||
| Health Care Option | Description | Contact/Website |
| Healthy Montana Kids | Healthy Montana Kids (HMK), Children’s Health Insurance Plan is just one of many Montana Healthcare Programs offering a free or low-cost health insurance plan which provides coverage to eligible Montana children up to age 19. Covered services include medical, dental, eyeglasses, and other related services. | Phone: (888) 706-1535 |
| Montana Medicaid | Medicaid provides medical benefits to low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. | Phone: (888) 706-1535 |
| Nebraska | ||
| Health Care Option | Description | Contact/Website |
| Nebraska CHIP | The Children’s Health Insurance Program, or CHIP, is an expansion of Medicaid for certain children who are without other health insurance and who do not qualify for Medicaid. It provides the same services covered under Medicaid in Nebraska. | Phone: (855) 632-7633 |
| Nebraska Medicaid | Medicaid provides medical benefits to low-income individuals and families. Although the federal government establishes the general rules for Medicaid, specific requirements are established by each state. | Phone: (855) 632-7633 |
| Nevada | ||
| Health Care Option | Description | Contact/Website |
| Nevada Check Up | Nevada Check Up is the State of Nevada’s Children’s Health Insurance Program (CHIP). Depending on your income, your children (birth through 18 years of age) may qualify for coverage through Nevada Check Up. | Phone: (755) 684-3660 |
| Nevada Medicaid | Medicaid is an optional medical coverage program that states elect to provide to their residents. Depending on your income and family size, you or your family members may qualify for government-supplied healthcare, such as Medicaid. | Phone: (800) 992-0900 |
| New Hampshire | ||
| Health Care Option | Description | Contact/Website |
| NH Easy | NH Easy is the single access point for a number of medical assistance programs in New Hampshire, including Medicaid, Expanded Children’s Medicaid, and the Children with Severe Disabilities program. | Phone: (603) 271-4344
Website |
| New Jersey | ||
| Health Care Option | Description | Contact/Website |
| NJ Family Care | NJ FamilyCare – New Jersey’s publicly funded health insurance program – includes CHIP, Medicaid and Medicaid expansion populations. That means qualified NJ residents of any age may be eligible for free or low-cost healthcare coverage that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services, and even hospitalization. | Phone: (800) 701-0710 |
| New Mexico | ||
| Health Care Option | Description | Contact/Website |
| Centennial Care | Centennial Care is the name of the New Mexico Medicaid program, providing services including physical health, behavioral health, long-term care and community benefits. | Phone: (800) 283-4465 |
| Centennial Care for Children | New Mexico Centennial Care provides a variety of health services for members under the age of 21 according to a federal Medicaid policy. This includes preventive health services, maintenance health services to improve a condition or prevent worsening, and treatment of medical conditions. It also includes a complete range of mental health services which include treatment for alcohol and substance abuse. | Phone: (888) 997-2583 |
| New York | ||
| Health Care Option | Description | Contact/Website |
| Child Health Plus | New York State has a health insurance plan for kids, called Child Health Plus. Depending on your family’s income, your child may be eligible to join either Children’s Medicaid or Child Health Plus. Both Children’s Medicaid and Child Health Plus are available through dozens of providers throughout the state. | Phone: (800) 693-4543 |
| New York State Medicaid | New York’s Medicaid program provides comprehensive health coverage to more than 7.3 million lower-income New Yorkers (as of December, 2021.) Medicaid pays for a wide-range of services, depending on your age, financial circumstances, family situation, or living arrangements. | Phone: (855) 355-5777 |
| North Carolina | ||
| Health Care Option | Description | Contact/Website |
| North Carolina Medicaid | North Carolina Medicaid is the program that provides health care to eligible low-income adults, children, pregnant women, seniors and people with disabilities. The program is funded by North Carolina and the federal government. | Phone: (800) 662-7030 |
| NC Health Choice | NC Health Choice is our state’s name for the Children’s Health Insurance Program (CHIP). It provides health care to eligible children in addition to Medicaid. This program is also funded by North Carolina and the federal government. | Phone: (800) 662-7030 |
| North Dakota | ||
| Health Care Option | Description | Contact/Website |
| Healthy Steps Children’s Health Insurance Program | CHIP is intended to meet the needs of working families, who cannot afford health insurance coverage for their children, yet earn too much to qualify for Medicaid. Coverage is available for uninsured children age 18 and younger who live in families with qualifying incomes. Single 18-year-olds with eligible incomes may also apply. | Phone: (800) 318-2595 |
| North Dakota Medicaid | Medicaid was authorized in 1966 for the purpose of providing an effective base upon which to provide comprehensive and uniform medical services that enable persons previously limited by their circumstances to receive needed medical care. | Phone: (800) 755-2604 |
| Ohio | ||
| Health Care Option | Description | Contact/Website |
| Healthy Start | Healthy Start includes Medicaid and CHIP programs.
The Medicaid program is available to insured or uninsured children (up to age 19) in families with income up to 156% of the federal poverty level, as well as pregnant women in families with income up to 200% of the federal poverty level.
The CHIP program is available to uninsured children (up to age 19) in families with income up to 206% of the federal poverty level. |
Phone: (800) 324-8680 |
| Healthy Families | Healthy Families is a Medicaid program available to families with income up to 90% of the federal poverty level and a child younger than age 19. | Phone: (800) 324-8680 |
| Oklahoma | ||
| Health Care Option | Description | Contact/Website |
| SoonerCare | SoonerCare is a program run by the Oklahoma Health Care Authority which helps pay for your medical care. | Phone: (800) 987-7767 |
| Soon-to-be Sooners | Soon-to-be-Sooners (STBS) services are provided to qualified unborn children to support healthy pregnancy and birth. | Phone: (800) 987-7767 |
| Oregon | ||
| Health Care Option | Description | Contact/Website |
| Oregon Health Plan | Welcome to the Oregon Health Plan (OHP). OHP is free health coverage from the State of Oregon. People who meet income and other requirements can get OHP. OHP covers medical, dental, and mental health care. | Phone: (800) 273-0557 |
| Oregon State Children’s Health Insurance Program (SCHIP) | CHIP provides low-cost comprehensive health coverage to children, and sometimes pregnant women, for families that earn too much money to qualify for Medicaid. | Phone: (800) 699-9075 |
| Pennsylvania | ||
| Health Care Option | Description | Contact/Website |
| Pennsylvania CHIP | The Children’s Health Insurance Program — or CHIP — is Pennsylvania’s program to provide health coverage to uninsured children and teens who are not eligible for or enrolled in Medical Assistance. | Phone: (800) 986-5437 |
| Pennsylvania Medical Assistance | Medical Assistance (MA), also known as Medicaid, pays for health care services for eligible individuals. | Phone: (866) 550-4355 |
| Rhode Island | ||
| Health Care Option | Description | Contact/Website |
| RIte Care | RIte Care manages the state’s Medicaid and Children’s Health Insurance Programs (CHIP), which provide no-cost or low-cost health coverage for eligible children in Rhode Island. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy. | Phone: (855) 697-4347 |
| South Carolina | ||
| Health Care Option | Description | Contact/Website |
| South Carolina Healthy Connections | Healthy Connections is the name of South Carolina’s Medicaid program, a grant-in-aid program by which the federal and state governments share the cost of providing medical care for needy persons who have low income. | Phone: (888) 549-0820 |
| South Dakota | ||
| Health Care Option | Description | Contact/Website |
| South Dakota CHIP | The South Dakota Children’s Health Insurance Program, more commonly referred to as CHIP, provides quality health care (including regular check-ups, Well-Child Care exams, dental and vision care) for children and youth. | Phone: (800) 305-3064 |
| South Dakota Medicaid | South Dakota Medicaid is a federal and state-funded program providing health coverage for people who meet certain eligibility standards. Medicaid acts as an insurance company for individuals and pays for medically necessary services. | Phone: (800) 597-1603 |
| Tennessee | ||
| Health Care Option | Description | Contact/Website |
| CoverKids | The Children’s Health insurance Program (CHIP) is a federally sponsored program that provides health insurance to uninsured children in all 50 states and the District of Columbia. In Tennessee, this program is called CoverKids. | Phone: (800) 318-2596 |
| TennCare | TennCare is the state of Tennessee’s Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children and individuals who are elderly or have a disability. To get Medicaid, you must meet the income and resource limits. | Phone: (800) 318-2596 |
| Texas | ||
| Health Care Option | Description | Contact/Website |
| Texas Medicaid and CHIP | Medicaid and the Children’s Health Insurance Program (CHIP) provide medical coverage for more than 4 million low-income Texans. | Phone: (877) 541-7905 |
| Utah | ||
| Health Care Option | Description | Contact/Website |
| CHIP in Utah | The Children’s Health Insurance Program (CHIP) is a state health insurance plan for children who do not have other insurance. It provides well-child exams, immunizations, doctor visits, hospital, emergency care, prescriptions, hearing and eye exams, mental health services and dental care. Preventative services (well-child visits, immunizations, and dental cleanings) do not require a copay. | Phone: (877) 543-7669 |
| Medicaid in Utah | Medicaid is a medical program for people who have low-income and limited resources. To be eligible for Medicaid, you must meet a program type and meet the rules for Utah residency, income, and citizenship. | Phone: (800) 662-9651 |
| Vermont | ||
| Health Care Option | Description | Contact/Website |
| Dr. Dynasaur | Dr. Dynasaur provides low-cost or free health coverage for children, teenagers under age 19 and pregnant women. | Phone: (800) 250-8427 |
| Green Mountain Care | Green Mountain Care is Vermont’s Medicare program, which provides medical assistance to those who are low-income. | Phone: (800) 250-8427 |
| Virginia | ||
| Health Care Option | Description | Contact/Website |
| Virginia FAMIS | FAMIS, or Family Access to Medical Insurance Security Plan, is Virginia’s health insurance program for children. | Phone: (855) 242-8282 |
| Virginia Medicaid | Virginia Medicaid has low-cost and no-cost health coverage programs. There are programs for children, pregnant women and adults, including those with disabilities. | Phone: (855) 242-8282 |
| Washington | ||
| Health Care Option | Description | Contact/Website |
| Apple Health | In Washington State, Medicaid is called Apple Health. Apple Health provides preventative care, like cancer screenings, treatment for diabetes and high blood pressure, and many other health care services. Apple Health also provides access to CHIP. | Phone: (800) 562-3022 |
| West Virginia | ||
| Health Care Option | Description | Contact/Website |
| West Virginia CHIP Program | WVCHIP was created to help working families who do not have health insurance for their children. | Phone: (877) 982-2447 |
| West Virginia Medicaid | Medicaid is a federal and state-funded program providing health coverage for people who meet certain eligibility standards. Medicaid acts as an insurance company for individuals and pays for medically necessary services. | Phone: (877) 716-1212 |
| Wisconsin | ||
| Health Care Option | Description | Contact/Website |
| BadgerCare Plus | BadgerCare Plus is a health care coverage program for low-income Wisconsin residents, combining Medicaid and CHIP. | Phone: (800) 362-3002 |
| Wyoming | ||
| Health Care Option | Description | Contact/Website |
| Kid Care CHIP | Kid Care CHIP provides affordable health coverage for the children of some higher income parents in Wyoming. The program provides free preventive dental and health care. Other health services are available for a small co-pay. | Phone: (855) 294-2127 |
| Wyoming Medicaid | Wyoming Medicaid is a joint federal and state government program that pays for medical care for some low-income and medically needy individuals and families. | Phone: (855) 294-2127 |
- To qualify for Medicare due to disabilities, your child must meet the disability criteria established by Social Security. The application and determination process can be complicated and time-consuming. Access the help available to you through your local Social Security office. The agents there know what information you need to provide.
- Keep good medical records related to your child’s journey with a disability. You will need those, along with a list of health care professional contacts to support your disability request.
- If your child is eligible for Medicare due to disability, speak with a State Health Insurance Assistance Program (SHIP) agent to discuss your Medicare options. You may be eligible for Medicaid or a Medicare Savings Program for financial assistance.
- Caring for a child with a disability is hard work. Take advantage of the online and in-person resources available to you to find health insurance and financial assistance. Visit ssa.gov and search for resources related to disabilities. The site is a wealth of helpful information.
Learn More From Our Sources
- HealthCare.gov | Children’s Health Insurance Program (CHIP) | Last accessed December 2024
- Medicare | Children and Dialysis | Last accessed December 2024
- Medicare | Children and End-Stage Renal Disease | Last accessed December 2024
- Medicare | Children and Kidney Transplants | Last accessed December 2024
- SSA | Benefits for Children | Last accessed December 2024
- SSA | Benefits for Children with Disabilities | Last accessed December 2024
- SSA | Disability Benefits | Last accessed December 2024
- SSA | Family Disability Benefits | Last accessed December 2024
- SSA | How to Apply for SSI Benefits | Last accessed December 2024
- SSA | How to Qualify for SSDI Benefits | Last accessed December 2024
- SSA | Retirement Benefits Planner | Last accessed December 2024