THE RELATIONSHIP BETWEEN MEDICAID AND FAMILY LIFE FOR CHILDREN WITH DISABILITIES

Introduction

Most children with disabilities need medical care, therapies, or equipment–often all three–to thrive. For some, without these services provided in their homes, they are forced to grow up in facilities, away from their families and communities. Private insurance, even when affordable, provides only very limited coverage for the needs of the most vulnerable children. Medicaid, fortunately, has been able to fill in many of the gaps. While staff shortages have still left too many children without needed care, Medicaid has enabled family life for hundreds, if not thousands of Pennsylvania children. Preserving this safety net for children requires certain provisions of Title XIX of the Social Security Act (Medicaid) to be adequately funded – specifically, Early and Periodic Screening, Diagnostic, and Treatment services, or EPSDT, defined at 42 USC § 1396d(r), and Home and Community-Based Services (HCBS), defined at 42 USC § 1396n(c). 

Read our Impact Alert: THE RELATIONSHIP BETWEEN MEDICAID AND FAMILY LIFE FOR CHILDREN WITH DISABILITIES

BEHAVIORAL HEALTH & MEDICAID

Does your child receive Intensive Behavioral Health Services (formerly “TSS” or “wraparound”) or other behavioral health services?

If their services are paid by one of the plans below, your child’s services may be reduced by federal Medicaid cuts:

• Community Behavioral Health (CBH)

• Community Care Behavioral Health (CCBHO)

• Magellan Behavioral Health of PA (not Magellan employer-based plans)

• Perform Care

• Carelon Health

To learn more, click here.

MEDICAID--WHAT’S IN A NAME?

Sometimes it’s called MA, or Medical Assistance. Sometimes it’s called ACCESS. Sometimes it’s referred to by one or more of seven health plan names. Is it any wonder it’s confusing? Medicaid, known in Pennsylvania as Medical Assistance or MA, provides a free and comprehensive package of healthcare services to children with disabilities. Most of these children receive their services through managed health care plans that contract with the state. To learn more, click here.

ACA PREMIUMS UPDATE

CHILDREN WITH DISABILITIES IMPACT ALERT!!!

CAREGIVERS WITH INSURANCE THROUGH PENNIE LIKELY TO SEE HIGHER PREMIUMS WHEN REENROLLING

Reductions in subsidies for Pennie (Marketplace) premiums will go into effect January 2026 unless Congress acts, but reenrollment starts November 1st.  As Congressional leaders have failed to take action, both professional and family caregivers on Pennie will soon be getting reenrollment notices with the higher premium rates.  

For more information, see PHAN’s statement at https://www.pahealthaccess.org/news/phan-statement-on-2026-pennie-monthly-cost-increase/ and this article from Politico:

https://www.politico.com/news/2025/10/16/its-too-late-to-extend-aca-subsidies-without-major-disruptions-some-states-and-lawmakers-say-00612001?utm.

GOVERNMENT SHUTDOWN AND HEALTHCARE

On October 1st, the federal government is set to shut down many of its operations due to the failure of Congress to pass a budget bill. The impasse is a result of a profoundly important dispute over the funding of healthcare. Republicans recently voted to cut hundreds of billions of dollars from the Medicaid Program, to end eligibility for many, and to end federal subsidies that currently make healthcare affordable for low- and middle-income families through the Healthcare Marketplace (Obamacare). Democrats are insisting that these programs be reinstated and funding be provided for them in any new budget. To learn more, click here.