Special Needs Planning: What to Know About Age 21

Age 21

Transition to adult Medicaid Children who are enrolled in a Medicaid program are entitled to robust medical services, some of which are mandated by the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) law.  Services may include physician and hospital services, diagnostic and screening services, home health services, prescriptions, and dental, vision, and hearing care.  In New Hampshire, children’s Medicaid typically ends when your child turns age 19.  Children who retain Medicaid coverage past their 19th birthday will be eligible for EPSTD services until turning age 21.  Therefore, if your child has a severe health condition or disability and qualifies for Aid to the Permanently and Totally Disabled (APTD) or Aid to the Needy Blind (ANB) at age 18, children’s Medicaid coverage will continue until your child turns 21 and the comprehensive coverage provided to children will continue. When children’s Medicaid benefits end, your child will transition to an adult Medicaid program, which generally does not include the same comprehensive set of benefits as children’s Medicaid.  For example, your child will only receive coverage for acute dental issues, such as tooth extractions, and will no longer be eligible for coverage of routine maintenance of dental health.  Therefore, it is recommended that, prior to your child’s 21st birthday, you work with your child’s health care providers to identify and treat any issues that may not be covered under an adult Medicaid program, and that you ensure your child receives a full vision exam and a full dental check-up and cleaning. Special Education Services During K-12 schooling, your child may be entitled to services under one of two federal laws, either the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973.  Elementary and high schools are responsible for identifying students with disabilities, screening them, and providing services designed to allow students to be successful in school according to each student’s individual needs and abilities.  However, these mandates are not imposed on colleges providing post-secondary education. IDEA provides special education services for children starting at age 3 by requiring the development of an Individualized Education Plan (IEP) that modifies the school curriculum, information delivery, or testing to meet each child’s individual needs.  IDEA covers children through high school graduation or through age 21, whichever comes first. Section 504 protects individuals with disabilities from discrimination while attending a school or college that receives federal funds. However, Section 504 has different requirements for K-12 schooling than it does for post-secondary education.  During K-12 schooling, the school must provide children with disabilities with a “free appropriate public education” (FAPE) that adequately meets their needs.  During this time your child may have a “504 plan” that offers modifications to the physical environment or learning process.  In contrast, Section 504 requires that a post-secondary educational institution provide access to an individual with disabilities, but does not require the institution to modify its program to ensure student success. Colleges do not have the same legal obligations as elementary and high schools, although they are subject to certain portions of Section 504, mentioned above, and the Americans with Disabilities Act.  The focus shifts from ensuring your child’s academic success to providing equal access to education, and the responsibility for obtaining the protections offered under these laws shifts from the school to the student.  Colleges are not required to identify students with disabilities, nor are they allowed to speak with parents about a student’s performance unless the student gives the school permission. Therefore, your child will need to self-identify as disabled, may need to pay for their own screenings, and will need to advocate for reasonable accommodations, as they are needed.  Services available vary from college to college, and may include receiving materials in large print or in Braille, having a note taker for lectures, receiving a single dormitory room, or taking exams in a quiet room alone.