What Happens to My Special Needs Child’s Health Care Coverage When She Turns 18?

February 6, 2009

The idea of a special needs kid turning 18 can be scary – that is when she is legally an adult and things start to change.  In another post I will address her legal decision-making power.  This post looks at health care coverage. 

If your child is on your private health insurance policy (i.e., the family plan you have through your employer), the good news is that she should be covered through age 25, so long as she is still your “dependent,” meaning that she receives over one half of her financial support from you.  After 25, if she is not employed, you will probably need to look at MassHealth. 

On the other hand, if your child has been on MassHealth as a minor, her current coverage will end somewhere between 18 – 22, depending on which program she has been enrolled in.  The good news here is that there are several MassHealth programs that she can switch over to as an adult.  

A word of warning – there are many different MassHealth programs, and they each of different enrollment criteria.  The enrollment process itself is long, tedious, and frustrating.  (If you’ve dealt with MassHealth in the past, you already know this.)  So if you are planning to enroll your child in MassHealth as an adult, get started on that process early.  Record-keeping is critical.  Keep all receipts related to medical care and medical purchases (doctor’s visits, prescriptions, equipment, even the little things from the pharmacy). 

The Boston Children’s Hospital and the Boston Bar Association wrote a good guide on this topic, see chapter 7 here