The Transition Process
As youth transition to adulthood many factors must be considered including maintaining health insurance coverage and finding new physicians that serve young adults. The Maryland Office for Genetics and Children with Special Health Care Needs has developed a reference guide titled Ten Steps to Health Care Transition. This guide was created to assist families and young adults plan for the transition from a child-centered to adult-centered health care systems.
Additional health care transition resources include:
- Talking With Youth Doctor And Other Health Care Professions: Created by the University of Florida, this website includes videos, tips, and strategies for youth with disabilities and special health care needs to communicate with health care providers.
- Adolescent Health Transition Project: Created by the Center on Human Development and Disability at the University of Washington, this website includes health care transition information and materials for youth with special health care needs, chronic illnesses, and disabilities.
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Finding a Physician
Transitioning from a pediatrician to a primary care physician is part of the transition process for most youth. Click here if you are interested in searching for a new physician in Maryland.
Planning to Attend College?
Most colleges now insist that students have health care insurance while attending school. In assisting students, many colleges will offer insurance through a contracted insurer. This may be a good option for students who are unable to remain on their parents’ health insurance plan or will attending college outside the network service area. For more information, view the National Association of Insurance Commissioner's publication, College Health Insurance Needs.
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Private Insurance
Recent changes to health insurance now allow families to maintain dependent children on their health insurance policy until their 26th birthday, regardless of the youth's student status. Families may re-enroll dependent youth who previously lost coverage due to age and student status during their first open enrollment period after October 1, 2010.
Starting in 2014, young adults up to the age of 26 will be able to remain on their parents’ employer plan even if they are eligible for insurance through their employer. Visit Healthcare.Gov for more information on Health Care Reform changes for young adults. Click here for information on Health Care Reform changes for individuals with disabilities, including those to pre-existing conditions.
In addition, the Maryland Insurance Administration has created the Consumers Guide to Health Insurance to assist Marylanders in comparing different forms of insurance and options available.
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Medical Assistance
Medical Assistance (also known as Medicaid) provides coverage for a wide variety of medical expenses. If you also receive Medicare, Medical Assistance will eliminate almost all the Medicare costs you would otherwise need to pay. If you have private insurance, Medical Assistance may cover some items your private insurance does not.
There are a number of ways to qualify for Medical Assistance.
- Individuals who are receiving Supplemental Security Income (SSI) are automatically eligible to receive Medical Assistance.
- People who earn enough money from work to reduce their SSI checks to $0 usually still qualify for Medical Assistance until they earn over $38,328 per year (or sometimes more) from work through a rule called “1619(b)”.
- People who receive services through a Medicaid Waiver Program are eligible for Medical Assistance.
- Those who live in certain mental health housing programs (called “residential rehabilitation programs”) and receive Public Assistance to Adults qualify for Medical Assistance.
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Mental Health Services
Mental Health Parity: On July 1, 2010 the Mental Health Parity Act went into place, requiring that health care insurers provide the same coverage for mental health care as they provide for somatic (physical) care. Under the Act, insurers may not charge separate deductibles for mental health care, may not place a different number of visit limitations on mental health care than somatic care, and may not charge greater co-pays for mental health care than somatic care. If you experience unresolved problems with your health insurer regarding these new provisions contact the Maryland Insurance Administration to file a complaint or call 1-800-492-6116.
Public Mental Health System: The Mental Hygiene Administration (MHA) oversees the Public Mental Health System (PMHS), which includes funding community mental health services for Medicaid-eligible individuals and for individuals who, because of the severity of their mental illness and their financial need, qualify to receive state subsidized services. At the local level, Core Service Agencies (CSAs) assist with linking individuals to services in their community. Contact your local Core Service Agency for more information.
For those currently eligible for services under the Public Mental Health System who are looking for additional information, including finding a provider, view the Value Options website, or call 1-800-888-1965.
Healthy Transitions Initiative: For youth who reside in Frederick or Washington Counties, the Healthy Transitions Initiative (HTI) is a program administered by the Mental Hygiene Administration (MHA) and provides transitioning youth with serious mental health conditions with various services including mental health treatment. .
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Primary Adult Care Program
The Primary Adult Care (PAC) program covers some medical expenses, but not as many as Medical Assistance. If you don’t qualify for Medical Assistance or Medicare, you may be eligible for PAC if you:
- Live in Maryland
- Are a U. S. citizen
- Are 19 - 64 years old
- Have very low income
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Employed Individuals with Disabilities Program (EID)
The Employed Individuals with Disabilities program extends Medical Assistance health benefits to working Marylanders with Disabilities at a low cost. Learn more about the EID Program on Maryland Department of Disabilities website.
Advance Directives
As youth transition to adulthood most will begin to make decisions regarding their own health care. Through Advance Directives individuals are able to determine ahead of time what medical treatment they prefer and identify a health care agent to make decisions for them if they wish. This allows individuals to communicate their preferences about treatment to family, friends, and health care professions. Click here for more information on Advance Directives in Maryland.
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