Law & Finance

Law & Finance

Ages: 22+

Government and Legal Services for Adults: Guidance and Resources

Government and Legal Services for Adults: Guidance and Resources

Be aware that you must leave high school by age 22. It can be the exact date of your birthday or shortly before or after based on the school’s choice. If you haven’t yet, at this point you’ll transition to employment, day program or post-secondary education as appropriate.

As an adult you transition to adult medical care and receive services from adult providers. Some pediatric doctors and dentists may still be willing to see you but many have limits for the maximum age their patients can be.

While early intervention, childhood-based and school services exist, adulthood services specific to autism are limited. Usually you pay for services you need either yourself (if they are not covered by health insurance) or through your health insurance.

If you’re looking into getting services like a type of therapy, ask your health insurance if it is covered and whether the provider is considered “in network.” In network means your health insurance company has an agreement with the provider for how much they can charge but it is important to look up the information to see what your costs are likely to be.

Medicaid may be another source of coverage for medical care and mental health services. Medicaid is a need-based federal program that provides health coverage for people with disabilities and low-income adults and children.

Depending on your state, if you have certain types of issues like challenging behaviors that could be of harm to yourself or others you may be able to use waivers from your county or state developmental disabilities agency to cover related therapy. For more information, visit the waivers section of the Legal Resources Tool Kit.

The Milestones free autism Helpdesk is here to support you and connect you with resources.

Applying for Social Security Disability Insurance (SSDI)

You can consider applying for Social Security Disability Insurance (SSDI) though it is a process to qualify. You must qualify as having a disability, have worked recently and can’t anymore. It is income that comes to someone who proves they cannot work. You may need to appeal if your initial application gets rejected, and if you disagree with the determination you may wish to consult with an attorney or Legal Aid.

SSDI is based on your earnings history and credits earned in the Social Security System. If you have sufficient credits and become disabled, you may be eligible for SSDI. If you do not have sufficient credits and are disabled, you may be eligible for Supplemental Security Income (SSI).

Supplemental Security Income (SSI) is a federal program that provides financial help for adults and children with disabilities who have low incomes and resources. SSI is a means-tested program (meaning it's based on income and resources) while SSDI is an entitlement program (meaning a government funded program for citizens who meet requirements set by law).

Supplemental Security Income (SSI)

SSI is available for individuals over the age of 18 who meet the Social Security Administration’s definition of disability for an adult. In addition to meeting the disability criteria, the person must have low income and resources that do not exceed $2,000. There are some exemptions to the resource requirement in that a house and car are exempt as an example. Once a child with disabilities turn 18, the parents’ income and resources are not counted toward the adult child with disabilites’ eligibility for SSI.

Start by contacting the Social Security Administration because the process is paperwork driven. Provide them with documentation such as medical materials. You will need to sign permission to allow Social Security to speak with your medical providers. If you qualify for SSI, you will automatically be enrolled in Medicaid.

If they receive SSI, you may want to create a rental agreement for your loved one that states how much rent they pay. If your adult child with disabilities lives with you and does not pay his/her fair share of rent, then the SSI benefit will be reduced by one-third because the child is receiving “in kind support and maintenance.”

Note that there is an ongoing evaluation to re-determine that your loved one still qualifies every certain number of years. This often requires you to go to a doctor or medical professional you don’t know as they select who they want you to see.

A Note about Substantial Gainful Activity (SGA) for Either SSI or SSDI

Another concept to be aware of is how income and disability-related expenses can affect benefits. In order to be considered disabled under either SSI or SSDI you may not be able to engage in “substantial gainful activity.” Substantial gainful activity (SGA) is measured in part by how much you earn each month. Impairment-Related Work Expenses (IRWE) can reduce your countable income so that you are still considered unable to engage in SGA. The Social Security Administration provides more information here.

We know these can be complicated issues. The Milestones Helpdesk is here for you and can be a resource.

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