Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Federal, exists in every state

Other ways into Medicaid when the usual income test does not fit

Some Medicaid routes look at your child’s care needs or medical bills when ordinary income-based coverage does not fit.

What it is

Some Medicaid routes look at your child’s care needs or medical bills when ordinary income-based coverage does not fit.

The Children’s Waiver can use your child’s finances instead of yours when assessed care needs qualify. The Excess Income Program uses qualifying medical bills toward a spend-down. The hospital enrollment specialist can compare these with ordinary Medicaid and SSI-linked coverage.

Eligibility rules
  • The Children’s Waiver serves eligible children through age 20 who meet hospital, nursing-facility or ICF/IID care-level criteria.
  • The local district uses the child’s own income and resources for the Children’s Waiver.
  • Excess Income eligibility includes children under 21; the local district sets the actual budget and bill amount.
  • An SSI award links an eligible child to Medicaid in New York.
What you get
  • A review of Medicaid routes that may fit after the ordinary income screen.
What coverage includes
  • OPWDD’s separate waiver requires a qualifying developmental disability. Leukemia alone does not establish that eligibility.
If you decide to apply
  1. Ask the hospital enrollment specialist about the Children’s Waiver and Excess Income Program. Bring income details, bills and a description of daily care.

Hospital enrollment specialist or C-YES, 833-861-4467 · Official page ↗

After you ask
  • Ask C-YES about the current referral form and assessment process.
Good to know

A disability finding and a review of daily care needs are different tests.

Other details
  • Other routes include SSI-related Medicaid and the Medicaid Buy-In for Working People with Disabilities. The buy-in is for a qualifying employed person age 16–64. Its net available income limit is 250% of poverty, with a separate resource test. It is not a simple family gross-income cap. For a long hospital stay, the enrollment specialist can check the institutional route, admission dates and whose income counts. The Children’s Waiver is not the only possible door.

Related New York cards: Children’s Waiver · Excess Income Program.

Official sources
Ask your social worker

“If ordinary Medicaid does not fit, what are the benefits and drawbacks of the other routes? Could you help us decide which application is worth making?”

Why I’m asking: We want to compare coverage options without assuming they all ignore our income.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask which state option fits, confirm its application requirements and gather the requested financial and medical records.

Your social worker

Names the state's option and its phone number, and sends the medical application paperwork to the clinician who writes it.

The care team

Writes the medical application paperwork: diagnosis, treatment plan, daily care.

Who decides
The state Medicaid agency's disability unit
Ask your social worker
“Which option does this state have for a child with leukemia whose family is over the income limit: Katie Beckett, a buy-in, or SSI? Who on the team writes the medical application paperwork, and how soon can we file?”

How to apply

First step: Ask the hospital enrollment specialist which actual state Medicaid route fits and when to submit the required application.

  1. Ask which option the state runs for a child over income.
  2. File within two weeks while the medical evidence is fresh.
  3. Never drop a plan a buy-in requires.

Where it starts: The state's TEFRA, buy-in or SSI-linked application

What to gather

  • Pathology report and the oncologist's letter with the diagnosis date
  • The child's own accounts (most options test the child's money, not yours)
  • Pay stubs if the option charges a premium by income

How long: Up to 90 days by federal rule for a disability-based application. The state item says what is typical.

What a yes looks like

Medicaid behind your plan with a card, sometimes a premium notice, and a review date (often near the end of treatment).

What a no looks like, and the next move

“Over the child's savings”, “level of care not met” or “no such option here”. The letter names the test that failed, and each has its own appeal.

Watch out

  • The agency checks documented disability, the program's financial rules and any required care assessment separately. Do not assume a diagnosis satisfies every requirement.
  • The buy-in states (Colorado, Iowa, Louisiana, North Dakota, Texas) can require you to take an employer plan when the employer pays half the premium. Then the buy-in premium is often lower.
  • Spend-down (medically needy) is the last resort, not the first option.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 7, 2026.

What it is worth

Full Medicaid behind your plan, sometimes for a premium, in a family whose income is far above the ordinary line.

Covers: Full Medicaid benefit package · Home services through EPSDT and waivers once Medicaid is in place

Legal protection: Buy-in premiums and cost-sharing capped at 5% of income up to 200% FPL and 7.5% at 200–300%

What it costs the family: $0 in TEFRA states (Nevada excepted). A premium by income in buy-in states (Texas up to $230. Louisiana $0 to $35).

The eligibility facts, as published

State specific
yes
Non magi
yes
Disability standard
Where the route uses the SSI medical standard, documented acute leukemia is considered disabling for at least 24 months from diagnosis or relapse, or at least 12 months after transplant, whichever is later; financial and other program requirements still apply
Buy in ceiling
up to 300% FPL, state-selected
Employer plan rule
buy-in states may require enrollment in an employer plan that pays 50% or more of the dependent premium

Decisions this site cannot make: Child disability · Child's own finances (most options) · Level of care where the option requires it

Expect friction on: Medical packet · Separate agency desks

The trap: Separate requirements can include documented disability, financial eligibility and an assessment of care needs. Some routes count parental finances. Meeting one requirement does not establish eligibility.

What changes by state: Which option exists, whether there is a premium (buy-ins charge by income. Nevada charges for TEFRA), and the level-of-care standard.

Where I read this

← Back to your options