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Paying for it

How school, Medicaid, insurance, scholarships, SSI and ABLE accounts fit together for children with disabilities.

What school pays for

Special education and related services in an IEP must be free to your family (34 CFR 300.17 and 300.39). A school can charge only the same small fees every student pays. Section 504 services are free too (34 CFR 104.33).

A school can bill Medicaid for health services in an IEP, but it must ask your consent first, and it cannot make you enroll in Medicaid or pay a co-pay (34 CFR 300.154).

Medicaid and EPSDT

If your child is under 21 and has Medicaid, Medicaid must pay for any medically necessary service that federal law lets Medicaid cover, even if your state does not cover it for adults. This is called EPSDT (42 U.S.C. 1396d(r)(5)).

Separate CHIP plans do not have to follow EPSDT. Ask whether your child's coverage is Medicaid or CHIP.

Many states offer Medicaid to children with significant disabilities whatever the parents' income (often called Katie Beckett or TEFRA).

Private insurance

Most states require insurance plans they regulate to cover autism services. Self-funded employer plans may not have to. Ask your plan for its autism and therapy benefits in writing.

Scholarships and education savings accounts

Many states have private school scholarships or education savings accounts (ESAs) for students with disabilities.

Read the fine print. When a parent chooses a private school, the child usually gives up the individual right to a free appropriate public education from the district, and the private school does not have to follow the IEP. Many programs ask parents to sign a notice that says so.

SSI and ABLE accounts

  • SSI for children: Social Security counts part of the parents' income until 18. At 18, parent income stops counting and Social Security reviews the young adult under adult rules.
  • ABLE accounts: tax-advantaged savings for a person whose disability began before age 46 (since 1 January 2026). Up to $100,000 does not count against SSI.
  • More on work and benefits at Employment Atlas.

State by state

StateMedicaid for childrenCoverage whatever the incomeAutism insurance lawScholarship or ESA
AlabamaAlabama Medicaidyes (KFF 2026: state plan option or comparable waiver)yesuniversal: CHOOSE Act ESA (eligibility universal from 2027-28; income-limited before); Ala
AlaskaDenali KidCare (Alaska Medicaid for children and pregnant women)yes: TEFRA (state plan option)yesnone
ArizonaAHCCCS (Arizona Medicaid)yes (KFF 2026: state plan option or comparable waiver)yesboth: Empowerment Scholarship Account (universal ESA); Lexie's Law Disabled/Displaced Stud
ArkansasARKids First A (Medicaid)yes: TEFRA (ARKids TEFRA, income-based premium)yesuniversal: Education Freedom Accounts (universal ESA, LEARNS Act); Succeed Scholarship (SW
CaliforniaMedi-Calyes (KFF 2026: state plan option or comparable waiver)yesnone
ColoradoHealth First Coloradoyes: Health First Colorado Buy-In Program for Children with yesnone
ConnecticutHUSKY Health (HUSKY A)yes: Katie Beckett Waiver (1915(c))yesnone
DelawareDelaware Medicaid (Diamond State Health Plan)yes: Children's Community Alternative Disability Program (TEyesnone
District of ColumbiaDC Medicaidyes: TEFRA/Katie Beckett optionpartialgeneral-limited: DC Opportunity Scholarship Program (federal voucher, income-limited)
FloridaFlorida Medicaid (Florida KidCare Medicaid)yes (KFF 2026: state plan option or comparable waiver)yesboth: Family Empowerment Scholarship for Students with Unique Abilities (SWD ESA); FES-EO
GeorgiaGeorgia Medicaidyes: TEFRA/Katie BeckettyesSWD-specific: Georgia Special Needs Scholarship (SWD voucher); Georgia Promise Scholarship
HawaiiMed-QUEST (Hawaii QUEST Integration)yes (KFF 2026: state plan option or comparable waiver)yesnone
IdahoIdaho Medicaidyes: Katie Beckett (TEFRA), Home Care for Certain Disabled Cnouniversal: Parental Choice Tax Credit (2025 refundable credit, universal eligibility, capp
IllinoisIllinois Medicaid (All Kids)yes (KFF 2026: state plan option or comparable waiver)yesnone
IndianaHoosier Healthwiseyes (KFF 2026: state plan option or comparable waiver)yesboth: Indiana Education Scholarship Account (SWD ESA); Choice Scholarship voucher (near-un
IowaIowa Medicaid (IA Health Link)yes: Iowa HCBS children's waivers (Iowa was the first Katie yesuniversal: Students First ESA (universal since 2025-26); tax-credit scholarship
KansasKanCareyes (KFF 2026: state plan option or comparable waiver)yesgeneral-limited: Tax Credit for Low Income Students Scholarship
KentuckyKentucky Medicaidyes (KFF 2026: state plan option or comparable waiver)yesnone
LouisianaHealthy Louisiana (Louisiana Medicaid)yes: Children's Medicaid Option (TEFRA)yesboth: LA GATOR ESA (phased rollout toward universal eligibility, funding-limited); School
MaineMaineCareyes: Katie Beckett (TEFRAyesgeneral-limited: Town tuitioning (geographic eligibility only)
MarylandMaryland Medicaid (HealthChoice)yes (KFF 2026: state plan option or comparable waiver)yesgeneral-limited: BOOST voucher (income-limited)
MassachusettsMassHealthyes: Kaileigh Mulligan Program (TEFRA)yesnone
MichiganHealthy Kids (Michigan Medicaid)yes: Home Care Children's/TEFRA Programyesnone
MinnesotaMedical Assistance (Minnesota Medicaid)yes: MA-TEFRAyesgeneral-limited: K-12 Education Credit (refundable, income-limited, excludes tuition); K-1
MississippiMississippi Medicaidyes: Disabled Children Living at Home (TEFRA)yesSWD-specific: Equal Opportunity for Students with Special Needs ESA; Nate Rogers Scholarsh
MissouriMO HealthNet for Kidsyes (KFF 2026: state plan option or comparable waiver)yesgeneral-limited: MOScholars tax-credit ESA (income-limited; IEP students get priority and
MontanaHealthy Montana Kids Plus (Medicaid)no (KFF 2026)yesunclear: Special Needs ESA (HB 393, 2023) ruled unconstitutional by district court Dec 202
NebraskaNebraska Medicaid (Heritage Health)yes: Katie Beckett Program (TEFRA) and Medicaid HCBS waiversyesnone
NevadaNevada Medicaidyes: Katie Beckett Program (TEFRA)yesgeneral-limited: Nevada Opportunity Scholarship (tax-credit scholarship, income-limited)
New HampshireNew Hampshire Medicaidyes: Home Care for Children with Severe Disabilities (Katie yesuniversal: Education Freedom Accounts (universal ESA since 2025); tax-credit ESA
New JerseyNJ FamilyCareyes (KFF 2026: state plan option or comparable waiver)yesnone
New MexicoTurquoise Care (New Mexico Medicaid; formerly Centennial Care)no (KFF 2026)yesnone
New YorkNew York Medicaidyes (KFF 2026: state plan option or comparable waiver)yesnone
North CarolinaNC Medicaidyes (KFF 2026: state plan option or comparable waiver)yesboth: Education Savings Account+ (ESA+, SWD); Opportunity Scholarship (universal voucher)
North DakotaNorth Dakota Medicaidyes (KFF 2026: state plan option or comparable waiver)limitednone
OhioOhio Medicaid (Healthy Start)no (KFF 2026)yesboth: Autism Scholarship; Jon Peterson Special Needs Scholarship; EdChoice Expansion vouch
OklahomaSoonerCareyes: TEFRA Childrenyesboth: Lindsey Nicole Henry Scholarship (SWD voucher); Oklahoma Parental Choice Tax Credit
OregonOregon Health Plan (OHP)yes (KFF 2026: state plan option or comparable waiver)yesnone
PennsylvaniaMedical Assistance (Pennsylvania Medicaid)no (KFF 2026). KFF lists No. Pennsylvania's PH-95 Medical Asyesgeneral-limited: EITC and OSTC tax-credit scholarships (income-limited)
Rhode IslandRIte Careyes: Katie Beckett Program (TEFRA)yesgeneral-limited: Corporate tax-credit scholarship (income-limited)
South CarolinaHealthy Connections Medicaidyes: Katie Beckett TEFRA ChildrenyesSWD-specific: Exceptional SC (SWD tax-credit scholarship); Education Scholarship Trust Fun
South DakotaSouth Dakota Medicaidyes: Disabled Children's Program (TEFRA)yesgeneral-limited: Partners in Education tax-credit scholarship (income-limited; cap raised
TennesseeTennCareyes: Katie Beckett Program (1115 demonstration, Parts A and limitedboth: Individualized Education Account (SWD ESA); Education Freedom Scholarship (universal
TexasTexas Medicaidno (KFF 2026). KFF lists No. Texas Medically Dependent Childyesuniversal: Texas Education Freedom Accounts (SB 2, 2025; universal eligibility, first awar
UtahUtah Medicaidyes (KFF 2026: state plan option or comparable waiver)yesboth: Utah Fits All Scholarship (universal ESA; ruled unconstitutional Apr 2025, operating
VermontDr. Dynasaur (Green Mountain Care)yes: Disabled Children's Home Care, Katie Beckett Program (Tyesgeneral-limited: Town tuitioning (geographic eligibility only)
VirginiaFAMIS Plus (Virginia Medicaid for children), Cover Virginiano (KFF 2026)yesgeneral-limited: Education Improvement Scholarships tax credit (income-limited, higher lim
WashingtonApple Health for Kidsno (KFF 2026)yesnone
West VirginiaWest Virginia Medicaidyes: Children with Disabilities Community Service Program (Tyesuniversal: Hope Scholarship (universal ESA)
WisconsinBadgerCare Plusyes: Katie Beckett Program (TEFRA)yesSWD-specific: Special Needs Scholarship Program (SWD voucher); Milwaukee, Racine and state
WyomingWyoming Medicaidno (KFF 2026)nouniversal: Steamboat Legacy Scholarship ESA (universal; upheld by Wyoming Supreme Court Ma

This is general information, not financial or legal advice. Programs change. Check with the program named before you decide.

Last reviewed: November 2026. Rules, programs and phone numbers change. Check with the office named on this page. Report outdated or wrong information.