Turning 18: the checklist

For eligible Medicaid members under 21, EPSDT requires medically necessary care within the federal Medicaid benefit categories in section 1905(a) to correct or improve identified conditions, even when the state does not cover that service for adults. Medical necessity is decided case by case. This does not guarantee approval of every requested therapy or number of hours.

Source: Medicaid.gov, EPSDT · How we verify

IDEA generally requires a free appropriate public education for eligible children ages 3 through 21. Eligibility is decided individually. Age and graduation exceptions can apply.

Source: IDEA, 34 CFR 300.101 · How we verify

MHPAEA generally restricts differences between mental-health or substance-use benefits and medical or surgical benefits in plans it covers. It addresses financial requirements and treatment limits, including how prior authorization is applied. Exceptions include certain small self-funded plans. Parity does not by itself establish that a particular ABA request must be approved.

Source: CMS, Mental Health Parity and Addiction Equity · How we verify

Parental deeming ends, other rules continue

Parental deeming stops the month after the 18th birthday. Adult disability and financial rules still apply. Shelter support and applicable spouse or sponsor deeming can affect SSI. A denial based on parental income can be reconsidered through a new adult application; eligibility is not automatic.

Source: SSA, deeming · How we verify

2026 federal SSI maximum

For 2026, the maximum federal SSI payment is $994 monthly for an eligible individual and $1,491 for an eligible couple. Actual payments depend on countable income and other rules; state supplements may differ.

Source: SSA, 2026 SSI amounts · How we verify

SSI countable resources

The SSI countable-resource limit is no more than $2,000 for an individual, assessed at the start of the month. Exclusions include the home the person lives in and one vehicle used for transportation by the person or household. Income and other eligibility rules still apply.

Source: SSA, resources · How we verify

Disability onset is one eligibility condition

From January 1, 2026, ABLE's disability-onset threshold is before age 46. The person also needs qualifying disability-benefit status or a qualifying disability certification. An autism diagnosis alone does not establish eligibility.

Source: SSA policy, ABLE accounts · How we verify

2026 contribution limit

The ordinary 2026 ABLE contribution limit is $20,000 in total across contributors. Qualifying employed beneficiaries may make additional contributions under separate rules. This limit is different from the 2026 annual gift-tax exclusion.

Source: IRS Revenue Procedure 2025-32, section 4.34 · How we verify

ABLE and SSI have separate income and resource rules

SSA excludes the first $100,000 in an ABLE account from SSI resources. Other SSI rules still apply. Moving income already received into ABLE does not erase its otherwise countable income treatment, and contributions must stay within the applicable limits.

Source: SSA policy, ABLE accounts · How we verify

Florida supported decisionmaking

Guardianship is not automatic at 18. Florida law favors less restrictive alternatives. Supported decisionmaking can help an adult understand information and communicate choices; it does not authorize the supporter to make binding decisions for the adult. Any authority under a separate legal document or court order has its own limits.

Source: Florida Statutes, section 709.2209 · How we verify

Confirm each program's exit and coverage rules

EPSDT applies to eligible Medicaid members under 21. Before that boundary, ask about each service's adult coverage and authorization rules. IDEA generally covers eligible students through age 21, with exceptions such as graduation with a regular high school diploma and certain state age rules. Ask the district for the actual exit date and transition plan.

Source: IDEA, 34 CFR 300.102 · How we verify