Benefits
The Program pays for a participant’s medically necessary and reasonable expenses for :
- Health insurance premiums
- Medical, hospital, and rehabilitative care
- Nursing, attendant, residential, and custodial care
- Therapeutic services (such as occupational or physical therapy)
- Dental care
- Medication, supplies, and special equipment
- Durable medical equipment (such as wheelchairs and lifts)
- Travel
- Psychotherapeutic services for family members up to $10,000 annually
- Housing assistance (including construction and modifications)
- Motor vehicles equipped to accommodate people with disabilities
- Disability support payments (ages 18-65)
- Guardianship, conservatorship, and trust fees
- Education advocate services
- Funeral, cremation, and burial costs up to $10,000
These benefits are provided for the lifetime of an admitted participant.
These benefits are in effect as of July 1, 2026. Previous caps on the amount or level of benefits that can be provided have been removed except where specified.
Upon the entry to the Program, a family may receive a monetary award to cover expenses to date including reimbursement of attorney fees.
If an infant admitted to the Program dies within six months (180 days) after birth, the family may receive a monetary award up to $500,000.
Recent Updates
The interim policies will be in effect on July 1, 2026 and will guide all benefits administration to align with new state laws. For more information about the new and expanded benefits see the following:
Coverage & Compensation
Compensation from the Program may help to provide for the following:
The Program may cover expenses for all necessary and reasonable care, services, drugs, equipment, facilities, and travel, except when excluded or covered by private or government insurance.
Benefits FAQ
The Interim Policies will apply until they are replaced by regulations or final policies. The Program will be going through the process as required by law to update the current regulations. In addition, the FAC will help work to develop other policies that are needed to help meet participants’ needs.
The Interim Policies were developed in 2026 by the Program in consultation with the Family Advisory Committee (FAC). The FAC is made up of nearly 20 members who have a participant in the Program. The FAC provided input during a series of five meetings between April and June 2026.
The Interim Policies:
- Describe the Program’s benefits including new and increased benefits to align all benefits with new state laws (HB1007) going into effect July 1, 2026
- Explain how participants can get services such as medical and nursing care, motor vehicle and housing assistance, and disability support payments
- Cover how to get supplies, medication, and durable medical equipment
- Remove “any policy, rule, or guideline that extinguishes, limits, caps, or unreasonably delays payment of benefits to admitted claimants…”.
- Override any contradicting information in the regulations and handbook, effective July 1, 2026.
Starting July 1, 2026, benefits are changing. Whether your family is new to the Program or you have been participating for years, there are expanded and new services along with different and less restrictive requirements. In general, all benefits must be medically necessary and reasonable.
The benefits include items such as:
- Health insurance premium coverage
- Medical and hospital care
- Nursing and custodial care
- Medication, supplies, and durable medical equipment
- Therapies
- Vehicles equipped to accommodate persons with disabilities
- Housing assistance
- Disability support payments
Please reach out to your Case Specialist to talk about your individual situation. Please see our Interim Policies for all of the benefits that will be in effect starting July 1, 2026.
