Prader-Willi Syndrome Benefits in Virginia

People with Prader-Willi Syndrome may qualify for federal disability benefits if their condition causes significant functional limitations. For Supplemental Security Income (SSI), eligibility is based on low income and limited assets, and a medical determination of disability. For Social Security Disability Insurance (SSDI), you must have a work history and enough Social Security credits. Both programs require a formal disability determination from the Social Security Administration (SSA). In Virginia, qualifying for SSI also means you qualify for Medicaid, which can cover medical and support services[2].

In Virginia, individuals with Prader-Willi Syndrome may be eligible for Medicaid waivers designed for people with developmental disabilities. These waivers provide home and community-based services, such as personal care, respite, and supported living. Eligibility for waivers is based on medical need, functional limitations, and urgency of need. There is a waiting list, and slots are assigned based on priority. You must contact your local Community Services Board (CSB) to begin the application process. Children and adults with Prader-Willi Syndrome may also qualify for Medicaid through the Aged, Blind, or Disabled (ABD) program if they meet income and functional criteria[1][6].

• Contact your local Community Services Board (CSB) to start the Medicaid waiver process.
• Apply for SSI or SSDI through the Social Security Administration.
• Gather medical records and proof of income.
• Complete all required forms and submit them to the appropriate agency.
• Follow up regularly to check the status of your application.

• Step 1: Contact your local Community Services Board (CSB) to request an assessment for Medicaid waiver eligibility. The CSB will help you complete the application and determine your priority for services[1].
• Step 2: Apply for SSI or SSDI through the Social Security Administration. You can apply online, by phone, or in person at a local SSA office. You will need to provide medical records, proof of income, and other documentation[2].
• Step 3: If you are approved for SSI, you will automatically qualify for Virginia Medicaid. If you are approved for SSDI, you may need to apply for Medicaid separately if your income is low enough[6].
• Step 4: For Medicaid waivers, the CSB will review your application and assign a priority level based on urgency of need. You may be placed on a waiting list if slots are not available.
• Step 5: Once approved, you will work with a case manager to develop a service plan and select providers.
• Step 6: Keep all agencies updated about changes in your situation, such as income, address, or medical needs[2].

• Supplemental Security Income (SSI): Provides monthly cash payments to people with disabilities who have limited income and resources. In 2025, the maximum federal SSI payment is $967 per month for an individual[2].
• Social Security Disability Insurance (SSDI): Provides monthly payments based on your work history. The maximum SSDI payment in 2025 is expected to be around $3,917 per month[5].
• Medicaid: If you qualify for SSI, you automatically qualify for Medicaid in Virginia, which covers medical and support services[2].

• Medicaid Waivers for Developmental Disabilities: Virginia offers three waivers for people with developmental disabilities: Building Independence, Family & Individual Support, and Community Living. These waivers provide home and community-based services such as personal care, respite, supported living, and behavioral supports. Services are tailored to individual needs and may include help with daily living, medical care, and community integration[1].
• Aged, Blind, or Disabled (ABD) Medicaid: Individuals with Prader-Willi Syndrome who are aged, blind, or disabled may qualify for Medicaid through the ABD program if they meet income and functional criteria[6].
• ABLE Accounts: Virginia residents with disabilities can open ABLE accounts to save for disability-related expenses without losing eligibility for means-tested benefits[2].

ABLE accounts allow people with disabilities to save money for disability-related expenses without losing eligibility for SSI, Medicaid, or other means-tested benefits. In Virginia, you can open an ABLE account through the state's ABLE program. Contributions are limited, and funds can be used for qualified disability expenses such as education, housing, transportation, and personal support[2].

For SSI in Virginia, the income limit for an individual in 2025 is $967 per month. For SSDI, there is no strict income limit, but you must be unable to engage in substantial gainful activity (SGA). The SGA limit for non-blind individuals in 2025 is expected to be $1,530 per month[3].

It is important to report any changes in income, resources, or living situation to the Social Security Administration and Medicaid to avoid overpayments. If you receive an overpayment, you may be required to repay the amount. Reporting changes promptly can help prevent overpayments and ensure you receive the correct amount of benefits[2].

• Virginia Department of Behavioral Health and Developmental Services
  Phone: (804) 786-3921

  TTY: (804) 371-8977

  Email: [email protected]

  Website

  For questions about Medicaid waivers for developmental disabilities.

• Does Prader-Willi Syndrome qualify for SSI in Virginia?

  Yes, Prader-Willi Syndrome can qualify for SSI if it causes significant functional limitations and you meet the income and asset requirements. You must apply through the Social Security Administration and provide medical documentation[2].

• What Medicaid waivers are available for Prader-Willi Syndrome in Virginia?

  Virginia offers three Medicaid waivers for developmental disabilities: Building Independence, Family & Individual Support, and Community Living. These waivers provide home and community-based services tailored to individual needs[1].

• How do I apply for Medicaid waivers in Virginia?

  Contact your local Community Services Board (CSB) to request an assessment and begin the application process. The CSB will help you complete the required forms and determine your priority for services[1].

• Can I work and still receive SSI or SSDI in Virginia?

  Yes, there are work incentive programs that allow you to work and keep your benefits up to a point. The SGA limit for non-blind individuals in 2025 is expected to be $1,530 per month[3].

• What is an ABLE account and how can it help in Virginia?

  An ABLE account allows people with disabilities to save money for disability-related expenses without losing eligibility for means-tested benefits. Virginia residents can open an ABLE account through the state's ABLE program[2].

• Are there special benefits for veterans with Prader-Willi Syndrome in Virginia?

  Veterans with service-connected disabilities may be eligible for additional VA benefits, such as job training, home loan fee waivers, and student loan forgiveness. Contact the VA for more information[4].