Turning 21 with Autism in Georgia: What Families Should Know Before the Transition

Turning 21 with Autism in Georgia: What Families Should Know Before the Transition

For many families, turning 21 is an exciting milestone. It’s a time filled with new opportunities, greater independence, and planning for the future. However, for autistic individuals and their families, it can also bring unexpected changes to healthcare, services, and support programs.

Many of the services available during childhood either change or end once a person reaches adulthood. Understanding these changes before they happen can help families avoid unnecessary stress and better prepare for the years ahead.

Healthcare Coverage Changes

One of the biggest changes occurs with Medicaid coverage.  Children enrolled in Medicaid receive protections through a federal program called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). This benefit allows medically necessary services, including therapies such as Applied Behavior Analysis (ABA), speech therapy, occupational therapy, behavioral health services, and autism evaluations, to be covered for individuals under the age of 21.

Once someone turns 21, those protections end. Adult Medicaid follows different coverage rules, meaning some services available during childhood may no longer be covered in the same way.  This doesn’t mean support disappears, but families should expect changes and begin planning well before their child’s 21st birthday.

1. Apply for Waivers Early

Many long-term supports for autistic adults are provided through Georgia’s Home and Community-Based Services (HCBS) waivers rather than traditional Medicaid benefits.

The two primary waiver programs are:

New Options Waiver (NOW) – Designed for individuals who can continue living at home or in their community while receiving support services.

Comprehensive Supports Waiver Program (COMP) – Provides more intensive services for individuals who require residential support or around-the-clock care.

These waivers can help pay for services such as:

• Personal support staff
• Community access services
• Respite care
• Day programs
• Supported employment
• Residential services for those who qualify

Unfortunately, demand is much greater than the number of available waiver slots. Many Georgia families remain on wait lists for years before services become available.  Because of these long wait times, experts recommend applying as early as possible, even if your child doesn’t immediately need services.

2. Supplemental Security Income (SSI)

When an autistic individual turns 18, they may become eligible for Supplemental Security Income (SSI), a federal program that provides monthly financial assistance to individuals with disabilities who meet income and resource requirements.  Unlike benefits for children, SSI eligibility after age 18 is generally based on the individual’s own income and resources rather than their parents’ finances.  Receiving SSI may also help individuals qualify for Medicaid, depending on their circumstances and eligibility pathway.

Families should begin learning about SSI before their child turns 18 so they understand the application process and documentation requirements.

3. Education Doesn’t End at Graduation

Many students receive autism supports through their school system under an Individualized Education Program (IEP).  These services can continue until a student graduates with a regular diploma or reaches age 22, depending on their educational program.

As graduation approaches, families should begin discussing transition planning with the school.  Transition planning may include:

• Employment goals
• Postsecondary education
• Independent living skills
• Community participation
• Daily living supports

Starting these conversations early gives students more time to develop the skills they’ll need as adults.

4. Employment and Vocational Services

Many autistic adults want to work, attend college, volunteer, or participate in their communities.  Georgia offers employment support through organizations such as the Georgia Vocational Rehabilitation Agency (GVRA), which helps eligible individuals prepare for, obtain, and maintain employment.  Services may include:

• Career counseling
• Job coaching
• Resume assistance
• Workplace accommodations
• Vocational training

Employment looks different for everyone.  Some individuals may work independently, while others benefit from supported employment services that provide ongoing assistance.  The goal isn’t simply finding a job, it’s finding meaningful work that matches a person’s strengths, interests, and support needs.

5. Guardianship Isn’t the Only Option

As children become adults, parents often wonder whether they need guardianship.  The answer depends entirely on the individual’s abilities and support needs.

Some autistic adults make their own medical, financial, and legal decisions independently.  Others may benefit from less restrictive options, such as Supported Decision-Making or a Power of Attorney.  Some individuals with significant support needs may require limited or full guardianship.   Families should carefully consider all available options before making legal decisions that affect an adult’s independence.

6. Keep Important Records Organized

One of the simplest ways to prepare for adulthood is to keep important documents in one place.  Helpful records include:

• Autism diagnostic evaluations
• Psychological evaluations
• Medical records
• Therapy reports
• School records
• Individualized Education Programs (IEPs)
• Medicaid and insurance information

These documents are often needed when applying for adult services, benefits, waiver programs, or vocational supports.  Having organized records can make future applications much easier.

Start Planning Earlier Than You Think You Should

One of the biggest mistakes families make is waiting until their child turns 21 to begin planning.  Many adult services involve lengthy applications, waiting lists, or eligibility reviews that can take months (or even years!) to complete.  Starting early gives families more time to explore options, gather documentation, and make informed decisions about healthcare, employment, education, housing, and long-term supports.

By: Savannah Pollock and Autism Toolkit

Sources

Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) – New Options Waiver (NOW) and Comprehensive Supports Waiver Program (COMP)

Georgia Vocational Rehabilitation Agency (GVRA) – Vocational Rehabilitation Services

Georgia Advocacy Office – Supported Decision-Making in Georgia (Georgia Advocacy Office)

Georgia Department of Education – Secondary Transition Planning for Students with Disabilities

Social Security Administration – Supplemental Security Income (SSI) for Adults with Disabilities

Social Security Administration – Benefits for Children with Disabilities

Centers for Medicare & Medicaid Services (CMS) – Home and Community-Based Services (HCBS) Waivers

Autism Speaks – Transition to Adulthood Toolkit

Autism Society of America – Transition to Adulthood Resources

U.S. Government Accountability Office (GAO). Youth with Autism: Roundtable Views of Services Needed During the Transition into Adulthood (GAO-17-109). (GAO)

National Library of Medicine

Ferguson EF, et al. Family Experiences with Supplemental Security Income and Legal Guardianship for Autistic Adults: A Mixed-Methods Study. Research in Autism Spectrum Disorders. 2024. (PMC)