Photo by Rebecca Drake/Post-Gazette -- Chitra Sharathchandra gives a kiss to her son Tejus as his brother, Akshay, 17, looks on during the celebration of Tejus' 21st birthday at their home in Squirrel Hill

For families in Pennsylvania who have a child with an intellectual or developmental disability, a 21st birthday can be an unhappy milestone — an end to the vital services their children receive.

Until age 21, the care they receive, such as behavior and occupational therapy, is considered a federal entitlement — that is, Medicaid has to pay for it. At 21, that entitlement ends, which can lead to a “cliff” effect of a sudden cutoff of services and being put on a waiting list until additional funding is available.

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