Health Reform and People With Disabilities
The Affordable Care Act contains several provisions that will affect people with disabilities. Many of the provisions take effect in 2014.
For a fact sheet in Spanish, follow this link
Accessibility and Nondiscrimination:
- Requires individuals to have health insurance unless they are eligible for health care through government programs such as Medicare, Medicaid, Veterans Affairs or military service.
- Pre-existing conditions: health insurance providers will no longer be allowed to deny coverage, charge higher premiums or exclude benefits based on a pre-existing condition.
- Creates the Pre-Existing Condition Insurance plan to make coverage available to individuals who are uninsured, have been denied coverage due to a pre-existing condition or are otherwise ineligible.
- Prohibits discrimination based on disability under any health program or activity that receives federal funding or assistance.
- Prohibits providers from rescinding coverage after someone is injured or acquires a new condition.
- Temporary high-risk pools: between now and 2014 individuals with pre-existing conditions are eligible to purchase coverage through high-risk pools if they have been without coverage for at least six months. Pools have yet to be created.
- No annual caps on benefits after 2014.
- No lifetime caps on benefits beginning immediately.
- Creates state-based health insurance exchanges to offer a variety of options for coverage and provides tax credits to those who cannot afford coverage.
- Places limits on out of pocket expenses and deductibles.
- Requires insurance providers to disclose and justify unreasonable premium increases.
- Certain essential benefits are mandated to be covered, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services.
- Extends certain prescription drug coverage for Medicaid recipients.
- Mandates coverage of anti-seizure, anti-spasm and smoking cessation medications.
Home and Community Based Services:
- Expands home and community based services for people with disabilities and chronic conditions to be able to live at home and participate in their communities rather than living in nursing homes or institutions.
- Community Living Assistance Services and Supports (CLASS): allows people with disabilities to buy into insurance programs whereby they receive benefits to help pay for long-term supports and services.
- Substantially increases funding for community health centers.
- Requires standards for accessible medical diagnostic equipment for people with disabilities to ensure accessibility to such equipment in doctors’ offices and other medical facilities.
- Eliminates the option to purchase wheelchairs under Medicare – rentals only will be covered.
- Increases the excise tax on durable medical equipment manufacturers, which will likely result in higher costs to consumers.
- Establishes Medicare durable medical equipment bidding program whereby HHS will choose suppliers that will be covered by Medicare, limiting consumers’ choices for wheelchairs and other equipment.
Training and Data Collection:
- Requires disability awareness training for medical professionals.
- Requires the federal government to collect health survey data from people with disabilities in order to better understand their needs.
- Expands Medicaid coverage to all people under age 64 who have household income less than 133% of the Federal Poverty Line.
- Community First Choice Option: allows state Medicaid plans to choose home and community based services for people with disabilities who would otherwise require institutional care.
- Extends the Money Follows the Person program until 2016 to cover costs of moving eligible Medicaid recipients from in-patient facilities to community-based settings.
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