The Affordable Care Act for Americans with Disabilities
A Brand New Day for Accessible, Affordable Health Insurance and an Enhanced Commitment to Community Living
- Coverage for Young Adults: The new health care law generally allows young adults, including those with disabilities and chronic conditions, to stay on their parents’ plan up to age 26 even if they do not live with their parents or if they graduate from school. Already 2.5 million young adults who were uninsured have gained coverage, giving both young Americans and their families peace of mind.
- Eliminates Insurance Company Discrimination: Most health plans cannot limit or deny benefits or deny coverage outright for a child younger than age 19 simply because the child has a “preexisting condition.” The parents of over 17.6 million children with pre-existing conditions no longer have to worry that their children will be denied coverage because of a pre-existing condition in the individual market. And in 2014, the law will prohibit insurance companies from denying coverage or charging more to any person based on their medical history.
- Secure Health Insurance Coverage: Because of the law, insurance companies cannot rescind or take away coverage when people get sick just because of an unintentional mistake on an application. The Affordable Care Act also provides for a new right to appeal an insurance company’s coverage decision and provides consumers with information and assistance to give them more control over their health care decisions.
- Pre-Existing Condition Insurance Plan: The Pre-Existing Condition Insurance Plan provides coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. More than 50,000 Americans with pre-existing conditions have gained coverage through this plan, which helps build a bridge to 2014, when Americans will have access to quality, affordable care through Affordable Insurance Exchanges.
- Ends Annual and Lifetime Limits: The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. 105 million Americans no longer have a lifetime dollar limit on essential health benefits. It also restricts and phases out the annual dollar limits a health plan can place on most of your benefits—and does away with these limits entirely in 2014 (except for certain individual policies that were in existence on March 23, 2010).
- Access to Preventive Services: The law helps make wellness and prevention services– like cancer screenings and wellness visits– affordable and accessible to you by requiring many health plans to cover certain preventive services without charging you a copayment, coinsurance, or deductible. 54 million additional Americans now receive coverage through their private health insurance plan for many preventive services without copays or deductibles.
- Expands the Medicaid Program: With 100 percent Federal funding for the first three years and at least 90 percent after that, the new health care law expands the Medicaid program to more Americans, including people with disabilities, starting in 2014. States have the option to expand their programs now.
- One-Stop Shopping and Accessibility to Coverage: Starting in 2014, Affordable Insurance Exchanges will make it easy for individuals and small businesses to compare qualified health plans, get answers to questions, find out if they are eligible for health programs like Medicaid and the Children’s Health Insurance Program (CHIP) or tax credits for private insurance, and enroll in a health plan that meets their needs.
- New Out-of-Pocket Limits: Starting in 2014, all non-grandfathered plans will be required to limit the amount you pay in out-of-pocket expenses annually, such as co-pays and deductibles.
- Helps Americans Understand Their Health Coverage: The Health Insurance Finder on HealthCare.gov gives Americans important information about their health plan choices that has never before been made public. And in the fall of 2012, health plans will provide consumers with clear, consistent and comparable information about their health plan benefits and coverage. Known as the Summary of Benefits and Coverage, these forms will enable consumers to easily understand their health coverage and determine the best health insurance options for themselves and their families.
- Extends and Enhances the Successful Money Follows the Person (MFP) Program through 2016 with an additional $2.25 billion in funding ($450 million for each FY 2012-2016). This extension builds on the program’s success in its first five years: 20,000 individuals with disabilities transitioned from institutional to community settings, with improved quality of life. The law:
- Supports the continuation of program in 30 participating States and DC.
- Extends the MFP to 13 new States seeking to rebalance their long-term care systems, bringing total participation to 43 States and DC. Many of these new States have already begun to transition individuals to community settings. In 2012 CMS released a Grant Funding Opportunity for the remaining 7 non-participating States and Territories to apply for an MFP Rebalancing Demonstration Grant (solicitation closes August 8, 2012).
- Expands the definition of who’s eligible for the MFP Program to include people that live in an institution for more than 90 consecutive days.
- Creates Community First Choice (CFC) Program: A new Medicaid State Plan option called Community First Choice gives States an increase of 6 percentage points in their federal matching rate for providing community-based attendant services and supports as an alternative to nursing home and institutional services for people with Medicaid, including those with disabilities. States must develop “person-centered plans” that allow the individual to determine how services are provided to achieve or maintain independence. States can take advantage of this enhanced match today!
- Gives incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Institutions: Under the Balancing Incentive Program, $3 billion in enhanced Medicaid matching funds are available to States that have spent less than 50% of total Medicaid long term care medical assistance dollars in home and community based settings. In March 2012, New Hampshire and Maryland were the first states to receive this new funding.
- 1915(i) State Plan Home and Community-Based Services (HCBS): Improves the option for States to create a HCBS State Plan Benefit. People must meet State-defined criteria based on need (which are not required to be linked to the criteria for institutional care) and typically get a combination of acute-care medical services (like dental services, medication) and long-term services (like respite, case management, supported employment and environmental modifications).
- Invests in Preventive Care for Better Health: The law invests in prevention and public health efforts at the local, State and national levels to control the obesity epidemic, fight health disparities, train the nation’s public health workforce, and reduce tobacco use, among other things.
- Ensures Accessible Examination Equipment: The Affordable Care Act improves access to medical diagnostic equipment so people with disabilities can receive routine preventive care and cancer screenings by establishing exam equipment accessibility standards. These standards will be set by the Access Board in consultation with the Food and Drug Administration. A notice of proposed rulemaking with draft standards was issued in February 2012.
- Fights Health Disparities: The law improves data collection on health disparities for persons with disabilities, as well as training and cultural competency of health providers. Initial guidance was issued in October 2011.
- Improves Coordination of Care for Populations with Complex Health Care Needs:
- State Financial Alignment Demonstrations to Support Care Coordination for Medicare-Medicaid Enrollees: The law also invests in innovations such as care coordination demonstrations in Medicare and Medicaid to help the one in 10 Americans today who experiences a major limitation in activity due to chronic conditions. Thirty-eight States and the District of Columbia expressed interest in developing strategies for implementing person-centered care models that fully coordinate primary, acute, pharmacy, behavioral health and long-term supports and services for Medicare-Medicaid enrollees. Fifteen of these States were awarded up to $1 million to support design of such an approach. States will work with beneficiaries, their families and caregivers, and other partners and stakeholders to develop their demonstration proposals.
- Medicaid Health Homes: Effective January 1, 2012, the Medicaid Health Home option allows States to submit a State Plan Amendment to develop health homes, which are person-centered systems of care that facilitate access to and coordination of the full range of services and supports for people with chronic conditions who meet eligibility requirements, including dual eligibles. Participating States get a temporary 90% match for payments to home health providers for these care management, coordination, and related services for the first eight fiscal quarters home health services are offered.
Posted: November 16, 2010
Last updated: April 5, 2012