The Affordable Care Act and People with Disabilities

SEPTEMBER 30, 2013 VOLUME 20 NUMBER 37

The Affordable Care Act is upon us, or almost so. October 1, 2013, is usually listed as a key date for the ACA, and it is — but nothing actually changes on that date. Quite a few changes have become effective already. The changes receiving the most media attention — the availability of health care exchanges and individual insurance policies, and the related requirement that almost everyone get some sort of health insurance coverage — begin to kick in on January 1, 2014.

October 1 is important, though. That’s when the health exchanges are supposed to be available, even though customers won’t be able to secure policies for another few months after that date. That’s when we should have at least a partial answer to some of our questions, like how much ACA insurance will cost. Many, many other questions will still remain unanswered.

One question that we at Fleming & Curti think should be asked more often: what effect will the Affordable Care Act have on care of people with disabilities? Maybe the reason the question isn’t asked more often is that the answer is (as we look into our Magic 8-Ball): “Reply hazy – try again”.

There have been a few articles written about the relationship between the Affordable Care Act and patients with disabilities. The Obama Administration has a few suggestions about the benefits of the ACA for this population. The Special Needs Alliance (we love the SNA, and we are members) has written about the ACA, and individual SNA members have described the effect of the Supreme Court decision upholding the ACA, the ACA’s impact on people with special needs, and how the new health care exchanges may affect care for those with disabilities (among other topics). The National Academy of Elder Law Attorneys has provided a fair amount of information, too.

But what does it really mean? We can provide some highlights:

  • The ACA means the end of pre-existing conditions limitations. This might be a huge item. People with special needs have largely been frozen out of the health insurance market because they haven’t been able to get coverage. That should now change. People with cerebral palsy, mental illness, physical disabilities — all should be able to qualify for insurance. Coverage might be limited, or expensive, or both — but it should be available. That, of course, only works if almost everyone is insured — we will have to see how that plays out over the next few months.
  • Most patients with disabilities, frankly, will be unaffected. Most already qualify for Medicare or Medicaid — or both. They will not, in most cases, be moving to private insurance (though some undoubtedly will).
  • Family members, including caretaker family members, may suddenly qualify for health care coverage. That just might prove to be a surprisingly strong benefit for patients with disabilities.
  • Some beneficiaries of special needs trusts may be in a position to leave Medicaid plans in favor of private insurance. Some special needs trusts might even be modified to provide better benefits for the beneficiary (since continued eligibility for Medicaid might not be as important). This, of course, will depend on the size of an individual special needs trust, and the cost of insurance. But a significant number of patients may move from the public health system to private insurance coverage.

It is early still, but the ACA might be a real game-changer. We’ll keep monitoring policies as they roll out, and as the industry adapts to change.

 

 

 

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