Affordable Care Act

By Andrew Boyer

How does the Affordable Care Act “Obamacare” impact persons with disabilities who rely upon public benefits to live safely and comfortably.

The ACA is complex.  Not many of the articles which are available on the Act are easy reading.  Much of the Act is geared to reducing health care costs.  Not all of the Act affects individuals, so breaking the individual provisions into smaller pieces makes it easier to understand. Let’s start with some of those easier-to-understand items.  The Act includes the following:

  1. Elimination of pre-existing conditions as a basis to obtain health          insurance – no matter what your medical conditions are, you can still buy health insurance
  2. Elimination of annual and lifetime policy payments – the insurer must pay for all covered expenses without capping the amount of payment in a single year or over a lifetime
  3.  Dependent coverage under a parent’s health insurance policy through age  26 so that persons with disabilities who are under the age of 26 can be covered under a parent’s group health insurance policy as long as they don’t have access to health insurance through their own work;
  4.  Expansion of Medicaid programs to increase availability of home and community based services; this expansion expands the number of people who can receive Medicaid services because it increases the amount of income individuals can have while still qualifying for benefits;
  5.  Availability of private health insurance from a health care exchange (HIX) which will approve and monitor insurance companies who sell private coverage; and
  6.  Gradual elimination of the Medicare Part D donut hole by 2020; each year the size of the donut hole will get smaller.

Effective January 1, 2014, private insurance companies were no longer be able to deny health insurance coverage to any individual based upon a pre-existing condition.  Standing alone, this portion of the law opens the door to the purchase of private health insurance coverage by persons with disabilities.  Private health insurance coverage expands the number of providers and treatments to which the insured has access and eliminates the unfair stigma of being on the public dole.  For planning purposes, the initial consultation with your lawyer now includes the questions: (1) are there sufficient funds to purchase health care coverage privately, through my state’s existing health care exchange, avoiding the requirements for SSI/Medicaid eligibility and coverage restrictions of public benefits programs; and (2) If private insurance won’t cover the home and community based services or treatments that I need, can I use the special needs trust to purchase private health insurance and also to preserve the trust money to be used for non-covered supports and services?

Unfortunately, the Affordable Care Act offers very little for individuals who need long term care services such as assisted living and skilled nursing care – placement in care facilities will still be necessary but there is no change in the Medicaid covered services offered in each state.

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