2010 Health Care Reform for People With Special Needs

Although it took more than a year of back and forth, a comprehensive health care reform bill and an associated reconciliation bill finally passed both houses of Congress and were signed into law by President Obama.

People from both sides of the aisle have complaints about various portions of the legislation, but it is clear that the new law will have far-reaching consequences for people with special needs. Since the size of the law is staggering, ElderLawAnswers has highlighted some of the most important features of health care reform as it pertains to people with disabilities.

Funds to Move People From Institutions Into the Community

The Community First Choice Program will offer states that develop community support programs for people with disabilities partial Medicaid reimbursement from the federal government. States that participate in the program would have to create specialized programs that specifically help people with special needs who require an institutional level of care move into the community.

Most of the suggested programs will focus on providing in-home support and attendants. The program is funded for five years, but can be extended in the future if necessary.

Insurers Will Not Be Able to Refuse Coverage tor People With Pre-Existing Conditions

One of the most talked-about provisions of the new law prevents health insurance companies from denying coverage to people with pre-existing medical conditions. People with special needs who do not receive comprehensive health insurance coverage through government programs or a relative's health insurance have routinely been denied private coverage because of their special needs.

The new law prevents insurance companies from denying coverage based on these pre-existing conditions. This portion of the law will not apply to coverage for adults until 2014, but children with pre-existing conditions should be covered under the new law this year.

No Lifetime Limits on Coverage

No matter the amount of care an insured receives, they will be able to keep their insurance coverage.

Children Can Remain on Parents Policies Until Age 26

Parents will be able to keep children on their medical insurance until their children reach age 26, whether or not they are in school. Insurance policies differ considerably on coverage they provide the children of insured beneficiaries.

Extension of Mental Health Parity

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 recently took effect for group insurance plans covering more than 50 people. This law requires plans that include coverage for mental illness to provide that coverage on an equal footing with coverage for other medical conditions.

For instance, insurers are no longer allowed to charge higher co-pays for visits to mental health professionals than they would for visits to medical doctors. The health care reform law eventually extends mental health parity to all plans, regardless of the number of participants, and it goes one step further by including mental health care as "essential" care that plans are required to cover.

New Office Will Help Integrate Medicaid and Medicare Benefits

A sizable number of people with special needs, known as "dual eligible" beneficiaries, receive both Medicaid and Medicare. As anyone with a dual eligible family member knows all too well, coordinating the various benefits offered by Medicaid and Medicare is next to impossible. What makes matters worse is that some provisions of Medicare law, especially prescription drug coverage, can directly contradict and cancel out better coverage offered by Medicaid.

The health care reform law will create the Federal Coordinated Health Care Office to coordinate between the two programs and encourage the states to provide a higher level of care to dual-eligible beneficiaries.

Dramatic Expansion of Medicaid

Current federal regulations require states participating in the Medicaid program to provide coverage for children in families living under the federal poverty level, and to extend coverage to their parents in certain situations. Although people who qualify for Supplemental Security Income (SSI) often obtain Medicaid benefits, for the most part adults who do not have severe disabilities and who do not have children have a hard time getting Medicaid.

Under the health care reform law, states can choose to accept federal funding to offer Medicaid to all adults making less than 133 percent of the poverty level. This dramatic expansion of Medicaid could provide benefits to many people with special needs who do not otherwise qualify for the program because they are able to work, albeit in low-paying jobs.

Higher Medicaid Payments to Doctors

It can often be difficult to find doctors who accept Medicaid because of the program's low reimbursements, which average only 72 percent of rates paid by Medicare. In 2013 and 2014, Medicaid's reimbursements to doctors rose to the same level as Medicare, making it more likely that a doctor will participate in the program.

Additional Training For Workers Who Assist People With Disabilities and Funding for Research

The new law also designates funds for the training of behavioral health workers who assist people with special needs. Funds are also set aside for private research institutes devoted to researching mental illness.

Read more about the Patient Protection and Affordable Care Act.

Access the full text of the Reconciliation Act of 2010.

More Reading

• Consumers Guide to Health Reform
• Health Insurance Reform: A Guide for Seniors
• The Patient Protection and Affordable Care Act, Section by Section Analysis
• Summary of The Health Care and Education Reconciliation Act