How the ACA Helps Medicare’s Disabled Beneficiaries

By Mark Taylor/Medicare NewsGroup

The Affordable Care Act, which was passed in 2010 and upheld by the U.S. Supreme Court in 2012, includes numerous provisions that impact people with disabilities through expansions of Medicaid, private health insurance reforms, new care coordination programs and efforts to transition elderly and disabled populations from institutional to home and community settings. The ACA:

  • establishes health insurance exchanges in states that will allow people to purchase affordable commercial insurance without entering high risk insurance pools;
  • heavily subsidizes expanding Medicaid eligibility to single adults under the age of 65 with incomes under $15,000 for single people ($38,000 for families of four) as of 2014 (potentially affecting more than 3.5 million Americans with disabilities );
  • will qualify more than 3 million people with disabilities or pre-existing conditions for health insurance exchanges as of 2014 through insurance reforms that forbid private health plans from discriminating against people with pre-existing conditions. The law already forbids exclusions for pre-existing conditions for people under 19.
  • will disallow insurers from imposing annual or lifetime dollar caps on policies;
  • expands private health insurance to dependent children under 26 on their parents’ policies (providing coverage to more than 4 million young people with disabilities);
  • improves data collection requirements to include gathering data on where and how people with disabilities access health care with locations of accessible healthcare facilities;
  • adds disability status to health disparities in calculations for reporting surveys, along with health provider training and cultural competency;
  • improves access to medical diagnostic equipment for people with disabilities by setting exam accessibility standards;
  • establishes care coordination demonstrations in Medicare and Medicaid for those with chronic conditions. States will work with beneficiaries, their families and caregivers, and health care providers to develop state pilot programs;
  • allows states, starting in 2014, to submit plans under the Medicaid Health Home option to develop medical homes, which are patient-centered care systems that improve coordination and access of care to improve treatment for people with chronic conditions, including dual eligibles. States get a 90 percent federal match for payments to home health providers.
  • bolsters Medicaid’s Money Follows the Person program by funding it through 2016 with an infusion of $450 million annually. The program helps people with disabilities eligible to live in nursing homes to transition to home- or community-based programs. Medicare will bring the program to 43 states.
  • offers the Community First Choice Option, which increases federal match rates to states by 6 percent by providing home care attendant and other services to allow beneficiaries to live at home as an alternative to costly skilled nursing nursing facilities.
  • creates the Balancing Incentive Program, which offers states $3 billion in federal Medicaid matching funds to states to encourage greater transitioning from institutional to home-based and community care settings. The 1915 (i) State Plan Home and Community-Based Services broadens the path for states to create that benefit, which combine acute care services with long-term care services.