- Special Needs Alliance - https://www.specialneedsalliance.org -

Special Needs and the Affordable Care Act

Shirley B. Whitenack, Esq. [1]

The Affordable Care Act (ACA) was passed nearly six years ago and its insurance exchanges are over two years old. How have individuals with disabilities fared under the new system, which is meant to make health coverage universally available? Improvements are undeniable, but gaps remain. While there are more options, making the best choice can be complicated.

Key benefits

How to Choose?

Before ACA, individuals with disabilities often had to choose between Medicaid, with its strict means-testing, or being uninsured. Today there are more options, but making the best selection can be complicated.

Fluctuating Income

Eligibility for Medicaid and insurance subsidies is based on an individual’s last income tax return. Job security is an issue for many people, and even more so for individuals with disabilities, since health changes can affect their ability to work. This can mean back-and-forth qualification for Medicaid and subsidies, accompanied by dramatic differences in coverage, drug formularies and physician networks. Such disruptions can be especially difficult for those with disabilities.

Community-Based Services

ACA’s Community First Choice program offers financial incentives to states that provide in-home attendant care through Medicaid. Its intent is to improve the availability of community-based long-term care, and it prohibits enrollment caps or waiting lists.

ACA also extended Money Follows the Person, which seeks to accelerate the movement of institutionalized individuals into the mainstream community. Progress under these programs varies from state to state.

Remaining issues

There are numerous medical issues that ACA has only begun to address. Healthcare providers are often inexperienced in communicating with individuals who have developmental disabilities; sign language interpreters are scarce; documents are unavailable in Braille; diagnostic equipment is inaccessible. While ACA calls for training for medical staff and the development of access standards covering diagnostic equipment, progress is slow.

The verdict? ACA has definitely expanded options for individuals with disabilities, but the system is complicated and some individuals continue to struggle with inadequate coverage.