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Affordable Care Act and People with Disabilities

What is the Affordable Care Act (ACA)?

  • The Affordable Care Act (ACA) is the most significant overhaul of the healthcare system in the United States since 1965. 
  • The goal of the ACA is to reduce the number of uninsured Americans and improve the quality of healthcare. 
  • Through the law, health insurance marketplaces have been created across the country to provide affordable coverage to those  who need or want it, and who are eligible. 

 

Affordable Care Act Eligibility

WHO IS ELIGIBLE?

  • Individuals and families who are uninsured and don’t have access to other affordable and adequate insurance through their employers.
  • Currently insured Texans who are buying their coverage directly from an insurance company.

 

WHO IS NOT ELIGIBLE?

  • Because the Medicaid expansion piece of the ACA was not implemented by Texas, most adults in the state that are below 100 percent of the federal poverty level are not eligible and are not covered by the ACA programs.
  • However, ACA health care “navigators” and other community-based application helpers try to help ineligible adults to find local health care resources. 
  • Several Texas organizations have launched a website, www.TexasLeftMeOut.org to inform and engage individuals who have “fallen through the cracks” as a result of the decision not to expand Medicaid in Texas.  

How does the ACA affect people with disabilities?

The ACA affects people with disabilities in the following ways:

  • Insurers cannot deny coverage due to pre-existing conditions.  
  • It prohibits health plans from putting annual and lifetime limits on most benefits.
  • All plans in the ACA Marketplace and all other “non-grandfathered plans” will have a cap on what insurance companies can require beneficiaries to pay in out-of-pocket expenses such as co-pays and deductibles. 
  • The ACA requires free preventative care such as wellness services and screenings. 
  • Free prevention and wellness services and screenings will also be available for individuals on Medicare.
  • It requires the development of federal standards for accessible medical exam and diagnostic equipment.
  • It requires that all plans provide certain essential health benefits (EHBs). These are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment services and drug treatment; prescription drugs;  rehabilitative and habilitative* services and devices; laboratory services; preventative and wellness services and chronic disease management; and pediatric services including dental and vision care.
  • The ACA provides funding for Medicaid and/or Medicare innovation projects that will improve care for individuals with chronic disease in order to keep those chronic diseases from becoming disabling diseases.
  • •    It has a data collection component to look at health disparities for persons with disabilities, as well as training and cultural competency of health care providers.

*Habilitative Services: Services designed to assist in acquiring, retaining and improving the self-help skills that are necessary to reside in home and community-based settings.  Examples of habilitative services are:

  •    Basic social skills
  •    Ability to administer one’s own medications safely
  •    Knowledge of one’s right to privacy
  •    Usage of a phone
  •    Ability to interact productively with health care professionals
  •    Ability to reliably speak about one’s own feelings

Does The ACA address longterm care Programs ?

Yes. The ACA continues or enhances funding for a number of home and community-based services and supports, such as:

 

  • Money Follows the Person – extends and enhances MFP program through 2016 with $2.25 billion in additional funding through 2016; expands eligibility.
  • The Community Choice First Program – a new Medicaid State Plan option gives states a 6% enhanced match to offer several community-based services, including attendant care, as an alternative to nursing home and other institutional services.
  • The Balancing Incentives Payments Program (BIPP) – a $3 billion grant to encourage and assist states to “rebalance” the way in which they spend their Medicaid long-term care dollars, moving away from institutional care and toward community-based services and supports. 

 

If you have questions:

If you have questions about the Health Insurance Marketplace, visit  https://www.healthcare.gov or, for Spanish, https://www.cuidadodesalud.gov/es/.  You can also call 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325. Online chat is also available 24/7.

For local help, https://localhelp.healthcare.gov/ allows consumers to search by city, state, or zip code to see a list of all local organizations certified to assist individuals with Marketplace questions and enrollment.