» Hook Law Center Special Needs Attorney Explains Obamacare’s Impact on Special Needs Families

Hook Law Center Special Needs Attorney Explains Obamacare’s Impact on Special Needs Families

Virginia Beach, VA (Law Firm Newswire) February 28, 2014 – A part of the Affordable Care Act (ACA) expands treatment for people with developmental disabilities, but some states may leave insurers with ways to sidestep the new requirement.

Hook Law Center (formerly Oast & Hook)

Hook Law Center (formerly Oast & Hook)

The ACA, commonly called “Obamacare,” requires health insurance plans for individuals and small groups to include coverage for “rehabilitative and habilitative services and devices.” Most insurance plans already cover rehabilitative services, which help people regain skills, such as walking or talking, after a debilitating injury or illness, such as a stroke.

“But habilitative services are often excluded,” explains Virginia special needs attorney Andrew Hook. “These services help people learn or maintain skills — as opposed to regaining them. They are crucial for individuals with autism, cerebral palsy and similar disabilities, and prior to the ACA, insurers rarely covered them. They would classify these disabilities as educational issues as opposed to medical issues.”

But advocates fear insurers in many states will still find ways to avoid or minimize coverage for habilitative services. The Department of Health and Human Services (HHS) permits insurers and state governments to decide the scope of the habilitative services that must be covered.

Each state is required to identify a “benchmark plan” to form a basis for defining the benefits that insurers will be required to offer. HHS rules say that if the benchmark plan does not define habilitative benefits, a state may choose to set that definition separately. If a state chooses not to set such a definition, it may either require insurers to cover habilitative services to the same degree as rehabilitative services, or it may leave insurers to set those limits themselves.

So far, fewer than half of states have explicitly defined the scope of habilitative services or elected to require parity with rehabilitative services, sparking the concern of special needs advocates. Moreover, past insurance shoppers have often had difficulty determining the specifics of habilitative coverage using the summary of benefits that insurers publish online. The changes may leave shoppers with even more opaque information.

Hook pointed out that private insurance is not always the best option for special needs families.

“Medicaid covers comprehensive habilitative services for enrolled children,” he says. “Parents who wish to know the specifics of qualifying for and enrolling in Medicaid should consult an experienced special needs attorney.”

Hook Law Center
295 Bendix Road, Suite 170
Virginia Beach, Virginia 23452-1294
Phone: 757-399-7506
Fax: 757-397-1267

SUFFOLK
5806 Harbour View Blvd.
Suite 203
Suffolk VA 23435
Phone: 757-399-7506
Fax: 757-397-1267
http://www.hooklawcenter.com/

  • Why You Need an Elder Law Attorney
    As elder law attorneys, we help our clients navigate through a host of issues: planning for incapacity or death; determining which long-term care services are appropriate for them; handling concerns about family dynamics, divorcing, feuding, or dysfunctional children; providing for children and grandchildren with special needs; and qualifying and applying for long-term care Medicaid and […]
  • Medicare Actively Expanding MSP Compliance for Personal Injury Claimants
    On February 3, 2017, the Centers for Medicare and Medicaid Services (CMS) announced that they would be establishing two new Medicare Set-Aside (MSA) processes – one for Liability Medicare Set-Asides (LMSA) and the other for Non-Fault Medicare Set-Asides (NFMSA). As a result, CMS will begin rejecting claims for payment of Medicare expenses associated with an […]
  • Predators and Creditors: How to Protect Your Family
    Estate planning has come a long way from when I first began practice in 1993. At the time, estate planning was highly driven by a need to avoid or minimize estate taxes and the tax rules took precedence over many other considerations for many families. Now, with possibility of estate tax repeal again looming on […]
  • Events That Inspire Estate Planning
    Frequently clients call our office due to a perceived risk, such as an upcoming surgery or a long-distance vacation. The refrain is usually, “I need to update (or create) my will in case something happens!” Fear of one’s own mortality naturally arises prior to these events because there is always an inherent risk in certain […]
  • Beware Hospital “Outpatient” Observation Status
    Picture this: You’re 80 years old and you suffer a fall that lands you in the hospital for a week. At the end of your stay, you are discharged to a rehab facility for three weeks of rehabilitation and skilled nursing care. The time you spend in the hospital and at rehab is stressful, but […]

See other news sources publishing this article. BETA | Tags: , , , , ,



Get headlines from Law Firm Newswire sent right to your inbox.

* indicates required