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.
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
5806 Harbour View Blvd.
Suffolk VA 23435
- Help may be needed in deciding on senior housing
Elderly people who value their independence and are accustomed to living alone are increasingly becoming incapable of doing so. The need for medical attention may prompt some older individuals to consider their options, including moving to a nursing home or another kind of assisted living facility. Another possibility is to have in-home care along with […]
- Net gifts can be used to reduce gift tax rate
One strategy to lower your taxable estate is lifetime giving. However, there is a gift tax rate of 40 percent. If you have exhausted your $5.43 million gift and estate tax exemption, and you wish to lower your gift taxes, consider the possibility of making net gifts. This method obligates the recipient to pay the […]
- Andrew Hook talks to Stretcher about revocable living trusts
In an interview for Stretcher.com, Attorney Andrew Hook explains the meaning of a revocable living trust by dividing the term into its main parts: “revocable,” “living” and “trust.” He describes a revocable living trust as a legal agreement in which a person, who is referred to as the “settlor” or “grantor,” transfers property to a […]
- Learn what government benefits are available to help pay for long-term care
There are a few government programs, including Medicare and Medicaid, that can help pay for long-term care services. Each program has certain regulations concerning which services are covered, your eligibility for benefits, the length of time you can receive benefits, and your out-of-pocket costs. In order to prepare for your long-term care needs, you should […]
- How and why seniors should stay socially engaged
Experts believe that in addition to engaging in regular exercise and eating well, social networking can contribute to the health of seniors. As you become advanced in age, changes that occur in the brain can make it challenging for you to absorb new information or recall things. In people who are afflicted with dementia, the […]