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
- Many employers provide back-up elder care
Hundreds of New York employers provide back-up elder care, designed to help employees stay at work when an unexpected problem arises with elder care. Employees who have registered for back-up elder care can call a care organization when they face an unexpected interruption in elder care. Within hours, the organization will send a home health […]
- How your life insurance policy can pay for long-term care expenses
A number of companies, such as Life Care Funding, will purchase a senior’s life insurance policy from him or her. In exchange, the company provides a portion of the face value of the policy to individuals facing high long-term care costs. These “life settlement” companies purchase the policy from the policyholder, then continue to pay […]
- Study supports doctor-led approach to end-of-life care planning
The end of a person’s life is a time of intense transition and difficult choices. Although nothing can fully prepare an individual or a family for the gravity of the decisions that need to be made, end-of-life care planning can help ensure that a dying individual’s wishes about his or her care are followed. Traditionally, […]
- The effect of procrastination and debt on retirement planning
The desire to create a comfortable, secure retirement is almost universal. Unfortunately, procrastination and debt can have a devastating, though not irreversible, effect on these efforts. While Americans can now anticipate longer-than-ever retirements with ever-higher costs of care, they tend to be less prepared for retirement than in decades past. Procrastination can affect one’s retirement […]
- Reducing caregiver stress helps prevent elder abuse
Elder abuse has long been associated with the stress caregivers experience when providing care for older loved ones. Reducing caregiver stress is a key factor in preventing the abuse and neglect of elders. As much of health care moves out of hospitals and into homes, caregivers are charged with providing care to increasingly ill loved […]