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
- Strategies to make sure your retirement savings last
Americans are living longer than ever before, and for many people, Social Security retirement benefits represent only part of the income they wish to have in retirement. The average American life expectancy is about 79 years, and millions will live to be much older. The average life expectancy for a person who reaches age 65 […]
- How divorce affects retirement planning
Older people are getting divorced more frequently than ever before. Divorce can be a significant roadblock for retirement planning and financial security. Although divorcing earlier in life can have a minimal impact on retirement, divorcing after the age of 50 can have huge implications. Couples who are getting divorced should collect information about all of […]
- Choosing between Original Medicare and Medicare Advantage
Deciding what type of health insurance to get can be a daunting task for seniors. Medicare is highly regarded and very popular, but Medicare Advantage differs in ways that could be advantageous to some. Original Medicare includes Medicare Part A (hospital expenses) and Part B (other health care such as doctor’s office visits). The monthly […]
- How to appeal a Medicare denial
If you were denied coverage or payment by Medicare, you have the option of filing an appeal. The denial must be from Medicare, your Medicare Prescription Drug Plan or your Medicare health plan. It is within your right to file an appeal if you were denied any of the following: A health care service, prescription […]
- Defining common terms in Virginia estate planning
Estate planning is a complex process, and typically involves learning some new terms and concepts. Some of the most important estate planning terms to understand include: Advance medical directive – A document that details a person’s health care wishes in case they become incapacitated. An advance medical directive also allows the individual to name someone […]