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Read moreAlthough it took more than a year of back and forth, a comprehensive health care reform bill and an associated reconciliation bill finally passed both houses of Congress and were signed into law by President Obama.
People from both sides of the aisle have complaints about various portions of the legislation, but it is clear that the new law will have far-reaching consequences for people with special needs. Since the size of the law is staggering, ElderLawAnswers has highlighted some of the most important features of health care reform as it pertains to people with disabilities.
Parents will be able to keep children on their medical insurance until their children reach age 26, whether or not they are in school. Insurance policies differ considerably on coverage they provide the children of insured beneficiaries.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 recently took effect for group insurance plans covering more than 50 people. This law requires plans that include coverage for mental illness to provide that coverage on an equal footing with coverage for other medical conditions.
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For instance, insurers are no longer allowed to charge higher co-pays for visits to mental health professionals than they would for visits to medical doctors. The health care reform law eventually extends mental health parity to all plans, regardless of the number of participants, and it goes one step further by including mental health care as "essential" care that plans are required to cover.
A sizable number of people with special needs, known as "dual eligible" beneficiaries, receive both Medicaid and Medicare. As anyone with a dual eligible family member knows all too well, coordinating the various benefits offered by Medicaid and Medicare is next to impossible. What makes matters worse is that some provisions of Medicare law, especially prescription drug coverage, can directly contradict and cancel out better coverage offered by Medicaid.
The health care reform law will create the Federal Coordinated Health Care Office to coordinate between the two programs and encourage the states to provide a higher level of care to dual-eligible beneficiaries.
Current federal regulations require states participating in the Medicaid program to provide coverage for children in families living under the federal poverty level, and to extend coverage to their parents in certain situations. Although people who qualify for Supplemental Security Income (SSI) often obtain Medicaid benefits, for the most part adults who do not have severe disabilities and who do not have children have a hard time getting Medicaid.
Under the health care reform law, states can choose to accept federal funding to offer Medicaid to all adults making less than 133 percent of the poverty level. This dramatic expansion of Medicaid could provide benefits to many people with special needs who do not otherwise qualify for the program because they are able to work, albeit in low-paying jobs.
It can often be difficult to find doctors who accept Medicaid because of the program's low reimbursements, which average only 72 percent of rates paid by Medicare. In 2013 and 2014, Medicaid's reimbursements to doctors rose to the same level as Medicare, making it more likely that a doctor will participate in the program.
The new law also designates funds for the training of behavioral health workers who assist people with special needs. Funds are also set aside for private research institutes devoted to researching mental illness.
Read more about the Patient Protection and Affordable Care Act.
Access the full text of the Reconciliation Act of 2010.
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