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Healthcare for People with Disabilities After the Supreme Court Ruling

  • Synopsis: Published: 2012-07-26 (Revised/Updated 2017-06-28) - Article provides information for persons with disabilities after the supreme court ruling on healthcare - Tricia Blazier.

Main Document

Quote: "The law establishes affordable insurance exchanges in each state, and these are required to allow individuals and small businesses to compare and enroll in health plans."

The U.S. Supreme Court ruling on key provisions of the Affordable Care Act of 2010 (ACA) offered both additional clarity and additional murkiness. On the one hand, it clearly upheld the individual mandate requiring that everyone have healthcare coverage. On the other hand, it made the Medicaid expansion optional for the states, adding to the complexity for low-income individuals who must comply with the individual mandate.

Having access to affordable care is particularly important for people with disabilities, who often have limited incomes, serious medical conditions and tenuous healthcare coverage. In fact, my organization, Allsup, has found that one-third of those who have serious disabilities will lose their health insurance while awaiting Social Security Disability Insurance (SSDI) benefits.

Following is a summary of the Supreme Court ruling on key provisions, and what it means for people with disabilities.

The Individual Mandate

The Supreme Court's decision upholding the individual mandate means all U.S. citizens and legal residents will be required to have qualifying health coverage starting in 2014.

For people with disabilities, this means a number of positive developments. For example, insurers already are required to provide coverage to children with pre-existing conditions. Starting in 2014, insurers can no longer deny coverage to anyone with pre-existing health conditions and lifetime limits will be eliminated.

Also in 2014, state exchanges come online. It is hoped they will provide an affordable option for people who today can't afford coverage. For example, through the exchanges, people who make less than 400 percent of the federal poverty line will be eligible for federal subsidies of between 2 to 9.5 percent of income.

The law establishes affordable insurance exchanges in each state, and these are required to allow individuals and small businesses to compare and enroll in health plans. Exchanges also must clarify if individuals are eligible to receive tax credits for private insurance, or notify them if they're eligible for health programs such as Medicaid or the Children's Health Insurance Program (CHIP).

States can run their own exchanges, which are eligible for federal grants. If they choose not to, they will default to a federal exchange program. But for many people with disabilities, affordable care still may be a significant challenge, especially since the Medicaid expansion is likely to fluctuate from state to state.

Medicaid Expansion

Specifically, the ACA calls for expanding Medicaid to cover people under age 65 with income of 133 percent of the federal poverty line starting in 2014. This move is estimated to increase the number of people currently in Medicaid by at least 15 million. (The federal poverty line is $23,050 for a family of four in 2012.)

However, the U.S. Supreme Court ruling makes complying with Medicaid expansion optional for states. As a result, each state is able to determine whether or not to comply. As of late July, more than half were uncertain or had not commented on whether or not they would opt in to the Medicaid expansion.

States that choose to opt-out may experience the creation of a new "at risk" population: individuals and families who are required to have healthcare coverage, but are unable to qualify for Medicaid and unable to afford private coverage.

For those with disabilities, it becomes even more critical to ensure they are taking steps to receive Medicare eligibility by qualifying for SSDI benefits. Specifically, 24 months after being entitled to SSDI cash benefits, the beneficiary becomes eligible for Medicare.

Taking Control of Healthcare

As ACA continues to roll out, it's important that people with disabilities take time to understand its impact and their healthcare options. Steps people can take right now include the following:

  • 1. Those who currently have health insurance should take advantage of preventive services offered under ACA. Mammograms, routine vaccinations and other preventive care are provided without charging a deductible, co-pay or coinsurance.
  • 2. Those who may be eligible for Medicaid should apply, including those who are seeking SSDI benefits. By doing so, you may receive "past-due" benefits from Medicaid if the Social Security Administration determines that you are disabled.
  • 3. If you need health coverage now and have been denied as a result of pre-existing conditions, consider Pre-Existing Condition Insurance Plans (PCIPs). Created by ACA, PCIPs essentially are healthcare plans for people with pre-existing conditions who have no other options. PCIPs were created to fill the gap until the state healthcare exchanges come online in 2014. Unfortunately, the cost of PCIPs has been higher than initially expected, but still they remain an option for some individuals who can afford them and do not want to risk being without coverage.

Related Information:

  1. How Will the Affordable Care Act Affect 15M. Uninsured Young Adults - Young adults continue to represent one of the largest groups of Americans without health insurance.
  2. Health Reform Essential to Young Adults - Young adults ages 19 to 29 are struggling to get the health care they need more than almost any other age group.
  3. Nearly all Uninsured Women Will be Insured by 2014 with Health Reform Law - New health reform law will expand health insurance coverage to nearly all uninsured women and will make health care more affordable.

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