Hook Law Center Special Needs Attorney Explains Obamacare’s Impact on Special Needs Families
Feb 28, 2014
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.”
Learn more at http://www.hooklawcenter.com/
Hook Law Center
295 Bendix Road, Suite 170
Virginia Beach, Virginia 23452-1294
5806 Harbour View Blvd.
Suffolk VA 23435
- Medicaid Rule Change Strengthens Home- and Community-Based Care
Millions of low- and fixed-income Americans depend on Medicaid for health care. Many are fortunate enough to receive that care in their homes or at nearby facilities. Unfortunately, some have no choice but to receive treatment in nursing homes and in other institutional settings that may be nowhere near their homes, friends and family. Such […]
- Four Legal Documents for Managing an Incapacitated Parent’s Affairs
When an elderly parent becomes incapacitated or terminally ill, the management of the parent’s financial and medical affairs often falls to one of the children. By having the proper legal documents in place, you can help ensure that this process goes smoothly. They help to keep an already difficult situation from becoming much worse because […]
- Companies to Rehire Boomers as Post-Retirement Consultants
Large numbers of baby boomers will reach retirement age soon, and that could result in a shortage of knowledgeable and experienced managers at many companies. To fix this problem, many executives are planning to rehire boomers as independent contractors after they retire. According to executive recruiting firm Lucas Group, 27 percent of executives at small- […]
- VA Expands Disability Coverage to Illnesses Related to Brain Injury
The Department of Veterans Affairs (VA) recently announced that some veterans with traumatic brain injury (TBI) and certain related illnesses will be eligible for additional disability benefits. The new regulation takes effect on January 15, 2014. It will affect some veterans with TBI who are also diagnosed with Parkinson’s disease, depression, certain diseases of the […]
- VA Reports Big Reductions in Backlog of Benefits Claims
The Department of Veterans Affairs has recently made significant progress in reducing its huge backlog of claims for disability compensation. Since it peaked in March 2013, the backlog has been reduced from 611,000 to just under 401,000 — a 34 percent decrease. The agency also reported that it has concurrently increased its decision accuracy. The […]