I was definitely among those Americans breathing a huge sigh of relief on learning yesterday that the Supreme Court upheld most of the provisions of President Barack Obama’s Affordable Care Act. Among the myriad concerns my husband Jim and I have on our minds as our teenage son Charlie, who’s on the moderate to severe end of the autism spectrum, approaches adulthood is providing for his medical care.
The ACA’s provision that children can stay on their parents’ health insurance under they are 26 makes a huge diference for Charlie and for other kids and individuals with disabilities. It is very uncertain what sort of employment (if any) Charlie will have after he finishes school when he is 21 years old and definitely up in the air if a job for him would come with insurance.
ACA Benefits Individuals With Disabilities
As Nirvi Shah writes on Education Week’s On Special Education blog, some of the law’s other provisions make a big difference for families with children with disabilities. Under the ACA, lifetime caps on coverage that many insurance companies now have are removed. Shah quotes Dr. Paul Lipkin, who specializes in the care of children with developmental disabilities, cerebral palsy and other conditions, as saying that “For a person with chronic health issues, lifetime caps have always been something that have been feared.”
A child with CP or severe epilepsy could certainly need a great deal of medical care, with accompanying expenses. Families cannot simply seek our difference insurers as their children’s disability is considered a preexisting condition and a reason to be denied coverage.
Other benefits provided in the ACA for individuals with disabilities are :
- The ACA establishes the Community First Choice Option, which can help support community living for individuals with disabilities by providing states with the opportunity to receive increased federal matching funds.
- The ACA requires insurances plans to cover a number of “essential benefits” including mental health services, habilitation and rehabilitation services and behavioral health treatment (this latter is of particular concern to families with autistic children).
A Caveat About Medicaid
The one setback, noted by Disability Scoop, concerns Medicaid. While the Court affirmed most of the ACA, the justices did rule against a provision that required that states expand Medicaid to include people earning up to 133 percent of the federal poverty level (about $14,856 for a single person) or lose federal funds. People with disabilities would not be eligible for Medicaid if they earn too much, notes Marty Ford, director of public policy at The Arc, should the Court’s ruling leads to states deciding not to expand Medicaid.
I can imagine such a scenario happening to Charlie. He will not be earning much in whatever job (most likely part-time) that he is able to get. It would be a bit ironic (though hardly unheard of) if he earned just enough to place him above 133 percent of the federal poverty level and then had to stop working to qualify for Medicaid for his health coverage.
People with disabilities and their families have their lives dictated by the status of their health insurance. The Supreme Court’s ruling today tells these families they can make decisions about what is best for them as a family, and not be controlled by fear of losing health insurance coverage.
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Photo by Clarkston SCAMP