The Affordable Care Act for Americans with Disabilities

October 4, 2012

Greater Choices and Enhanced Protections for Americans with Disabilities

Pre-Existing Condition Insurance Plan: The Pre-Existing Condition Insurance Plan provides coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. More than 50,000 Americans with pre-existing conditions have gained coverage through this plan, which helps build a bridge to 2014, when Americans will have access to quality, affordable care through Affordable Insurance Exchanges.

Ends Annual and Lifetime Limits: The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. 105 million Americans no longer have a lifetime dollar limit on essential health benefits. It also restricts and phases out the annual dollar limits a health plan can place on most of your benefits—and does away with these limits entirely in 2014 (except for certain individual policies that were in existence on March 23, 2010).

Improves Medicaid Home-and-Community-Based Services (HCBS)

Creates Community First Choice (CFC) Program: A new Medicaid State Plan option called Community First Choice gives States an increase of 6 percentage points in their federal matching rate for providing community-based attendant services and supports as an alternative to nursing home and institutional services for people with Medicaid, including those with disabilities. States must develop “person-centered plans” that allow the individual to determine how services are provided to achieve or maintain independence. States can take advantage of this enhanced match today!

Gives incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Institutions: Under the Balancing Incentive Program, $3 billion in enhanced Medicaid matching funds are available to States that have spent less than 50% of total Medicaid long term care medical assistance dollars in home and community based settings. In March 2012, New Hampshire and Maryland were the first states to receive this new funding.

1915(i) State Plan Home and Community-Based Services (HCBS): Improves the option for States to create a HCBS State Plan Benefit. People must meet State-defined criteria based on need (which are not required to be linked to the criteria for institutional care) and typically get a combination of acute-care medical services (like dental services, medication) and long-term services (like respite, case management, supported employment and environmental modifications).