Opportunities, Challenges and Gaps for the Disabled - the Affordable Care Act Lyn Weiss, M.D. Chair of Physical Medicine and Rehabilitation Nassau University Medical Center

Purpose of the Presentation Initiate Discussion

Concept: Issues of Concern for Our Patients “People with diverse disabilities continue to experience fundamental, sometimes life threatening, barriers to care today.” Lack of health insurance leads the list of most pressing problems Commentary, Mary Lou Breslin, Disability Rights and Education Defense Fund, in Kirschner KL. ed. Attending to Inclusion: People with Disabilities (PWD)

Physicians’ reaction to the ACA Sad because I will make less money. Happy that as a patient advocate, my patients will get better care

Opportunities Focus on preventative care (without co-pays or deductibles) The best rehabilitation is prevention

Opportunities – Essential Benefit Package Section 1302 of the Affordable Care Act requires health plans to provide coverage for at least the following categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health services and substance use disorder services Prescription drug coverage Rehabilitative and habilitative services and devices Laboratory tests and services Preventive and wellness services as well as the management of chronic diseases Pediatric services (including both oral care and vision care)

Pre-Existing Conditions NO exclusion due to pre-existing conditions!!!

Opportunities Presently-disabled person disincentivised from working so that they can receive Medicaid benefits ACA - disabled will be able to work and still afford to buy health insurance (but they may not be as good as Medicaid…)

Opportunities The law bans insurance companies from imposing lifetime dollar limits on health benefits The disabled are a group more likely to be affected by lifetime limits. Caveat: plans can put a limit on health care services not deemed “essential”

Funding and the ACA -Navigating Health and Long-term Care Options Provides $50 million over five years for Aging and Disability Resource Centers

Funding and the ACA - Helping People Remain at Home ACA’s Balancing Incentive Program - up to $3 billion in Federal Medicaid grant funding available to support States’ efforts to help keep people out of institutions and to help them live productive lives in their communities. Extends the Money Follows the Person program (support State efforts to transition individuals from institutional living back to the community) Supports efforts in 15 states to develop better ways to coordinate care for people with Medicare and Medicaid coverage (dual eligibles), who often have complex health care needs. Community First Choice Option allows states to offer home and community based services to disabled people through Medicaid rather than institutional care in nursing homes.

Challenges Draft bill to decrease reimbursement for rehabilitation stays and physicians

Challenges Still is a yearly cap on amount Medicare will pay for outpatient rehabilitation therapies ($1,900 for physical therapy and speech language pathology combined, and $1,900 for occupational therapy)

Challenges What impact will that have on patients who need rehabilitation but don’t have access?

Challenges States can choose an existing model to determine amount of minimum benefits Missouri limiting rehabilitation and habilitation benefits

Gaps Illegal immigrants

Gaps Patients who choose not to take insurance and pay the penalty. Who will pay if they are injured?

Why Should I Care?

If we live long enough, we will all eventually become disabled