1. 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

2. Purpose of the Presentation
Initiate Discussion

3. 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)

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

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

7. 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)

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

9. 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…)

10. 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”

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

12. 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.

13. Challenges
Draft bill to decrease reimbursement for rehabilitation stays and physicians

14. 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)

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

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

17. Gaps
Illegal immigrants

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

19. Why Should I Care?

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