Sunday, October 7, 2012

ACA Update: Healthcare Law Working for Children with Special Health Care Needs

By Emily McKinley, Health Information Specialist

The Affordable Care Act (ACA), aka Obamacare, was signed into law in March 2010. Since then, Americans have enjoyed greater health care coverage and options rolled out in a stepwise approach. Provisions of the law will continue to unfold through 2014. The legislation immediately increased protections for the most vulnerable populations, namely children and individuals with special health care needs.

When the ACA was signed into law, children under the age of 19 years were immediately protected from pre-existing condition exclusions, which was a huge step for children and youth with special health care needs. Traditionally families of these children struggled to find and maintain health care coverage for their entire families. If they were able to find adequate coverage for their children with special health care needs worries of maintaining that coverage into adulthood plagued many. Now, however, children are able to remain insured on their parents insurance plans to the age of 26 unless the adult child is offered insurance by his own employer. This provision not only gives peace of mind to vulnerable populations and their families, but it also allows more time for individuals with special health care needs to pursue employment and educational options in their young adulthood.

Furthermore, the ACA acts as a safety net for families who face major medical expenses. The law forbids insurers from imposing lifetime limits on coverage expenses or dropping covered individuals from insurance plans due to honest application errors. These protections are paramount for those currently living with and those who, in the future, are diagnosed with special health care needs.

The ACA also called for an expansion to Medicaid programs. This provision was challenged in the Supreme Court, and the Court ruled that states may choose to opt out of the Medicaid expansion. States that opt to participate in the expansion will extend their Medicaid programs to cover more low income children, families, and childless adults, including those with special health care needs.

Additionally, the legislation sought to ensure adequate coverage for all Americans. In that vein, the ACA has established that certain Essential Health Benefits must be covered by all insurance plans. Those benefits include preventative and chronic care management, rehabilitative and habilitative services and devices, maternity and newborn care, and extended pediatric services, among others. Further, all plans must meet a “benchmark,” which is designed to ensure a consistent and adequate level of care for all, regardless of pre-existing conditions, age, and gender.

The ACA also promotes the expansion of and incentives for states to improve Home and Community Based Services versus institutionalized, long-term care. This provision is aimed at providing individuals with special health care needs and their families additional care options.

As the ACA continues to roll out all of its provisions, families of children with special health care needs will continue to see great benefits, including elimination of annual dollar limits for covered services and ensuring that individuals with special health care needs, chronic conditions and preexisting conditions are no longer charged higher premiums for coverage.

For more information about these and other provisions of the Affordable Care Act, please or visit our blog, If you have questions about how the ACA works for you, please contact us at 317.944.8982

1 comment:

Beth Dworetzky said...

Thanks for this good synopsis of how the ACA may affect families of kids with special health care needs. Readers interested in learning more might want to check out resources from the Catalyst Center (full disclosure: I work there), the federally funded national center dedicated to improving health care coverage for children and youth with special health care needs: