Healthcare reform and kids with special needs: what the new law means

The Affordable Care Act (ACA): Is it a good thing for kids with special needs? I really didn't have a clue how it will affect children with disabilities, and what cons there might be. Then Morris Klein, an attorney practicing in Bethesda, Maryland and the District of Columbia, kindly agreed to answer questions. He is a member of the Special Needs Alliance, a fellow of the National Academy of Elder Law Attorneys and an elder law attorney certified by the National Elder Law Foundation.

If you read this and still have q's, Mr. Klein will do his best to jump into the comments section and answer them, so feel free to ask.

When will changes for the ACA start taking place?

In 2014, although some states may seek to delay the deadline because they'll want to see how the Supreme Court ruled before taking any action to begin implementing the program.

Can you explain just how the ACA will affect kids with disabilities?

Children with disabilities will have more options for private healthcare coverage:

• Insurers will not be able to deny coverage for any child based on a pre-existing condition, nor can a premium rate be charged for such coverage.

• Insurers can no longer place lifetime limits on many benefits and, beginning in 2014, limits will be eliminated for most plans.

• Child-only policies must now be made available. This will facilitate coverage for kids whose parents have employer-provided insurance that doesn’t include dependent coverage or who are being raised by grandparents.

• Insurers must offer various wellness programs, such as well-child screenings, immunizations and, beginning in 2014, dental and vision care for children.

• Insurers will no longer be able to rescind policies because the applicant unintentionally made a mistake on the application. In the past minor oversights –even clerical errors—have resulted in lost coverage.

Previously, pre-existing conditions and lifetime coverage caps have led to situations in which a child’s only coverage option was Medicaid, unavailable to middle class families due to its strict eligibility guidelines. Families will also have access to insurance options through state-based “Health Benefit Exchanges.” There will be federal subsidies to help with the cost of private insurance for families living at the poverty level ($9,220 for a family of four).    

How does the ACA change the Medicaid program?

In addition to expanding the number of persons eligible for Medicaid, the ACA requires states to maintain currently eligibility standards and benefits for the Children’s Health Insurance Program (CHIP) under Medicaid until 2019 and to extend funding for CHIP through 2015. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the insurance exchanges.

What cons, if any, do you see in the Affordable Care Act for kids?

Poor persons in states that elect not to expand Medicaid are at risk; we do not yet know how much health insurance will cost once the ACA is implemented in 2014. Also, starting in 2013, healthcare Flexible Spending Accounts will be limited to $2500 per year per family, with annual adjustments for inflation (formerly, private employers could set their own caps on healthcare FSAs). Parents who use healthcare FSAs to pay for services, therapies and equipment for their children not covered by insurance may consider the limit a negative.

What are the financial implications of the ACA—can parents expect to save money? How so?

People who had to pay for healthcare out-of-pocket because they could not obtain health insurance will benefit. Even people who have health insurance now may save money because additional health services will be covered by insurance, such as vision programs for children.

Photo: Flickr/diana mai