The Patient Protection and Affordable Care Act (ACA) was signed into law in 2010. There are many ways the new law impacts children and youth with special health care needs (CYSHCN). Some examples of additional protections include:
- Providing greater coverage for more kids.
- Prohibiting insurance companies from denying or charging more for coverage due to a pre-existing condition, or rescinding coverage due to the cost or amount of services used.
- Eliminating lifetime limits on insurance coverage.
- Allowing children to remain on their parents’ insurance policies until age 26.
- Requiring health care plans to offer a comprehensive package of items and services, also known as essential health benefits. These include: ambulatory patient services; emergency services and hospitalization; laboratory services; maternity and newborn care; rehabilitative and habilitative services and devices; pediatric services, including oral and vision care; preventative and wellness services and chronic disease management; prescription drugs; and mental health and substance abuse disorder services, including behavioral health.
The next ACA open enrollment begins on November 1, 2016. This is the first day you can enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as early as January 1, 2017.
December 15, 2016 is the last day to enroll in, or change, plans for coverage starting January 1, 2017.
January 31, 2017 is the last day to enroll in or change a 2017 health plan. After this date, you can only enroll or change plans if you qualify for a special enrollment period.
Assistance with enrolling in an insurance plan is available for Michigan residents from insurance navigators and certified application counselors. Go to https://localhelp.healthcare.gov/#intro to find a navigator or counselor in your area.
In addition to the new federal law, Michigan enacted the Healthy Michigan Plan in April 2014. This program, also referred to as the Medicaid expansion, enables even more Michigan residents to be eligible for health insurance. For information about this plan, visit http://www.michigan.gov/healthymiplan/ or call 855-789-5610.
For more detailed information, see our section on Health Insurance & Finance, and the resources listed below.
Need help finding health insurance? Explore Coverage Options
CuidadoDeSalud.gov – Spanish version of healthcare.gov
Interested in seeing your eligibility for future insurance assistance? Try the Subsidy Calculator
Want to Learn More First? Start Here: a way for consumers to get some information about health and dental plans in their areas, and information about subsidies, without having to create an account.
What are Essential Benefits?
Consumer Call Center (1-800-318-2596) – open 24 hours a day, seven days a week to answer questions and provide personalized assistance for callers filling out their application or selecting a plan. The hotline will provide services in 150 languages.
Marketplace.cms.gov: This is the main avenue that CMS will use to communicate with interested stakeholders on Marketplace updates. It providesa wide variety of tools and resources to help people prepare to apply, enroll and get coverage in 2014. You can also sign up for updates by clicking on “Get updates.” After entering your email address, check the box that says “Health Insurance Marketplace (Exchange)” under the “Outreach and Education” section near the middle of the page
Navigator Tools for Consumers: The Answer My Questions page, from the National Health Council, is a collection of patient-focused materials and guides provided by trusted national organizations. These tools are designed to inform patients and family caregivers about health care reform and help them make good decisions about health insurance coverage. One of the resources is a worksheet to help people calculate the expected costs of their health care. Some of the resources are tailored to patients with specific chronic diseases and disabilities.
Financial Help for Health (from the Robert Wood Johnson Foundation)
Comparing Health Plans’ Benefits and Coverage Summaries (National Disability Navigator Resource Collaborative (NDNRC)
Questions and answers about securing insurance from Kaiser Health News.
What Obamacare Means for You – a video from the Whitehouse
Health Literacy: From Coverage to Care is an initiative from the Center for Medicare and Medicaid Services to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them, so they can live a long and healthy life. (English and Spanish resources)
The ACA and People with Disabilities
Catalyst Center Publications: The Catalyst Center is a national center dedicated to improving health care coverage and financing for Children and Youth with Special Health Care Needs (CYSHCN):
- The Affordable Care Act: A Side-by-Side Comparison of Major Provisions and their Implications for CYSHCN
This brief offers a concise description of select provisions in the Patient Protection and Affordable Care Act (ACA) with a side-by-side analysis of what they may mean for children and youth with special health care needs (CYSHCN) and their families.
- The Affordable Care Act and Children with Special Health Care Needs: An Analysis and Steps for State Policymakers
The Affordable Care Act (ACA) provides states with important tools to help children and youth with special health care needs (CSHCN) and their families access coverage that is universal and continuous, adequate and affordable. However, interpretation of the law and addressing implementation challenges with the unique needs of CYSHCN in mind will shape how well the ACA fulfills its promise to this vulnerable population. This paper developed by the National Academy for State Health Policy (NASHP) for the Catalyst Center reviews and analyzes key provisions of the ACA relevant for CYSHCN to help inform state policymakers’ decisions in implementing health care reform.
- Webcast: The Affordable Care Act and Children with Special Health Care Needs
As a companion activity to the release of the NASHP publication described above, NASHP and the Catalyst Center hosted a joint webcast at the end of January 2011. Policy experts from the NASHP and Catalyst Center teams presented highlights from their analysis. A panel of state and federal officials shared their perspectives on the report.
- Issue Brief: The Affordable Care Act and Children and Youth with Autism Spectrum Disorder and Other Developmental Disabilities
The Catalyst Center has developed a new report for the Association of Maternal & Child Health Programs (AMCHP) that offers a brief description of selected provisions in the ACA that have implications for children with ASD/DD. It describes how state Title V maternal and child health (MCH) programs can maximize opportunities under the ACA to develop and strengthen systems of care for children and youth with ASD/DD.
- Low Income Children with Special Health Care Needs and the Affordable Care Act
- Immigrant Children with Special Health Care Needs and the Affordable Care Act
The Affordable Care Act and the I/DD Community: An Overview of the Law and Advocacy Priorities Going Forward (Autistic Self Advocacy Network)
How People with Disabilities can Access the Marketplace under Healthcare Reform – Blog by Family Voices family leader, Lauren Agoratus
The ACA and Minorities
- Health Coverage for the Black Population Today and Under the Affordable Care Act (Kaiser Family Foundation)
Hispanics and Latinos:
- Health Coverage for the Hispanic Population Today and Under the Affordable Care Act (Kaiser Family Foundation)
- Coverage Opportunities and Obstacles for Hispanics Under the ACA (Commonwealth Fund)
Asians and Pacific Islanders:
- The Affordable Care Act and Asian Americans and Pacific Islanders (healthcare.gov)
American Indians and Alaska Natives:
- How Does the Affordable Care Act Impact American Indians and Alaska Natives? (healthcare.gov)
- Affordable Care Act: American Indians and Alaska Natives (Dept of Health & Human Services presentation)
- Setting the Record Straight on Immigrant Families and the Affordable Care Act (an op-ed in the Spanish-language publication La Opinion)
- Health Reform FAQs: Immigrants (Kaiser Family Foundation)
- Information on Eligible Immigration Status Types
- More Information on Eligible Immigration Status Types
- Citizenship and Immigration Status Questions
- Information on Immigration Documentation and how to correctly put it into the application
The ACA and Specfic Medical/Health Issues
- Clarification of Medicaid Coverage of Services to Children with Autism
A memo released on July 7, 2014 from CMS clarifying that children with ASD on Medicaid will now be able to get Applied Behavioral Analysis (ABA) and other therapies (e.g., physical, occupational and speech therapies) for their conditions. Under the guidance, services can be delivered by appropriately credentialed non-licensed practitioners as well as licensed practitioners, which is important in states that do not license providers such as behavior analysts, but instead rely on national certification for credentialing.
- AMCHP Issue Brief: The Affordable Care Act and Children and Youth with Autism Spectrum Disorder and Other Developmental Disabilities
This report, developed by The Catalyst Center at the Boston University School of Public Health, offers a brief description of selected provisions in the ACA that have implications for CYSHCN with ASD/DD. It also describes how state Title V maternal and child health (MCH) programs can maximize opportunities under the ACA to develop and strengthen systems of care for CYSHCN with ASD/DD.
Managed Long Term Services and Supports (MLTSS)
- Strengthening Long-Term Services and Supports – A Tool to Assess and Improve Medicaid Managed Care (Community Catalyst)
- Examining MLTSS Programs Key Issues to Consider (Kaiser Family Foundation)
- How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options (Kaiser Family Foundation)
Oral Health Care
- Kids’ Dental Coverage Uncertain Under Obamacare (Kaiser Health News)
- Rehabilitation and Habilitation Services and Devices (National Disability Navigator Resource Collaborative (NDNRC)
Answers specific questions that people with disabilities might ask about a health plans’ coverage of rehabilitation and habilitation services and supports as well as devices including wheelchairs, prosthetics, low vision aids and augmentative communication devices
Vision and Dental Care
- FAQ: Dental And Vision Care Part Of ‘Essential Benefits’ For Kids (Kaiser Health News)