by David Hoff
Institute for Community Inclusion, UMass Boston

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The recent health care reform legislation signed into law by President Obama contains a number of provisions that are very beneficial to people with disabilities, and will expand the availability of services and supports necessary to succeed in employment. It is absolutely critical for people with disabilities, families, and advocates to understand the facts about health care reform, and the many positive aspects of this legislation.

As health care reform is a very comprehensive piece of legislation (actually two pieces of legislation), the intent of this article is to simply provide some of the highlights of the legislation of particular interest to people with disabilities. At the end of the article is a list of resources for further information.

Improvement in Long Term Services and Supports

The ability to access long term supports and services are key to successful employment for people with disabilities. One of the major benefits in the health care reform legislation for individuals with disabilities are a number of new options for long term supports, that could be used for employment assistance.

CLASS Act

The Community Living Assistance Services and Support Act is a new long-term services and support program which will allow people with disabilities to have funds available to purchase long-term supports, including employment assistance. The program will work as follows:

• The program is voluntary, and individuals must sign up for it.
• Individuals must be employed at the time they enroll (although the level of employment required will be low)
• Individuals must pay a monthly premium: for full-time students and people with low-income, the premium will be $5.00; for others, the premium is expected to be $150 to $250 per month, although the exact figure is yet to be determined.
• You must pay into the program for five years to receive benefits.
• There are no exclusions allowed based on pre-existing conditions.
• You will receive benefits if you need assistance with activities of daily living.
• If you qualify for benefits, the minimum benefit will be $50 per day ($18,000 per year).
• The benefit will be a cash benefit, providing individuals with maximum choice and control. For example, an individual could use the funds for to pay for job coaching and other ongoing employment supports.
• Collection of premiums will start in January 2011, with the first payment of benefits in 2016.

Improvements in Medicaid funded supports

The health care reform legislation includes a number of features that improve the availability of community supports funded through Medicaid. These include

• A new Medicaid plan option that states may (but do not have to) adopt called the Community First Choice Option, through which states get a higher rate of federal matching funds for a range of community-based supported services. Employment-related supports could be among those services permitted under this option, depending on the language in the implementing regulations. (Effective October 1, 2011).
• Improvements in the existing Home and Community Based Services option to make it more attractive to states (effective October 1, 2010), as well incentives for states to move Medicaid funded services to the community from institutional settings (effective October 1, 2011).
• Extension of the Money Follows the Person Demonstration programs (http://www.cms.gov/CommunityServices/20_MFP.asp#TopOfPage) through 2016.

Expansion of Coverage

• Private insurance companies may no longer deny insurance coverage due to pre-existing conditions (effective for children under 19 in September 2010, and for everyone in 2014)
• Annual and lifetime limits (caps) on the amount of insurance benefits will no longer be allowed (gradual implementation through 2014).
• Health insurance companies will be prohibited from denying coverage due to pre‐existing conditions (effective in 2014).
• Insurance companies must provide coverage to policyholders children up to age 26 .
• Expands Medicaid to cover individuals with incomes up to 133 percent of the federal poverty line - approximately $29,000 per year for a family of four (effective in 2014).

Benefits

The minimum benefits provided by health insurance must include products and services that enable people with disabilities to maintain and improve function, such as rehabilitation and habilitation services and devices. Depending on the language in the implementing regulations, this could potentially include coverage for various employment assistance and supports.

Next Steps: Opportunities, Understanding, and Advocacy

As indicated above, various aspects of health care reform will be implemented over the next several years. The following are areas to keep a close eye on as the law is implemented:

• New options and services: Over the next few years there will be a variety of opportunities and options available to take advantage of the new aspects of health care coverage in our country, that allow individuals to maintain and succeed in employment.
• Development and implementation of regulations: Many of the details of how health care changes will be implemented will be dependent on the implementing regulations for the various aspects of the law. It is important to closely monitor regulations as they are issued in order to provide feedback on draft regulations, as well as to understand the details of implementation contained within the regulations as they are finalized.
• Assistance with advocacy at state level: Some aspects of the law, particularly the new options available under Medicaid, are going to require advocacy at the state level. Individuals with disabilities and advocates should work to understand what aspects of the law will require state level advocacy.

Resources:

For further information on the new health care reform legislation:
White House website: http://www.whitehouse.gov/issues/health-care
Kaiser Family Foundation: http://healthreform.kff.org/
Disability Policy Collaboration: http://www.ucp.org/ucp_general.cfm/1/8
Bazelon Center for Mental Health Law: http://www.bazelon.org/issues/healthreform/index.htm