What Persons with Disabilities Should Know about Health Reform
• Children under the age of 19 can no longer be denied coverage because of a preexisting condition, like asthma or diabetes. Starting in 2014, no one can be denied health coverage for a preexisting condition. Read more about coverage of preexisting conditions.
• Until 2014, there are options for those who are denied coverage in the private market, including the Minnesota Comprehensive Health Association, the Preexisting Condition Insurance Plan and Minnesota health care programs. Read more about alternatives when denied for coverage.
• In 2011, Minnesota was chosen as one of 15 states to receive funding to improve care for “dual eligible” Minnesotans who are served by Medicare and Medicaid.
• Insurance plans can no longer place a dollar limit on the health care that is covered in a lifetime. Starting in 2014, there will be no dollar limits on the care that is covered in one year. Read more about restrictions on lifetime and annual limits.
• In 2014, most Minnesotans will be required to have health coverage through their employer, a public program or a private insurance plan. Read more about the requirement to have health coverage.
• Starting in 2014, Medical Assistance will expand to cover more people, including individuals making up to 138 percent of the federal poverty level—about $15,000 per year in 2011. Read more about Medicaid expansion.
• Starting in 2014, individuals without employer coverage will be able to shop for and compare health insurance plans through the Minnesota Health Insurance Exchange. Depending on income, tax credits may be available to help pay for coverage. Read more about an Exchange.
- My child is disabled. Is there any extension available to keep my disabled young adult child on my plan?
Yes. Under Minnesota law, if a child is incapable of sustaining employment because of a developmental disability, mental illness or disorder, or physical disability, a parent may be able to keep the child on their plan. The child must be chiefly dependent upon the parent for support and maintenance.
The parent must notify the insurance company of the child’s disability within 31 days of the child reaching the age that coverage would otherwise terminate under the plan. The family will be required to provide documentation.
- Do all plans that cover Minnesotans have to follow Minnesota law about disabled young adult children?
No. If coverage is through an out-of-state plan or if the employer is self-insured, Minnesota’s law does not apply. If an employee doesn’t know whether their employer is self-insured, they can ask their human resources department or the company that processes their health claims.
- Who will determine what benefits are considered essential health benefits under federal health reform?
The U.S. Department of Health and Human Services (HHS) will determine which services are considered essential health benefits in consultation with the Institute of Medicine and the Department of Labor.
- When is the full list of essential health benefits expected to be released?
A proposed list is expected to be released in 2012 for public comment.
- How do I keep informed of when the list of essential health benefits is updated?
These FAQs regarding essential health benefits will be updated when the complete list of essential health benefits is made available.
- Do we know what any of the essential health benefits will be?
The following types of services are specifically mentioned in the federal health reform law as essential health benefits:
- Emergency services
- Ambulatory patient services
- Prescription drugs
- Mental health and substance use disorder services, including behavioral health treatment
- Maternity and newborn care
- Pediatric services, including oral and vision care
- Preventive and wellness services
- Rehabilitative and habilitative services and devices
- Laboratory services
- Chronic disease management
- What determines the additional services that will be considered essential health benefits?
Health reform requires essential health benefits to be equal in scope to the plans typically offered by employers today. The U.S. Department of Labor provided a report on employer sponsored health coverage and the U.S. Department of Health and Human Services is using this information, along with recommendations from the Institute of Medicine, to produce a proposed description of essential health benefits. There will be an opportunity for consumers, doctors, nurses and other stakeholders to provide public comment.
- Why is the list of essential health benefits important?
Even you already have coverage, the definition of essential health benefits may impact your plan. For example, plans cannot place lifetime dollar limits on anything determined to be an essential health benefits and only grandfathered individual plans can include annual dollar limits on essential health benefits.
- What is long-term care?
Long-term care refers to care that individuals may need for a long time because they are unable to take care of themselves due to an illness, disease, the aging process, or cognitive impairment (for example, Alzheimer’s disease).
Most long-term care is non-skilled personal care, such as help with everyday tasks, called Activities of Daily Living (ADLs):
• Using the toilet
• Transferring (moving to or from a bed or chair)
• Caring for incontinence and
The goal of long-term care is to provide help with routine functions when being fully independent is not possible. Long-term care can be provided at home, in a community setting or in an institution.
- What is the difference between long-term care and standard/basic health care?
Long-term care generally refers to the full spectrum of services needed due to physical and/or mental impairments, and includes both nursing facility care and home and community-based services. It can include things like housing with services, assisted living, and in-home services such as home care, transportation, companion services, and home delivered meals. Standard/basic health care services include hospital, physician, and prescription coverage.
- What is home care?
Home care provides health-related services and assistance with day-to-day activities to people in their home. It can be used to provide short-term care for people moving from a hospital or nursing home back to their home and can also be used to provide continuing care to people with ongoing needs. Home care services may also be provided outside the person’s home when normal life activities take them away from home.
- Who is eligible for home care services?
Home care services are available to some people through Medical Assistance and waiver programs for Minnesotans who have needs that are medically necessary, physician ordered and are provided according to a written service plan. Minnesotans with long-term care insurance may also have access to these services. The CLASS program will provide a new option for Minnesotans to purchase long-term care insurance.
- How can I get home care services?
You can call a home health agency or your county public health nurse. To find a home health agency in your area, look in the yellow pages of your local calling area telephone book under Home Health Services.
- What is being done on the state or federal level to encourage people to purchase coverage for long-term care?
Minnesota implemented a Long-Term Care Partnership program effective July 1, 2006. Under this program, Minnesota residents who purchase a specific type of long-term care insurance policy, called a Long-term Care Partnership policy, are able to protect more of their assets if they later need to turn to Medical Assistance (MA) to help pay for long-term care services. Information on this program is available on the Minnesota Long Term Care Partnership website.
The health reform includes a Community Living Assistance Services and Supports program (CLASS). The program will provide assistance with long-term care services and supportive services that allow people to stay in their homes. The Affordable Care Act requires the Secretary of Health and Human Services to announce the details of the CLASS benefit plan by Oct. 1, 2012. Information on this program is available through the Office of Community Living Assistance Services and Supports.
- How is health reform helping Minnesotans stay in their homes and communities?
In 2011, Minnesota was one of 13 states chosen to participate in the Money Follows the Person (MFP) program under health reform. MFP helps Minnesotans transition from institutions and nursing homes into community settings by:
• Supporting Minnesotans as they return to their homes after hospital or nursing facility stays.
• Better serving individuals with complex needs in the community.
• Helping individuals in their homes by strengthening connections between healthcare, community supports, employment and housing systems.
• Increasing the use of home and community-based services overall
- Where can I go for answers to disability related questions?
The Disability Linkage Line® (DLL) is a free, statewide information and referral resource that provides Minnesotans with disabilities and chronic illnesses a single access point for all disability related questions. DLL provides service to the entire state from four locations: St. Paul, Rochester, Bemidji and Brainerd.
- Disability Linkage Line® 1-866-333-2466
- MinnesotaHelp.info: Disability Link
- Disability Minnesota
- Disability Benefits 101 - Minnesota
- Information on improving care for Minnesotans who are eligible for Medicaid and Medicare
- Preexisting Condition Insurance Plan
- Minnesota Comprehensive Health Association
- Minnesota Health Care Programs for Adults with Disabilities or are Blind
- Minnesota Health Care Programs for Children with Disabilities or are Blind