Health Care Reform: Disabled and Older Persons

Expanded Medicaid Coverage
In 2014 all states will be required to expand the coverage offered by their Medicaid programs. Medicaid in every state will be required to cover people under age 65 who have income of 133 percent of the federal poverty line ($29,326.50 for a family of four in 2010). This is especially important to lower-income individuals applying for SSDI who have limited income and no coverage.

However, the health care reform legislation did not raise the asset value requirements of Medicaid eligibility. According to Mr. Gada, The maximum allowed asset value is determined by each state; among states that have asset value requirements, the maximum asset value generally ranges from $2,000 to $4,000 for single people and $4,000 to $6,000 for couples. This excludes someone's home, one car and their retirement savings, if they are under age 60; however, retirement savings are considered if they are 60 or older. As a result, someone no longer able to work because of their disability who had accumulated more than the allowable assets under Medicaid would have to chip away at this savings before becoming Medicaid eligible.

Expanded Long-term Care Options
Starting in January 2011, the health care reform law expands community living assistance options through a voluntary insurance program. Paid for through a payroll deduction of about $75 a month, all working adults will be enrolled automatically, unless they choose to opt-out. After a five-year vesting period, people with mobility issues are eligible for a cash benefit of at least $50 a day on average to buy non-medical services and support. Assistance may include caregiver support, adult day care and home modifications to support daily living, such as installing shower grab bars.

Banning Rescissions and Limits on Coverage
Starting in September 2010, individual policyholders no longer will be subject to lifetime caps or have their coverage dropped, except in instances of fraud. Individuals who already have been dropped from their insurance will be eligible for the high-risk pools. In 2014, annual limits are removed and people with health problems can no longer be denied coverage or charged higher premiums; limits also are placed on how much premiums can increase as people age.

Reducing Prescription Drug Costs
Effective immediately, Medicare recipients who have a gap in prescription drug coverage will receive a one-time, $250 rebate to supplement their medical expenses. Medicare Part D plan participants who have hit the donut hole will receive a $250 check. The first checks will go out in June to people who already reached the gap in early 2010. Additional checks will go out as people reach the donut hole, according to the U.S. Department of Health and Human Services. Starting in 2011, pharmaceutical companies are required to provide a 50-percent discount on brand-name prescription drugs for Medicare beneficiaries facing the prescription drug donut hole with additional subsidies.

"All of these provisions have the potential of helping people with disabilities improve their healthcare coverage," said Mr. Gada of Allsup Medicare Advisor. "However, more detail on how they will be carried out is needed to understand if they deliver."