Many children with special health care needs and their families rely on the support of state and federal government programs or benefits to allow them to get the care they need. Without this governmental support, many of these children and young adults would be unable to go to school; their parents would be unable to work, or to live healthy lives. As children transition to adulthood, many of these support systems and benefits fall away. Most of these programs are offered only to children. In order to keep getting the care they rely on, these kids must attempt to find adult programs that offer similar benefits. Due to the differences in programs, as well as differences in eligibility criteria, many of these disabled young adults end up going without much of the care they would need to become healthy, integrated members of society. Needless to say, the process of transitioning from childhood to adulthood is a complicated and confusing one.
How will the ACA change the situation of “transition-age youth”?
1. Dependent Coverage: The ACA mandates that insurance companies must let kids remain covered by their parents’ health insurance up until age 26. For disabled young adults who have insured parents, this is good news. Many children with disabilities receive health care through programs offered only to children, so when those programs come to an end typically at age 19, they lose insurance coverage. Coverage under a parent’s insurance until age 26 would give the family time to secure other insurance options for their disabled child.
2. New Insurance Purchasing Power: Starting in 2014, health insurance companies will no longer be able to deny coverage due to a pre-existing condition, a problem that has caused many issues for transition-age youth with a history of pre-existing conditions looking to purchase insurance.. Additionally, the state health benefits exchanges will begin operations in 2014. These exchanges are predicted to create a consumer-friendly marketplace for individuals and families to purchase insurance options. Tax credits will be offered to citizens between 133-400% of the Federal Poverty Level, in order to offset the costs of plan premiums. So, a transition-age youth or the family of a disabled child looking to purchase insurance will have new consumer powers and protections to aid in doing so.
3. An Expanded Safety Net: The Medicaid expansion will begin January 1, 2014. Under the expansion, all adults with income below 133% of the federal poverty level will become eligible for Medicaid benefits. Often, children who are eligible for Medicaid due to a disability as a child are no longer eligible when judged by the different disability criteria that are applied to adults. The expansion will allow many disabled transition-age youth to keep their Medicaid benefits, regardless of their disability status.