Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.
The Question: Will the Affordable Care Act streamline care for people with disabilities?
Christina Mitchell is a graduate student studying nonprofit leadership at the University of San Diego. She says she was born a volunteer, and grew even more passionate about giving back when she became a single mother at 18 and relied on welfare benefits to make ends meet.
"You realize very quickly that we have to help each other," Mitchell said. "Volunteering was a way that I could do that."
Mitchell now is helping families caring for disabled dependents through her graduate research. She's finding that they often deal with a tangled web of resources. Many have several doctors, multiple coverage providers, case workers and advocates and none of them are really talking to one another.
She wants to know if the Affordable Care Act will streamline the process for families caring for disabled individuals.
Here's Mitchell's question:
"I was wondering if the Affordable Care Act would be making changes for individuals with disabilities who rely on a combination of private, public and nonprofit care to meet their needs."
The Takeaway: A new pilot program could streamline care for some disabled people.
When people claim Social Security disability benefits, they also become eligible for Medi-Cal. After a two-year wait, they can also add Medicare to their coverage.
Having access to the dual plans helps ensure their needs are met, but sometimes it creates barriers. The plans cover different things and figuring out which one covers what can get tricky.
The Affordable Care Act will fund a three-year pilot program aimed at streamlining the process. In California, the program is called Cal MediConnect and is open to "dual eligible" — those in both Medi-Cal and Medicare.
The program is designed to bring all of the patient's doctors, coverage providers, social workers and family to the same table to establish "care coordination teams." It will try to centralize care management and simplify medical billing.
An ombudsman and state and federal officials will monitor the program.
Silvia Yee, an attorney with the Disability Rights Education and Defense Fund, outlined some additional wins for the disabled community under the Affordable Care Act:
- If their disabilities do not make individuals eligible for Social Security and public health programs, new rules on pre-existing conditions will make private insurance policies cheaper and easier to get.
- Habilitation – therapies that help individuals maintain the functions they have, such as speech therapy for children with autism – were not always covered by insurance policies. Now they have to be.
- The law asks the United States Access Board to draw up guidelines to standardize medical equipment. Current industry standards don't always accommodate people with disabilities. For example, people in wheelchairs can't be weighed on most scales.
The Orders: Enroll in Cal MediConnect starting in April.
Cal MediConnect will be offered in eight California counties, including San Diego. Enrollment is scheduled to start next spring through the county's Aging and Independence Services program.
Check out last week's Second Opinion: Will Obamacare help if my work benefits are too expensive?
