Many families of children with chronic conditions face challenges in securing insurance coverage for hearing aids, physical therapy or similar services necessary for their child’s optimal development. The reason? Insurers often will pay only for “rehabilitative services” - meaning that the patient must have had the skills already in place so they can be restored - rather than “habilitative” services to help the patient acquire the skills. Whether habilitative services are covered under insurance plans is therefore a matter of great importance in child health policy.
In this issue brief, Sara Rosenbaum, professor of health law and policy at the George Washington University School of Public Health and Health Services, examines coverage of habilitative services for children under the essential health benefits provisions of the Affordable Care Act.
Professor Rosenbaum concludes that while provisions of the ACA have advanced access to habilitative service coverage in individual and small group markets, federal regulations issued in February 2013 may cause health plans to favor more comprehensive adult rehabilitative services over child habilitative services. She notes that states will play a primary role in determining essential health benefits, and that establishing state standards for health insurance plans sold in the individual and small group markets will be key to health policy for children with disabilities.
The issue brief offers recommendations about important issues states must address in developing their health plans under the ACA. Advocates may find these recommendations useful in monitoring plan development in their states.
The subject of habilitative care also is covered in a public radio report, "For Kids with Chronic Conditions, a Looming Insurance Battle."