The Affordable Care Act (ACA) expanded eligibility for subsidized health insurance, and this has the potential to substantially increase health insurance coverage among persons with disabilities. The increase will depend, at least in part, on the complexity of the application process. To facilitate access, the ACA streamlined the application process for subsidized coverage; however, this did not include disability-based coverage. This article analyzes and describes the application process, identifies complexities, and defines steps to reduce complexities. The following application complexities were identified: (a) the need for applicants to apply separately for cash assistance and subsidized coverage, (b) the need for applicants to determine whether to pursue a disability-based Medicaid determination, and (c) the absence of a way for persons to self-identify their disability on the streamlined paper application form. The analysis indicates that the application process for subsidized coverage is complex and may hinder access among persons with disabilities. We identified operational steps that states and the federal government can take to reduce the complexities and improve access.
AutorD.DugganM. (2006, August). The growth in the Social Security Disability rolls: A fiscal crisis unfolding (Working Paper No. 12436). Retrieved from www.nber.org/papers/w12436
2.
BruenB. K.WienerJ. M.ThomasS. (2003). Medicaid eligibility policy for aged, blind and disabled beneficiaries. Washington, DC: The Urban Institute. Retrieved from http://assets.aarp.org/rgcenter/health/2003_14_abd.pdf
GettensJ.HenryA. D.HimmelsteinJ. (2012). Assessing health care reform: Potential effects on insurance coverage among persons with disabilities. Journal of Disability Policy Studies, 23, 3–13. doi:10.1177/1044207311416584
12.
GreenwoodK. (2012). The health insurance exchange, the Medicaid program, and the apportionment of responsibility for determining eligibility and effectuating enrollment in New Jersey. New Brunswick, NJ: Rutgers Center for State Health Policy.
13.
GruberJ.KubikJ. (2002, September). Health insurance coverage and the disability insurance application decision (Working Paper No. 9148). Retrieved from http://www.nber.org/papers/w9148
MathesonL. N.KaneM.RodbardD. (2001). Development of new methods to determine work disability in the United States. Journal of Occupational Rehabilitation, 11, 143–154.
16.
Medicaid Program; Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearings and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Final Rule, 78 Federal Register 42307. (2013a). (To be codified at 42 C.F.R. § 440.347).
17.
Medicaid Program; Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearings and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Final Rule, 78 Federal Register 42306. (2013b). (To be codified at 42 C.F.R. § 440.340).
18.
Medicaid Program; Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearings and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Final Rule, 78 Federal Register 42306. (2013c). (To be codified at 42 C.F.R. § 440.315).
19.
Medicaid Program; Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearings and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Final Rule, 78 Federal Register 42231. (2013d).
U.S. General Accounting Office. (2004). Social Security Administration: More effort needed to asses consistency of disability decisions. Retrieved from http://www.gao.gov/assets/250/243276.pdf
