Essential #7 – Disability Services

Number 7 on the list of Obamacare’s Essential Benefits is Rehabilitative and Habilitative Services. In case you’re wondering, as I was, just what that means, here’s what I can tell you. They are basically Disability Services but we give them different names depending on when and how you got your disabilities. Rehabilitation, as you probably know, involves helping people regain skills they had already developed but somehow lost. Well, ‘habilitation’ is helping people gain skills they haven’t developed yet. Generally rehabilitation targets adults and habilitation targets children, but not always.

Rehabilitative Services

Even before the Affordable Care Act, many health insurance plans have been set up to help pay for a certain amount of rehabilitative Man in business suit using a walker and walking with woman in business suitservices. Traditionally these are disability services that help a person improve skills that have been lost after a stroke, head injury, illness, or other medically diagnosed cause. These things mostly happen to adults but there are children who need these services, too. It is interesting to know, however, that rehabilitation is seen by professionals as a growing field. The Princeton Review tells us that recently the field for rehabilitation professionals is growing to include more disabilities. Emotional disabilities, mental retardation, substance abuse, and continued patterns of criminal behavior are some of the more newly defined ‘disabilities.’

Habilitative Services

Formerly many insurance plans included language specifying that disability services like physical therapy or speech-language pathologyBlind child learning mobility would be provided when skills have been lost due to illness or injury (rehabilitation). This language means no payments for services to those who haven’t been sick or injured but haven’t ever developed some important skills (habilitation).  Typically this lack of normal development is diagnosed in children who don’t have a specific medical diagnosis underlying their speech, language, swallowing, or hearing problems. But even some adults, particularly those with intellectual disabilities or disorders such as cerebral palsy may become more functional with habilitative services.

What Obamacare Does to Your Insurance

If you’ve been following this series, you know that the answer to how this affects your insurance coverage is likely to be different in different states. The law says that the Secretary of Health and Human Services is responsible for defining the benefits but she is letting each state set up its own specifics based on an insurance plan already used by a lot of people in that state (a benchmark plan). However, when addressing habilitation specifically in its bulletin, HHS acknowledges that these services are not well-defined and suggests that states either

  • make sure plans cover same kind and amount of services for rehabilitation and for habilitation, or
  • let plans decide what habilitative services to cover and provide for review and further definition in the future.

By early 2013 several states had already come up with statements about how they would handle the question.

  • California says habilitative benefits are “medically necessary health care services and health care devices that assist an individual in partially or fully acquiring or improving skills…” but also says that respite care, day care, recreational care, residential treatment, social services, custodial care,    or education services of any kind do not qualify as habilitative.
  • Colorado says they are “services that help a person retain, learn or improve skills and functioning for daily living…” and must be offered in “like type and substantially equivalent in scope, amount and duration” to rehabilitative services.
  • Kansas just says their benchmark plan includes well-defined rehabilitative services and expects plans to offer the same services for habilitation.
  • Rhode Island goes into a lot of detail about complying with governmental regulations and sets up an annual review of habilitative and rehabilitative insurance claims and expenses.
  • Ohio finds their benchmark plan does not include habilitative services and allows insurers to determine what they will cover. However, they must include specific services for children aged 0-21 diagnosed with Autism Spectrum disorder.

As you can see, coverage will surely be different in different states. But different companies and different plan levels will also surely offer different levels of coverage.

Find Out What Plan You Can Get

Health Insurance PolicySo whether you ever need or want these services or not, your insurance company is required to include them in your policy. Some states may require more of these services to be included than others. Even in the same state, different companies may offer more or less coverage for habilitative and rehabilitative services, but all of them will have to include both. Find out what is available to you by getting on the government’s website healthcare.gov and talking to somebody about the health care plans you can get. If your state has its own exchange, you will be referred to it for that information. Another resource is to go to a local insurance agent. Or you can use one of the private health insurance marketplaces on the web like eHealthInsurance.com. They are up and running, have free consultants to answer your questions and help you through the process of evaluating, choosing, and applying for affordable health care insurance. You’ll surely have some rehabilitation and habilitation coverage in your policy, but if you find you need or want more, you can talk with your consultant or agent about your options.


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