You have a Child with Special Needs: How the ACA Helps Children and Youth with Special Health Needs

Can Insurance Companies Refuse to Give My Child Health Insurance?

Before September 23, 2010, insurance companies could refuse to pay for things if a child had a “pre-existing condition”. A pre-existing condition is a health problem that started before the child joined the insurance plan. Insurance companies could also refuse to give insurance to someone with a pre-existing condition.

This made it difficult for families to find good insurance for children with special health needs. This also made it hard for families to change jobs if they got their insurance through their work.

Under the ACA, insurance companies cannot deny insurance coverage to people with pre-existing conditions. Also, they cannot charge people with pre-existing conditions more money for their insurance. This does not apply to grandfathered health plans.

How Can I Get Insurance for My Child with Special Health Needs?

The ACA makes it easier for children with special health needs to get and keep health insurance. There are many different ways children with special health needs can get insurance:

Different Types of Insurance For Children with Special Health Needs

Medicaid Beginning in 2014, the ACA will make it easier to qualify for Medicaid. This is called Medicaid expansion. Medicaid expansion allows people to get Medicaid if their income is less than 138% of the federal poverty level (this is about $16,242 a year for a single person in 2016).

However, only some states are expanding their Medicaid programs. If your state expands its Medicaid program, you or your child may qualify for Medicaid. To read more about Medicaid expansion, click here.

Even if your state does not expand its Medicaid program, the ACA does not allow states to make it harder to qualify for Medicaid. The ACA says that the rules for Medicaid have to stay the same as it was on March 23, 2010 (the day the ACA was signed into law). This is called “Maintenance of Effort.”
Children’s Health Insurance Program (CHIP) Maintenance of Effort also applies to the Children’s Health Insurance Program (CHIP). This means that states cannot make it harder to qualify for CHIP. The rules for CHIP have to stay the same as it was on March 23, 2010.
Dependent Coverage Under the ACA, children can stay on their parent’s health plan until they turn 26. This is called dependent coverage. It doesn’t matter whether they are married, single, in school, or working.

There is one temporary exception: Until 2014, grandfathered plans do not have to offer dependent coverage if the child qualifies for group coverage outside of their parent’s plan. To learn more about grandfathered health plans, click here.
Health Insurance Marketplace Since October 1, 2013, you can now use the Health Insurance Marketplace to buy insurance. The Marketplace is like Travelocity or Orbitz, except you can buy health insurance rather than book travel and hotels.

The Marketplace can also help you pay for your health insurance. When you use the Marketplace, it will tell you whether you qualify for tax credits or lower costs. This can help families of children with special health needs since they often have many expenses.

Each state has its own Marketplace. To find the Marketplace in your state, go to: https://www.healthcare.gov/what-is-the-marketplace-in-my-state/

To find more information about the Marketplace, click here.

How Else Does the ACA Help My Child?

The ACA requires most insurance companies to follow new rules. These rules help protect children with special health needs and their families:

Where Can I Find More Information?

A brief report developed by the Catalyst Center describing parts of the ACA with a side-by-side description of what they may mean for children and youth with special health care needs and their families: http://hdwg.org/sites/default/files/ACAsidebyside-catalystctr.pdf

A joint fact sheet developed by the Catalyst Center and Association of Maternal Child Health Programs which provides an overview of how children and youth with special health care needs may benefit from certain health care reforms: http://hdwg.org/sites/default/files/Fact%20Sheet%20-%20Health%20Care%20Reform%20and%20CYSHCN.pdf

Catalyst Center fact sheet discussing how Medicaid expansion affects children and youth with special health care needs. http://cahpp.org/resources/your-questions-about-the-medicaid-expansion-provision-of-the-affordable-care-act-answered/

An Issue Brief developed by the Association of Maternal Child Health Programs briefly describing parts of the ACA that affect children with Autism Spectrum Disorder and other Developmental Disabilities: http://cahpp.org/resources/resourcesissue-brief-the-affordable-care-act-and-children-and-youth-with-autism-spectrum-disorder-and-other-developmental-disabilities/

A presentation about how the Affordable Care Act affects children and youth with special health care needs given by Meg Comeau from the Catalyst Center at the WSGSC 2012 Regional Summit: http://www.westernstatesgenetics.org/files/ComeauMeg_ImpactofHealthCareReform.pdf

A paper developed by the National Academy for State Health Policy for the Catalyst Center which analyzes key parts of the ACA that affect children with special health needs to help states make decisions about health care reform: http://hdwg.org/sites/default/files/ACAandCSHCNpaper.pdf