In 2014, families across America began to experience a new healthcare system, known as the Affordable Care Act (ACA), or colloquially as “ObamaCare” (because the ACA was an initiative of President Barack Obama).
The ACA is implemented differently in different states. In general, individuals may choose a healthcare plan by shopping in the “Healthcare Marketplace.” The Marketplace is an online shopping terminal (though information can be accessed over the phone and sent by mail). In Pennsylvania, a child’s autism-related services are not covered by programs in the Marketplace and should be covered by private health insurance, the Medical Assistance (MA) program, or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62). The following Q & A applies to Pennsylvania currently (2020).
Can State-mandated autism insurance be accessed through the Healthcare Marketplace?
No, at this time there is no communication between mandated insurance options and the Marketplace. Autism mandated coverage remains limited and can be very different depending on the insurance carrier. For more information about accessing state-mandated autism insurance, please go to the following article within the CAR Autism Roadmap™:
How do you apply for Medical Assistance (MA) for a child with a developmental disability, such as Autism Spectrum Disorder?
The MA application process has not changed. The new health insurance Marketplace is not affecting the application process or the way MA insurance is being dispensed. The CAR Autism Roadmap™ contains directions on how to access MA in the following articles:
- How to Apply for Medical Assistance in Pennsylvania
- Quick Primer on Medical Assistance for Children and Adolescents in Pennsylvania
Is CHIP, the Children’s Health Insurance Program, affected by the new health insurance system?
Yes, CHIP is part of the Healthcare Marketplace. Child-only commercial plans within the Marketplace will be available for those who do not qualify for Medical Assistance (MA). A child may not qualify because they do not meet MA disability criteria. More information about CHIP can be found in the CAR Autism Roadmap™:
Can Supplemental Security Income (SSI) for an 18 year old (child) transitioning to adult status be accessed through the Marketplace?
No, the application process for SSI remains the same and is not accessible through the Marketplace. For more information and instructions, go to the following article within the CAR Autism Roadmap™:
Can adults apply for Social Security Disability Insurance (SSDI) through the Marketplace?
No, at this time there is no way for SSDI to be accessed through the Marketplace. To learn how to access this coverage, please go to the following article within the CAR Autism Roadmap™:
Is Medicaid still available to adults who have a disabling condition?
Yes, adults who have first applied and been approved for Social Security Income (“SSI”) (age 18 years or older, unable to work/disabled, earn less than $1,000.00 per month) may subsequently qualify for Medicaid. To learn more about these programs, read the following articles within the CAR Autism Roadmap™: