Health: Access to Care

 

About DREDF's Healthcare Work

We advocate for state and federal laws and policies aimed at eliminating the complex barriers people with disabilities experience when they try to access healthcare. We also conduct research, author journal articles, comment on Federal healthcare regulations, train Medicaid health insurers, develop model policies for accommodating people with disabilities in medical settings, and build alliances with like–minded colleagues in the health policy and aging fields.

The Affordable Care Act (ACA)

• US Supreme Court Ruling on the Affordable Care Act (ACA), June 2, 2012

  This historic decision means that people with disabilities will continue to benefit from the profound impact of the landmark law. By affirming the individual mandate, the Court ensured that private insurers will have access to the largest possible pool of enrollees, thus holding costs down. In combination with market reforms prohibiting discrimination against people with pre–existing conditions, this affirmation will make it possible for everyone, including an estimated 3.5 million uninsured people with disabilities, to benefit from more affordable insurance prices.

  DREDF response to the US Supreme Court decision

• DREDF comments on proposed ACA regulations:

  • Comments to CMS on the proposed Single Streamlined Insurance Marketplace Application (PDF)

  • DREDF provides extensive comments and recommendations on the Center for Medicare and Medicaid Services proposed rule regarding Medicaid, Children’s Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing

  • DREDF submits comments on the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs)

  • DREDF Submits Comments on Proposed Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation under the Patient Protection and Affordable Care Act (PDF)

  • The State Option to Provide Home and Community–Based Services (HCBS) for Medicaid-eligible individuals. (PDF)

  • DREDF and colleagues comment on Access Board's Proposed Accessibility Standards for Medical Diagnostic Equipment (PDF)

  • Electronic Health Record Incentive Program—Stage 2 (PDF)

  • Comments on Essential Health Benefits Bulletin (PDF)

  • Establishment of Exchanges and Qualified Health Plans (PDF)

  • Home and Community-Based Services Waivers (PDF)

  • Health Disparity Research and Data Collection (PDF)

  • Health Information Technology (PDF)

  • The new definition of medically underserved population (PDF)

  • Medicaid Core Quality Measures (PDF)

  • Accountable Care Organizations (PDF)

  • Proposed ACA disability data collection standards (PDF)

• DREDF joins other groups commenting on proposed Affordable Care Act regulations

  January 25, 2013
  The Consortium for Citizens with Disabilities (CCD) submitted comments to the US Department of Labor, Internal Revenue Service of the Treasury Department, and HHS/CMS on proposed regulations concerning Incentives for Nondiscriminatory Wellness Programs in Group Health Plans. DREDF contributed to the letter and signed on as a member of CCD.

• Duals Demonstrations

  The Centers for Medicare and Medicaid Services (CMS) is currently working with states to design and implement new models for integrating the benefits and financing of both programs. As states build these new models, advocates for dual eligibles must be involved.

  • Comments on Draft Health Risk Assessment Health Plan Guidance for California's Duals Demonstrations (PDF)

  • DREDF expresses deep concerns about California's plans to integrate Home and Community Based Services (HCBS) in the Coordinated Care Initiative, Feb. 6, 2013. (PDF)

  • Identifying and Selecting Long-Term Services and Supports Outcome Measures

    A guide for advocates prepared by DREDF in collaboration with the National Senior Citizens Law Center (NSCLC). January 2013.

  • Moving "Dual Eligibles" into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People with Disabilities, by Judith Solomon, Center on Budget and Policy Priorities, October 10, 2012. (PDF)

  • Advocacy Principles for the Dual Eligible Integration Policy Initiatives (PDF)

    Adopted by DREDF, NCIL, Community Catalyst, and several Independent Living Centers, February 2012

  • Long Term Services and Supports Principles, Disability Rights California, April 2012 (PDF)

  • The National Senior Citizen's Law Center has launched a content–rich website to support advocates who are working with their states on the duals demonstration projects — April 2012.

  • DREDF and NSCLC Launch Beneficiary Protections Toolkit

  • Managed Care Resources

    • Accessibility Related Network Readiness Review Criteria (PDF)

      DREDF has identified key accessibility criteria for ensuring readiness of managed healthcare and other provider networks to serve a large number of people with disabilities and seniors as CMS evaluates State duals demonstration proposals.

    • Resources from New York State

      • Analysis of ADA Compliance by Managed Long–Term Care Plans in New York—Center for Independence of the Disabled, NY (PDF)

      • New York State's Managed Long–Term Care Accessibility Chart (xls)

      • New York State's Guidelines for Managed Care (MCO Qualification Guidelines) (PDF)

      • Guidelines for Medicaid MCO Compliance with the Americans with Disabilities Act (ADA) (Appendix 4.11) (PDF)

  • Massachusetts and CMS Sign Off on First Memorandum of Understanding for Dual Eligible Integration Demonstration (PDF)

  • Administration for Community Living Webinar—Managed LTSS: Engaging in the Stakeholder Process

    DREDF's Silvia Yee and Mary Lou Breslin were presenters in this June 27, 2012 webinar in which 360 people participated.

    Download the PowerPoint presentation (PDF)

  • LTSS Webinar Archive: DREDF and the National Senior Citizens Law Center (NSCLC) presented a webinar on Long–Term Services and Supports in a Managed Care Environment on Monday, June 11, 2012. The transcript from the webinar and slides are available below.

  • Transcript

  • Slides

California Legislation and Health Care Policy

• Covered California, the Healthcare Insurance Exchange

  Testimony of Silvia Yee, DREDF Senior Attorney, before a meeting of the Board of Directors of Covered California, on health and healthcare disparities experienced by people with disabilities, March 21, 2013 (PDF)

• 1115 Waiver

  In May, 2012 California completed enrollment of 240,000 people with disabilities and seniors into mandatory managed care in 16 counties in California.

• In Transit: Mandatory Managed Care for Medi-Cal Seniors and People with Disabilities, a report from the California Healthcare Foundation on challenges and lessons learned

• California Department of Health Care Services website on the 1115 waiver

• California duals demonstration proposal

  • DREDF comments on California's Dual Eligibles Demonstration (PDF): Coordinated Care Initiative

  • California Department of Health Care Services, CalDuals website

Selected Articles and Publications

• "Disability Discrimination in Health Care (PDF)," presented by Silvia Yee, Senior Attorney, at the Jacobus tenBroek Disability Law Symposium held at the Jernigan Institute, Baltimore, MD, in April 2012

• Health and Health Care Disparities Among People with Disabilities, Silvia Yee, Senior Attorney, August 2011

  DREDF documents barriers that are unique to people with disabilities in minority populations

• Mudrick, N.R., Breslin, M.L., & Kailes, J.I., (2011, November 2). Response to the data challenges of the Affordable Care Act: Surveys of providers to assess access to care for people with disabilities and the presence of accessible exam equipment (Presentation to the American Public Health Association).

  An article summarizing the research findings presented in the slides above was published in July 2012 by the Disability and Health Journal. See Nancy R. Mudrick, Mary Lou Breslin, Mengke Liang, Silvia Yee. "Physical Accessibility in Primary Health Care Settings: Results from California on-site reviews," Disability and Health Journal 5 (2012) 159-167. A subscription is required.

• Disability Healthcare Access Brief, Statement of the Problem, by Silvia Yee, Staff Attorney, April, 2007

• Promoting Programmatic Access
  What does programmatic access mean in healthcare settings?
  DREDF's short summary explanation (PDF)

• Using the ADA and Section 504 of the 1973 Rehabilitation Act to Increase Architectural and Programmatic Access and Accommodations
  DREDF Legal Position Paper on Medicaid Healthcare Accessibility for People with Disabilities, by Silvia Yee

• Short visual representation of the theories or legal responsibility for healthcare access presented in the DREDF legal position paper

Other Recommended Readings and Resources

• Health Disparities for People with Disabilities, a presentation by Silvia Yee at Health Disparities Research at the Intersection of Race, Ethnicity, and Disability: A National Conference, April 25 & 26, 2013, Washington, DC

• DREDF led a team that authored The Current State of Health Care for People with Disabilities, released in November, 2009 by the National Council on Disability


• Structural Impairments that Limit Access to Health Care for Patients with Disabilities, by Kristi L. Kirschner, MD, Mary Lou Breslin, MA, Lisa I.Iezzoni, MD, MSc, in the Journal of the American Medical Association (JAMA), March 14, 2007, Vol. 297, No.10 (subscription required)


• It Takes More than Ramps to Solve the Healthcare Crisis for People with Disabilities (PDF), by Judy Panko Reis, Rehabilitation Institute of Chicago, Mary Lou Breslin, DREDF, Lisa Iezzoni, M.D., Harvard Medical School, and Kristi L. Kirschner, M.D., Rehabilitation Institute of Chicago. Published by the Rehabilitation Institute of Chicago. February 2004


• Access to Medical Care for People with Mobility Disabilities, US Department of Justice, May 2010

 

For more information about our healthcare work contact us at info@dredf.org

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updated 5.8.13