Rehab and Habilitation to Be Covered Under ACA

“To rehabilitate,” according to the Merriam-Webster dictionary, means “to restore to a former capacity.”

But what if that capacity — be it walking or talking or brushing one’s teeth — was never there in the first place?  In that case, you aren’t talking about “rehabilitation” but “habilitation.”

People need habilitation when they have a congenital defect or disease that impairs the development of basic life skills. For example, autism may leave a child unable to speak. Cerebral palsy may result in language deficits and severe physical limitations. Birth defects may leave a child deaf.

Thanks to the Affordable Care Act (ACA), habilitation services will now be widely covered for the first time in private insurance plans. Rehabilitative and habilitative services are among the 10 “essential benefits” that must be provided by all plans sold on all the state and federally run health insurance exchanges. 

Brain-Injured Suffer Major Treatment Gap

Larry Boswell sat slumped in a wheelchair. His sweatpants were soiled, his T-shirt soaked in saliva. Flies buzzed around his head.

He was able to walk when he arrived at Illinois’ Cobden Rehabilitation and Nursing Center in 2008, government records show, something he can’t manage now. Speech therapy for the 57- year-old ended shortly after he was admitted, according to a lawyer trying to persuade Medicaid to transfer him.
While much of what Boswell says is incomprehensible, he managed a clear “no” when asked if he wanted to stay where he was. Cobden officials didn’t respond to telephone calls.
Boswell is one of nearly 244,000 brain-injured people consigned to nursing homes, according to data compiled by Bloomberg from U.S. Medicare and Medicaid statistics. He’s also on the front line in a national battle to get people like him out of facilities that aren’t equipped to care for them.