Health: Access to Care

 

It is widely recognized that the healthcare system in the United States is failing. No group is more affected by this failure than individuals with disabilities. For us, problems cut across every aspect of healthcare including:

  • Lack of healthcare coverage

  • Inadequate coverage

  • Limits on benefits

  • Architectural barriers in the facilities of healthcare providers

  • Lack of accommodation and modification of policies and practices in healthcare settings such as:

    • lifting assistance

    • appointment flex-time

    • accessible examination tables, weight scales and diagnostic equipment

    • materials in accessible formats for blind or visually impaired patients

    • sign language interpreters for those who are Deaf or hard of hearing

  • Lack of professional training to ensure culturally competent care

  • Poor implementation of the 1990 Americans with Disabilities Act (ADA)

  • Restrictions on availability of assistive technology

  • Exclusion from prevention programs

  • Poor care and accommodations at school for children with diabetes and other chronic illnesses

Unequal treatment diminishes the opportunity of people with disabilities for longer, productive lives and can compromise the quality of those lives.

We are working to improve access to healthcare services and programs for people with disabilities by creating informational and training materials for advocates, parents and attorneys; creating assessment tools for health plans; drafting state and federal legislation; participating in the California Disability Health Coalition (DHC); and providing legal representation for children who require health services in school.

  • A Statement of the Problem

    Read DREDF's "Disability Healthcare Access Brief," by Silvia Yee, April, 2007

     

    Read "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)

     

  • Promoting Programmatic Access

    What does programmatic access mean in healthcare settings?

    Read DREDF's short summary explanation.

     

  • Using the ADA and Section 504 of the 1973 Rehabilitation Act to Increase Architectural and Programmatic Access and Accommodations

    Read the "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.

     

  • The National Council on Disability Selects DREDF to Conduct Research Project on the Current State of Health Care for Americans with Disabilities

    Read the Project Summary

     

  • Ensuring that Disability Issues are a Part of Healthcare Reform in California - The Disability Health Coalition

     

    Disability groups in the state have formed the Disability Health Coalition to advocate for specific healthcare principles that will affect all people with disabilities.

     

    Read the California Health Coalition Health Care Reform Principles (updated Membership List 1.14.07).

    Read the California Health Coalition Talking Points (updated Membership List 1.14.07).

    Read the California Health Coalition Talking Points (español).

    Disability Health Coalition Contact Information.

     

  • 2009 California Health Care Bills

    Nine bills were introduced this year that would reduce barriers to access to health care for people with disabilities.

    AB 2 (De La Torre) Individual Health Care Coverage - Applications
    AB 108 (Hiyashi) Individual Health Care Coverage - Cancellation
    AB 119 (Jones) Health Insurance Premiums and Gender
    AB 29 (Price) Dependent Coverage
    AB 214 (Chesbro) Durable Medical Equipment
    AB 244 (Beall) Mental Health Coverage
    SB 810 (Leno) Single Payer Health Care
    AB 602 (Price) Prescription Coverage.
    AB 722 (Lowenthal) Pre-existing Conditions.

     

    Referred to Appropriations:

    AB 2 (De La Torre) Individual Health Care Coverage - Applications

    Would require standard information and health history questions to be used health insurers for their individual health care coverage application forms.

    AB 108 (Hiyashi) Individual Health Care Coverage - Cancellation

    Would prohibit a health care service plan or health insurer from rescinding an individual health care service plan contract or individual health insurance policy for any reason, or from canceling, limiting, or raising the premiums of the plan contract or policy due to any omission, misrepresentation, or inaccuracy in the application form, after 24 months following the issuance of the plan contract or policy, except as specified.

    AB 119 (Jones) Health Insurance Premiums and Gender

    Would prohibit health insurers from charging a premium, price, or charge differential because of the sex of individuals.

     

    Held in submission:

    AB 29 (Price) Dependent Coverage

    Would prohibit, with some exceptions, limiting the age for dependent children covered by health care plans and group health insurance policies from being less than 27 years of age.

    AB 214 (Chesbro) Durable Medical Equipment

    Would require coverage for durable medical equipment as part of insurance plan contracts or health insurance policies.

    AB 244 (Beall) Mental Health Coverage

    Would expand coverage requirements to include the diagnosis and treatment of a mental illness of a person of any age and would define mental illness for this purpose as a mental disorder defined in the Diagnostic and Statistical Manual IV.

    SB 810 (Leno) Single Payer Health Care

    Would make all California residents eligible for specified health care benefits under the California Healthcare System, which would, on a single-payer basis, negotiate for or set fees for health care services provided through the system and pay claims for those services.

     

    Withdrawn:

    AB 602 (Price) Prescription Coverage.

    Would prohibit insurers from requiring prior authorization that requires the trial and failure of more than two formulary alternatives for pain treatment in advance of providing access to the prescribed drug, or requiring an enrollee or insured to try and fail on pain medication supported only by an off-label indication before providing access to a pain medication supported by an FDA-approved indication.

    AB 722 (Lowenthal) Pre-existing Conditions.

    Would prohibit denial of coverage to or allow exclusion of coverage due to a preexisting condition due to a mental or physical condition that is not life threatening nor chronic or severe, that is not considered to be a present condition at the time of enrollment, and for which the enrollee or insured has not received treatment for the past 12 months.

     

  • AB 214 — Requires Group and Individual Plans to Provide Durable Medical Equipment (DME) Coverage and Removes Benefit Limits on DME

     

    Update: 4.3.09

    This year, California Assemblymember Wesley Chesbro (D—Arcata) introduced AB 214, which would require private group and individual health plans to cover Durable Medical Equipment (DME) and to do so without limiting the annual DME benefit. (Many private health plans in California now limit DME coverage to around $2000 annually.) DME can change the lives of people with disabilities by fostering independence, self reliance and community participation, reducing or eliminating preventable pain, and warding off additional disabilities. When such equipment cannot be obtained, people with disabilities can face increased medical problems, a loss of autonomy, and confinement in their homes or even in institutions. If you live in California and have had problems acquiring needed DME because your private health plan limits your annual benefit or your plan does not offer DME coverage at all, we would like to hear from you.

    We've created a brief survey on the Survey Monkey website to collect information about DME coverage. Our experience has been that Survey Monkey has made its survey tool accessible, but if you have any difficulty accessing or using the survey, please contact us at info@dredf.org to let us know.



  • Initiative to Remove Annual Benefit Limits on Durable Medical Equipment in Private Health Plans in California

    California Senator Sheila Kuehl introduced SB 1198 on February 13, 2008, legislation crafted by DREDF that will prohibit private health insurers from limiting benefits for durable medical equipment. DREDF and Protection and Advocacy are working together to advocate for the bill's enactment.

     

    Update: 9.30.08

    In a veto that favors maintaining the deep pockets of the insurance industry over the individual consumer, California governor Arnold Schwarzenegger vetoed SB 1198, a bill with bipartisan support that would have ensured that group health insurance plans cover the costs of durable medical equipment in the same manner as other medical services.

     

    Update: 9.1.08

    No action will be taken by the governor on SB 1198 until the California budget impasse is resolved.

    An August 21, 2008 concurrence vote on SB 1198 in the California Senate was successful

    The California Assembly passed SB 1198 on August 14, 2008.

     

    Update: 6.6.08

    The California Senate Health Committee passed SB 1198 with a 10 to 0 vote on April 16, 2008.

    The California Senate passed SB 1198 with a 27 to 8 vote on May 12, 2008.

    The bill is scheduled to be heard by the Assembly Health Committee on June 24.

    Read DREDF's SB 1198 Support Letter (6.18.08)

     

    Read Questions and answers about DME coverage by private insurers in California

    Read A survey of DME benefit limits among 214 California private health care plans

    Read the bill (6.20.08)

    FAQ on SB 1198 (3.14.08)

     

  • Training Parents and Providers on School-Based Healthcare
    Services for California Children with Chronic Health Conditions

    DREDF, along with the American Diabetes Association, has developed a Sample 504 Plan and a Sample Health Plan for parents to use as a model when creating individualized plans for their own children.

     

  • Proposed Federal Legislation to Increase Healthcare Accessibility

    Senator Tom Harkin (D-IA) has introduced legislation to establish accessibility standards for medical diagnostic equipment and create wellness grants to fund health programs that focus on the unique challenges faced by individuals with disabilities.

    Read the "Promoting Wellness for Individuals with Disabilities Act of 2007"

 

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

 

The following publications and studies discuss this issue in greater detail.

 

The Future of Disability in America
Committee on Disability in America, Marilyn J. Field and Alan Jette, editors
Institute of Medicine of the National Academies
ISBN: 0-309-10795-4, 680 pages, 6 x 9, (2007)

 

This new and insightful report states, "The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities."

 

It Takes More than Ramps to Solve the Healthcare Crisis for People with Disabilities 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.

 

The U.S. Department of Health and Human Services Healthy People 2010

 

"The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities"

 

"Providing Primary Health Care for People with Physical Disabilities: A Survey of California Physicians" published by the Center for Disability Issues and the Health Professions (CDIHP).

 

Access to Medical Care: Adults with Physical Disabilities

A 22 minute video produced by the Oakland-based World Institute on Disability about mobility, vision, hearing and communication impairment in outpatient settings; a training curriculum and initial consultation is included.

 

DREDF joins with the Center for Disability Issues in the Health Professions and other groups in urging the California Department of Health Services to adopt performance standards for Medicaid MCO's that were identified by diverse stakeholders and submitted to the Department in November, 2005. These standards would improve access to healthcare services and programs for people with disabilities, if adopted.

 

Read the California Department of Health Services response to the proposed performance standards.

 

2006 Pilot Survey of Disability Access Services Provided by California Health Plans

 

"The Health and Health Care of People with Intellectual Disabilities"

New research studies conducted by Special Olympics found disturbing evidence that individuals with intellectual disabilities face widespread health problems, while physicians, dentists and other health professionals are not receiving adequate training in order to treat them.