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 comments on proposed ACA regulations:
DREDF and colleagues submit extensive comments to US Department of Health and Human Services Office for Civil Rights on Section 1557 of the Affordable Care Act, which prohibits discrimination in healthcare. Our comments were endorsed by fifty–seven diverse disability rights, health policy, consumer advocacy, racial and ethnic health disparity, public health, and research organizations nationwide.
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 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.
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.
DREDF and National Senior Citizens Law Center Release New Advocate's Guide on California's Coordinated Care Initiative (CCI)
The Advocate's Guide to California's Coordinated Care Initiative (PDF) helps advocates understand the Coordinated Care Initiative (CCI), a new state program that is changing the way people who have both Medicare and Medi–Cal (referred to as dual eligible beneficiaries) and other seniors and people with disabilities get their health care in eight California counties. July 2, 2013
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)
Adopted by DREDF, NCIL, Community Catalyst, and several Independent Living Centers, February 2012
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.
Managed Care Resources
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
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.
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.
HEALTHCARE STORIES are free, downloadable short videos that illustrate as no policy paper can, the obstacles and barriers that still stand in the way of getting appropriate health care for many people with disabilities.
California Legislation and Health Care Policy
DREDF and the National Senior Citizens Law Center (NSCLC) presented the webinar, "Coordinated Care Initiative (CCI) BASICS: Preparing for Changes." This webinar provided an overview of California's plan to enroll seniors and people with disabilities who have both Medicare and Medi–Cal into managed care and integrate Long–Term Services and Supports (LTSS). June 20, 2013
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)
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 duals demonstration proposal
DREDF comments on California's Dual Eligibles Demonstration (PDF): Coordinated Care Initiative
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 firstname.lastname@example.org