By expanding care and coverage, the Affordable Care Act was a milestone for communities most underserved by the health system. In particular, the ACA includes a number of provisions that improve coverage and access to care for people with disabilities and/or complex health care needs. These improvements in coverage are a critical foundation for a movement toward patient-centered policies, sustainable long-term care and quality primary care. 

One of the most widely known benefits of the law are protections for people with pre-existing health conditions – which includes anyone with a disability and/or complex health needs – from being denied or charged more for coverage. However, the ACA had huge impacts for people with disabilities that go beyond pre-existing conditions protections, especially for those who are eligible for both Medicare and Medicaid coverage. The ACA’s infrastructure and legal protections are at the core of health coverage for the disability community. The ACA’s Medicaid expansion provided a pathway to eligibility for people with disabilities who previously had been excluded from coverage, by lifting income limitations and expanding eligible health conditions.

The ACA made important strides in long-term services and supports (LTSS), a critical category of health care for people with disabilities. One part of LTSS is home and community-based services (HCBS), which are supports that enable people with disabilities to remain integrated and independent in the communities of their choosing. Over the past few decades, HCBS has enabled disabled people to transition back into the community after living in institutional settings. This shift towards community-based settings is the result of disability advocates pushing for deinstitutionalization and wash solidified by the ACA. The ACA’s expansion of Medicaid and long-term services and supports (LTSS) programming has allowed more people to access the LTSS they need to live in a community setting. Due to the ACA’s creation of more opportunities to divert LTSS away from institutional settings, states have increasingly focused their LTSS funding on more community-based settings.

Since 2013, HCBS expenditures have been the majority of LTSS spending and continue to increase each year.The 2021 policy priorities of Congress and the Biden administration provide opportunities to build upon the ACA’s legacy of HCBS expansion. The American Rescue Plan included an increase the federal matching rate (FMAP) for spending on Medicaid HCBS by 10 percentage points until March 31, 2022.

Just yesterday, President Biden unveiled the American Jobs Plan, his $2 trillion plan to address the nation’s infrastructure needs. Within the plan is $400 billion to improve home and community-based services and extend Medicaid’s Money Follows the Person program that allows people with disabilities to live independently and older adults to age in place, something an overwhelming majority would prefer. It also proposes better wages and benefits for direct care workers, the majority of whom are women and people of color. These provisions would be a good compliment to the temporary boost in home and community-based services (HCBS) present in the American Rescue Plan. 

Additionally, a draft bill called the HCBS Access Act is advancing through Congress, which would provide HCBS services for all people who are eligible and choose to receive services. The bill’s elimination of waitlists would have a massive, life-changing impact for people with disabilities waiting to receive the services they have been denied access to for years. The legislation represents the renewed push on Capitol Hill for the Biden administration to implement the plans outlined on the campaign trail.

Expanding HCBS funding and eligibility is critical to ensure every person with a disability has access to the services and supports they need to thrive. Doing so would realize the original intentions of the Affordable Care Act and continue its legacy as a legal safeguard for the disability community.