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Kaiser Report Looks at Benefits and Cost-Sharing for Workers with Disabilities

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Kaiser Report Looks at Benefits and Cost-Sharing for Workers with Disabilities

November 7, 2014

The Kaiser Commission on Medicaid and the Uninsured has published an issue brief titled, "Benefits and Cost-Sharing for Working People with Disabilities in Medicaid and the Marketplace." The brief uses hypothetical examples of working people with disabilities to illustrate the experiences they might have with Medicaid and Marketplace coverage in four states (California, Kentucky, New Jersey, and Ohio), with a focus on benefits that are typically important to people with disabilities. 

Several key themes emerge from the analysis in the brief, including:

  • Due to mental health parity requirements, Medicaid benefits for newly eligible adults may include more extensive mental health and substance use treatment services, unless states also modify their Medicaid state plan benefits to reflect the full extent of required coverage for new adults;
  • Prescription drug coverage is likely to vary between Medicaid and Marketplace Qualified Health Plans (QHPs) as well as among QHPs within a state;
  • Within a benefit category, Marketplace QHP coverage of specific services, such as rehabilitative and habilitative services, may differ from Medicaid coverage and may be subject to different utilization limits than apply in Medicaid in some states. Coverage of specific services also may vary among QHPs within a state;
  • Coverage of long-term services and supports may be more extensive in Medicaid than in Marketplace QHPs;
  • Provider networks may differ between Medicaid and Marketplace QHPs; and
  • Beneficiaries are likely to experience higher out-of-pocket costs in Marketplace QHPs than in Medicaid.