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Medical Coverage for People with DisabilitiesEntering the Workforce - In the Workforce - Or Losing a Job
No doubt medical coverage is an important factor and consideration as you prepare to enter (or are in) the workforce -- or if you're about to lose your job. This section will hopefully provide information you need to help in your planning and acquaint you with available options. As legislative changes and program funding reductions do occur, be sure to contact the individual program of interest to receive current information. As you know, what's here today can easily be gone tomorrow! Now, let's explore medical coverage....
Medical Coverage Contents
Work Incentive Programs - Continuation Of Medical Coverage:
Federal Acts:
Oregon State-Sponsored Health Plans and Services:
Washington State-Sponsored Health Plans and Services:
Colleges and Universities:
Health Insurance and Federal Laws:
Is there a federal law requiring employers to provide health insurance coverage? Unfortunately for many workers, including full-time workers, there's no federal law that requires employers to provide coverage for health insurance. Health insurance, at the federal level, is not an entitlement. It's a benefit provided by employers on a voluntary basis only. However, some states may have state and local laws requiring coverage under certain conditions, but not all states do. Even if no law exists, it's important to note that if an employer says health insurance will be a provided benefit, as stated in the employee handbook for example, the employer must provide the benefit to all employees as promised. Also, health coverage benefits must not discriminate against any one employee or group of employees who the employer feels might incur higher medical costs. Because of the voluntary nature of health insurance coverage, employers can decide what and how much they will provide, if they provide any coverage at all. If coverage is provided, employers can:
If health insurance coverage is a desired benefit, look for employers that offer health insurance coverage to employees!
Health Insurance and State Laws:
Although there is no federal law requiring employers to provide health insurance, some states and local governments may have laws and regulations related to health insurance coverage. For example, Hawaii requires employers to provide health insurance coverage to employees earning a specified amount per month. In Oregon, the Department of Consumer and Business Services Insurance Division provides information on insurance-related laws and administrative rules. At the time of this writing, Oregon does not require employers to provide health insurance coverage, but the state offers health care coverage through state-sponsored programs to eligible residents. These programs are described later in the Oregon State-Sponsored Health Plans and Services section. In Washington, the Washington State Insurance Commissioner's Office provides information on insurance-related and administrative rules. At the time of this writing, Washington State does not require employers to provide health insurance coverage, but the state offers health care coverage through state-sponsored programs to eligible residents. These programs are described later in the Washington State-Sponsored Health Plans and Services section.
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Health insurance policies provided by health plans may place conditions and limits on coverage of pre-existing conditions -- recent illnesses or chronic conditions. Policies may deny coverage for that illness or condition, require a specified wait period for coverage to begin, or require higher premiums (payments) for coverage. Some protection against pre-existing condition denial now exists for employees participating in group health plans, and former employees, under a recent 1997 federal law, The Health Insurance Portability and Accountability Act. This Act will be described later in the Federal Acts section. If a pre-existing condition exists, it's important to carefully study and compare each health plan policy regarding coverage of pre-existing conditions before choosing a health plan offered by the employer (if given a choice of plans).
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When Congress passed the Work Incentives Improvement Act of 1999, the doors of employment opportunity greatly expanded for people with disabilities. It's now possible for people with disabilities to become employed and still receive Medicare benefits. If your Social Security disability payments end because your work-related earnings are at or above the substantial gainful activity (income) level, but you are still disabled, your premium-free Medicare hospital insurance can continue for at least 93 months after the trial work period (9-month period). That's approximately 8 1/2 years! At the end of the 93-month period, you can purchase the same Medicare hospital coverage by paying a monthly premium. For more information, see the Social Security Administration's publication: A Desktop Guide to Social Security and SSI Work Incentives Or call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).
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The Work Incentives Improvement Act of 1999 has made it possible for SSI recipients who are blind or disabled to continue receiving Medicaid coverage (even if work-related earnings are over the SSI limits) if they cannot afford similar medical care and depend on Medicaid in order to work. This means your Medicaid coverage will continue, even after your SSI payments stop, until your income reaches a certain level. That level varies with each state and reflects the cost of health care in your state. (Your local Social Security office can tell you the Medicaid level for your state). However, if your health care costs are higher than this level, you can have more income and keep your Medicaid. Also, for Medicaid to continue, you must:
For more information, see the Social Security Administration's publication: A Desktop Guide to Social Security and SSI Work Incentives Or call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).
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Federal Law:
The federal Consolidated Omnibus Budget Reconciliation Act, also known as the COBRA Law, guarantees that working Americans who lose their jobs do not lose their health insurance. Under COBRA, the federal government allows those employees, retirees, their spouses, and their dependent children the rights to extend job-related coverage for up to 18 months at their own expense. Under COBRA:
The law has some exceptions, however. The law generally applies to employers who had 20 or more workers in the previous year. Seasonal-type operations may or may not qualify. Also, COBRA generally does not apply to employees who are terminated (fired) for "gross misconduct." Employees who quit or are dismissed for reasons other than "gross misconduct" may qualify. The U.S. Department of Labor is the enforcing agency. For more information, see the online publication:
Additional State Continuation Laws (COBRA):
In addition to the federal COBRA law, Oregon and Washington provide additional state laws for insurance coverage continuation.
Oregon Law: Or. Rev. Stat. §743.610 Former employees and eligible dependents who have been covered by a group health insurance plan for at least three months are entitled to continuation of coverage for six months after the end of employment. The employer must notify the employee of the right to continued coverage. The employee must request it within ten days of termination or notice, whichever is later, but no later than 31 days after termination. Continued coverage need not cover benefits besides hospital and medical. Enforcing agency: Oregon Department of Labor and Industries
Washington State Law: Wash. Rev. Code Ann. §§48.21.250 through 48.21.270 Former employees are entitled to continue group health insurance benefits for a period of time and at a rate upon which the employer and employee have agreed. When the continued policy terminates, the employee must be allowed to convert to an individual policy unless the employee was terminated because of misconduct -- in which case the spouse and children must still be given the right to convert. Employees must apply for continued coverage within 31 days of termination. Enforcing agency: Washington State Employment Security Division
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The federal Health Insurance Portability Act was enacted in 1996 to improve portability of health insurance coverage, reduce discrimination and fraud, and promote medical savings accounts. The following highlights key components of the law.
Portability Improvements
Pre-existing Conditions: Health insurance companies (insurers) providing group plan insurance coverage (health plans to a group of people through an employer, for example) face new restrictions when attempting to limit plan enrollment because of pre-existing medical conditions.
Discrimination Protection: Group health plans, and employers that provide group health insurance to employees, cannot deny coverage to individual group members and their dependents based on health status, physical or mental condition, claim history, genetic information, disability, or domestic violence.
Fraud and Abuse: The Inspector General and U.S. Attorney General are to implement and oversee federal, state, and local programs addressing and targeting health plan fraud and abuse, and impose criminal penalties to those that defraud a health benefits program.
Medical Savings Account: The Medical Savings Account provides tax advantages for those employees only enrolling in a high-deductible catastrophic health plan. These employees cannot also be enrolled in another basic health insurance plan with small deductible and co-payment requirements. Eligible employees are those employed at workplaces with 50 or fewer workers during the past two years. Self-employed workers are also eligible.
For further information, see the following web site: The Health Insurance Portability and Accountability Act of 1996
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The Mental Health Parity Act of 1996 is a federal law that may prevent your group health plan from placing annual or lifetime dollar limits on mental health benefits that are lower or less favorable than annual or lifetime dollar limits for medical and surgical benefits offered under the plan. The Mental Health Parity Act applies to most group health plans with more than 50 workers. The Act does not apply to group health plans sponsored by employers with fewer than 51 workers. The Act also does not apply to health insurance coverage purchased by an individual person (a person that's not part of a group plan). For more information, see the following web site: The Mental Health Parity Act: Summary Highlights and Questions and Answers
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Oregon's Senior and Disabled Services Division offers a program called the Employed Persons with Disabilities Program (EPD). This program provides Medicaid health coverage to eligible people with disabilities who are working. Even if your employer provides you with medical insurance, you may qualify for assistance if your disability limits your medical coverage. You may be eligible for the EDP Program if you:
You can apply at any Disability Services Office. You'll need to take along information (documentation) about your disability and income when you apply. For more information, contact your local Disability Services Office or see the Senior and Disabled Services Division web site: Employed Persons with Disabilities Program
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The Oregon Health Plan has three main components:
2. Provides affordable health plan
options for the self-employed and small 3. Provides a state-run health
insurance program (High Risk Insurance Pool)
Services covered by the Oregon Health Plan Medicaid Program include:
Services not covered by the Oregon Health Plan Medicaid Program:
For questions regarding eligibility, or to apply, call 1-800-359-9517 or 1-800-375-2863 (TTY). In Portland, call 503-273-4310. Also, visit the Oregon Health Plan web site!
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Contact your local County Health Department Office to receive information on medical and/or dental services available in your area for low-income individuals. To locate your County Health Department and learn about available services, go the following web site. County Health Department Offices - Listings by County
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For information or questions regarding eligibility, or to apply, call 1-800-826-2444 to speak to a benefits specialist, or 1-800-842-7712 to receive information from the automated telephone line. Basic Health is a state-sponsored program that provides affordable health care coverage to low-income Washington residents through eight private health plans. Basic Health contracts with health plans all over Washington State to provide reduce-cost health care coverage. Monthly premiums are based on family size, income, age, and the health plan selected. Co-payments are required for most services, but there are no deductibles or coinsurance. For those who qualify, state funds are used to pay a portion of the monthly premium. To qualify, applicants must:
Health plan benefits include:
All health plans in Basic Health offer these benefits, but monthly premium costs, providers, and details in coverage vary, depending on the plan chosen. For more information, visit the Basic Health web site: Washington State's Basic Health
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Basic Health Plus is a Medicaid program for children in low-income households. Parents pay no monthly premiums or co-payments for children. The Department of Social and Health Services pays the cost of coverage. Children must be under age 19, be U.S. citizens or legal residents who arrived in the U.S. on or before August 22, 1996.
Additional benefits that are available include:
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A statewide network of community and migrant health centers, public hospital-affiliated clinics, and local public health jurisdictions provide an array of medical and/or dental care services to low-income and/or special populations. The following web site provides a list of clinics: Health Care Authority Funded Community Clinics in Washington State
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Check local colleges and universities in your area that offer medical and/or dental allied health training programs. Some college programs, such as Dental Hygiene (teeth cleaning and basic dental care), Opticiary (eye glasses), Audiology (hearing tests and devices), and other training programs offer no-cost or low-cost services to the public by appointment. The following links will connect you to your local two- or four-year college or university! U.S. Community and Technical Colleges - State Listings U.S. Public Colleges and Universities - State Listings U.S. Private Colleges and Universities - State Listings Back to Medical Coverage Contents
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