On June 22, 2009 the U.S. Department of Housing and Urban Development joined President Obama’s commemoration of the tenth anniversary of the Supreme Court’s Olmstead decision by announcing that it will offer rental assistance to 4,000 non-elderly families with disabilities, including 1,000 vouchers specifically targeted to those transitioning out of nursing homes and other care facilities.

Through its funding notice, HUD is seeking comment from public housing authorities and others to ensure this critically needed assistance is distributed and administered in the most effective manner possible.

The announcement coincides with the tenth anniversary of the Supreme Court’s ruling in Olmstead v. L.C. & E.W. which affirmed the rights of individuals with disabilities to live independently. To commemorate this landmark decision, President Obama declared 2009 the Year of Community Living.

“As individuals with disabilities leave institutional care, it is essential that they have housing options that will allow them to live independently,” said HUD Secretary Shaun Donovan. “As we prepare to launch this initiative, we also want to make certain that we get input from local housing experts, disability rights advocates and others who can help us target this assistance to those who need it most. We also recognize how important it is for HUD and HHS to coordinate our resources to enable community-living for those individuals that live with disabilities.”

HUD’s Notice of Funding Availability (NOFA) will make $30 million in voucher assistance available to support approximately 4,000 Housing Choice Vouchers for non-elderly disabled families. HUD is making a 1,000 of those vouchers available specifically for individuals transitioning out of nursing homes and other institutions. These vouchers directly support a $1.75 billion initiative of the U.S. Department of Health and Human Services (HHS) to help persons who reside in health care settings move to community-based living. While HHS’ Money Follows the Person (MFP) program offers health care, case management and other services to qualified families, it does not include funding for housing. HUD’s funding initiative is designed to fill that gap.

The remaining 3,000 Housing Choice Vouchers are available to assist any non-elderly disabled family. The Department is encouraging local housing authorities to give strong consideration to using some or all of these vouchers to provide housing for those non-elderly persons that are living in the community, but are at-risk for institutionalization.

Adults covered by Medicare who have limited income and resources may be eligible for extra help – available through Social Security – to pay part of their monthly premiums, annual deductibles, and prescription co-payments.  The extra help is worth an average of $3,900 per year.

To figure out whether a Medicare recipient is eligible, Social Security needs to know the individual’s income and the value of her/his savings, investments, and real estate (other than the home lived in).   To qualify for the extra help, the individual must be receiving Medicare and also have income limited to $16,245 for an individual or $21,855 for spouses living together.  Even if the annual income is higher, one still may be able to get some help with monthly premiums, annual deductibles and prescription co-payments. Some examples where income may be higher include if either spouse:

** Supports other family members who live with them;
** Have earnings from work; or
** Live in Alaska or Hawaii; and
** Resources limited to $12,510 for an individual or $25,010 for a married couple living together (i.e. resources include such things as bank accounts, stocks and bonds. Social Security does not count a house
or car as resources).

Social Security has an online application. You can find it at www.socialsecurity.gov/prescriptionhelp. To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020).  Or go to your local Social Security office.

Individuals with various health conditions are often reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan. HIPAA (Health Insurance Portability and Accountability Act of 1996) limits the amount of time an insurer can refuse to cover pre-existing conditions to twelve months. HIPAA also ensures that in some cases there is no waiting period for new coverage. However, an insurer is still not required to cover every condition and disability. In some cases, they can still deny coverage altogether for certain conditions as long as the decision is based on sound actuarial data.State laws may offer more generous protections than HIPAA. You may want to contact your state insurance commissioner’s office to ask about the law where you live. A good place to start is the Web site of the National Association of Insurance Commissioners at www.naic.org.

A “pre-existing condition” is considered to be any condition for which medical advice, diagnosis, care or treatment was recommended or received within the previous six-month period. The maximum amount of time a plan can refuse coverage for any such condition is twelve months. If an individual starts a new job and is subject to a waiting period before being eligible to join the health plan, the waiting period and twelve-month period for the pre-existing conditions must coincide.

The twelve-month period for pre-existing conditions may also be reduced if the individual provides the new insurance plan with proof of their prior health coverage. When leaving a health plan, the plan must provide you with a Certificate of Coverage which details the dates you were covered under the plan. This continuous coverage can be credited toward the pre-existing condition period, provided there was not a “significant break” in coverage between jobs – this is defined as sixty-three days.

Therefore, if you had at least twelve months of “creditable coverage” (which can be from a group health plan, HMO, individual health insurance policy, Medicare, or Medicaid) and then left your job and you started a new job within sixty-three days thereafter, the pre-existing condition period would not apply. Your condition would be covered immediately (provided that the plan regularly covers that condition). COBRA coverage can also be credited towards continuous coverage.

HIPPA can also help provide access to individual insurance when group coverage is not an option. HIPAA guarantees access to an individual plan if: the individual had group coverage for at least eighteen months; did not have their group coverage terminated because of fraud or nonpayment of premiums; is ineligible for COBRA or has exhausted COBRA benefits; and is not eligible for coverage under another group health plan.

If an individual has group health insurance through his or her employer, the individual, his or her spouse and dependents can continue that coverage for eighteen months if a “qualifying event” (causing the employee to lose insurance coverage) takes place. This right to obtain continued coverage under COBRA only applies with regard to group health plans for private employers which have had 20 or more employees in the previous calendar year, and to state and local government employees. The most common qualifying events are the employee’s termination (including the employee voluntarily quitting), or a cut in the employee’s hours which results in the employee no longer satisfying applicable minimum work hour requirements for insurance coverage. However, COBRA coverage is not an option if the employee is terminated for “gross misconduct.” Also, qualifying events triggering the right of a spouse or dependent of an employee to obtain extended coverage include the death of the employee. 

The employer must notify the health plan within 30 days of a qualifying event (an employee’s termination, reduction in hours, or death). Within 14 days afterwards, the health plan must notify the employee (or beneficiary) of his or her right to continue coverage. The employee or beneficiary must respond within 60 days if they wish to continue on the group health insurance plan, and then has 45 days after electing coverage to pay the initial premium.

The individual who chooses continued coverage will have to pay both the employee and employer portions of the premium plus a 2% service charge. The individual’s continuing premium cost may not exceed 102% of the premium cost for the full employee rate. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees, while COBRA participants generally pay the entire premium themselves. It is ordinarily considerably less expensive, though, than individual health insurance coverage.

This coverage may continue for eighteen months, as long as the premiums are paid. If the individual should join a new employer’s group health plan, the COBRA coverage is not automatically terminated. The individual has the option of either continuing the COBRA coverage for the full eighteen months or terminating it. Continuing COBRA coverage when joining a new plan may be helpful if plan participants are subject to exclusions or waiting period requirements under the policy. However, the individual may need to carry the premiums of both policies during this time.

If an individual was determined to be disabled under the Social Security Act within the first sixty days of COBRA coverage, the individual may choose to buy an additional eleven months of COBRA coverage, extending the COBRA coverage to twenty-nine months. If the individual chooses this option, any beneficiaries also receiving the COBRA coverage will be eligible for this extended period.

When the COBRA coverage ends, an offer will be made for an option to convert to an individual health plan if this option is generally available to active employees under the plan. Assuming the employee wishes to convert, he or she will want to determine if the conversion plan is affordable (it is likely to be more expensive than group coverage) and extensive enough, or if an individual needs to seek coverage elsewhere.

COBRA coverage may also be terminated early if after electing COBRA the individual joins another health plan (including Medicare) that covers all existing conditions. If the new plan does not cover a certain condition that COBRA is currently covering, or if you are still subject to a twelve-month pre-existing condition clause, you can maintain the double coverage.