Your Child’s Health Care and the Affordable Care Act (ACA):
Habilitative Services

Do you have a child with a physical or developmental disability, or a
chronic (long-term) health problem? If so, you need to know:
Under the ACA, many health care services that can help
your child with the skills your child needs for everyday life
(called habilitative services) must be covered by insurance.
What are habilitative services?
Habilitative services help people of all ages develop new skills needed for
everyday life. They include things like occupational, physical, or speech
therapy — and hearing and vision services, too. Habilitative services may
also help people build mental, behavioral, or social skills. Certain devices, like
hearing aids, may also be considered habilitative.
Habilitative services are very important for children with disabilities who
need help from therapists and other professionals to learn to communicate,
get around, or take care of themselves.
What changed under the ACA?
Before the ACA became law, many individual and small employer health
insurance plans didn’t cover habilitative services. Now, these services are
included in the ACA as Essential Health Benefits (EHBs), which means that
individual and small group health insurance plans have to cover them.
This is a big step forward when it comes to helping children with disabilities
develop the skills they need to grow and learn.
What is the Affordable Care Act (ACA)?
The ACA is the federal health care reform law signed into law in 2010. (Some people
call the law Obamacare.) Most people know that the ACA is about health insurance,
but the law also includes many ways to improve health care in the United States.
Are all habilitative services covered by the ACA?
No. The law doesn’t say which specific services (or devices) are included.
It’s up to each state to decide the details. This means what’s covered under
habilitative services in one state might be different than what’s covered in
another state.
How do I know if the habilitative services my child needs will
be covered under my health plan?
If you already have an individual policy or small employer health plan, call
the customer service phone number for your health plan and ask for a list
of covered habilitative services.
If you’re shopping for a new health plan and need help understanding which
habilitative services are covered, go to localhelp.healthcare.gov. You can
type in your ZIP code or the name of your city or town to find a list of helpful
organizations who can work with you to choose the right plan for your family.
You can find another list of consumer assistance resources organized by
state at http://hdwg.org/catalyst/resources. Be sure to think about what
kinds of services your child needs before you choose a plan.
Where can I get more information?
To find out more about about EHBs like habilitative services, go to
www.healthcare.gov/glossary/essential-health-benefits
You can find more information about caring for children and youth with
special health care needs at www.medicalhomeinfo.org
You can find more information about health insurance for children and
youth with special health care needs at www.catalystctr.org
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CATALYST Children&Youth
C E N T E R
i m p r o v i n g f i n a n c i n g o f c a r e
for
with special health car e needs
Developed by the National Center for Medical Home Implementation at the American Academy of Pediatrics and the Catalyst
Center at the Boston University School of Public Health through cooperative agreements (U43MC09134; U41MC13618) with the U.S.
Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.