Health reform and persons with disabilities: Ensuring the "Bridge to Reform" is not a "Bridge to Nowhere"

The Patient Protection and Affordable Care Act (ACA) provides much hope that persons with disabilities and chronic health needs will be able to access health coverage in a more meaningful way. In recent months, however, California has created a “Bridge to Reform” waiver plan which will require those with disabilities and those who are elderly on California's public coverage systems to enroll in a mandatory managed care plan. This presentation will examine the California program and analyze what protections have been enacted (or may be needed) in order to ensure that the cost savings envisioned from the coordination of care in the managed care program will not cause vulnerable populations to shoulder the burden at the expense of their potentially complex health needs. If only certain classes of the population are required to enroll, the program must ensure that the involved providers can meet access and treatment needs. In addition, community based provision of service rather than facility based will also be a concern. Care should be taken to ensure that the mandatory program is a part of the solution, rather than exacerbating the problem of health disparities. The presentation will conclude with suggestions for avenues of policy advocacy for identified needs.