This is one of the most important implications of the ACA for occupational therapy practitioners and consumers, and you're likely to read a lot about it on this blog. Thanks to advocacy by AOTA and allied organizations, the ACA requires coverage of habilitative services as essential health benefits for millions of newly insured people who will be purchasing private health plans on health insurance exchanges, or obtaining coverage through states' Medicaid expansions. There will be a lot of variation around the country in terms of how habilitative services are covered, but there are a few key things to realize. 

  1. In the past, many insurance companies have denied coverage of occupational therapy services that develop function (as opposed to restoring function), but fewer will be able to do that starting in 2014. 
  2. While the number of visits and other utilization requirements will vary from plan to plan, virtually all plans are expected to cover at least some habilitative occupational therapy services. 
  3. With so many newly insured people with access to a greater range of occupational therapy services than was typical in the past, there will be an influx of new occupational therapy consumers.

All is not perfect with these new requirements. There's a lot of advocacy work that remains to be done before habilitative occupational therapy services are available to anyone for whom they are clinically appropriate, but a significant positive step was taken with the ACA. Read more about this issue and some of the remaining challenges in Kaiser Health News.