Requirements for Care in 2026
Despite broad public concern around health and healthcare affordability, our national health systems are still a “nightmare of complexity” (according to Health Affairs). With states like Minnesota losing up to $2 billion in annual federal Medicaid funds due to accusations of fraud, access to care without barriers is in the crosshairs of broader political fights. Advocates have already indicated that when states have lower federal funds for Medicaid, Home and Community-Based Services (HCBS) are one of the first programs to see cuts. Mental health and substance use parity is also at risk when cuts go into effect. Despite an insistence on taking action for affordability, the current administration’s policies are likely to harm people with disabilities’ access to care.
KFF assesses how health policy is showing up in national healthcare approaches as we start a heated electioneering season ahead of the midterm elections this November. Some congressional candidates are focused on drug prices, while others continue to raise the issue of health coverage affordability and the cost of premiums. We continue to emphasize the importance of comprehensive coverage as a cornerstone to achieving affordable care for people with disabilities. Many current proposals to address the cost of pharmaceuticals are leaving out a critical conversation on access to coverage that is durable enough to support people with all of their health needs. Medication access is just one part of a broader conversation on affordability. The Center on Budget and Policy Priorities talks more in-depth about the rise of health savings accounts, and the risks they pose of inadequate health coverage for enrollees.
Health coverage is on the decline for many. Georgetown’s Center for Children and Families shows that Medicaid and CHIP enrollments are declining, even as unemployment is rising. [They have a new Medicaid/ CHIP Enrollment Tracker showing developments in all 50 states for those who want to track enrollment data year round.] For those on ACA Marketplace plans, Families USA outlines how recent changes are decreasing consumer protections while implementing higher cost-sharing and deeper barriers to accessing insurance.
The proposed changes to ACA plans are outlined in a recently released CMS “payment rule” (aka The Notice on Benefit and Payment Parameters). Of note, essential health benefits could be undermined, reducing the care available as a core standard for all plans on the marketplace. At the same time that coverage is being eroded, there is a risk of higher cost-sharing for consumers. CMS is accepting public comments on these rule changes through March 13th. Families USA has a guide for submitting comments. The Commonwealth Fund provides an in-depth dive into essentials that consumers need to know about emerging plan options that fail to meet the requirements of the Affordable Care Act. Here are some of the plans they outline that people may be considering that don’t meet ACA requirements:
- Short-term insurance: Intended to fill a temporary gap in comprehensive coverage, such as might occur when a person changes jobs.
- Health care sharing ministries (HCSMs): Coverage arrangements in which enrollee-members agree to follow a common set of religious or ethical beliefs and make monthly payments to help cover the qualifying medical expenses of other members.
- Fixed indemnity/hospital indemnity insurance: Provides a fixed amount of money to an enrollee who experiences a qualifying medical event, like a hospitalization. The policy pays the predetermined amount regardless of the enrollee’s actual expenses, if any.
- Underwritten Farm Bureau plans: Health benefit arrangements for Farm Bureau members that are specifically excluded from the definition of insurance under some states’ laws. Membership in a Farm Bureau (and therefore, eligibility for a Farm Bureau plan) is usually open to the general public and does not require a connection to the agricultural industry.
For people with disabilities, these plans are likely to discriminate when people require care, limit coverage for certain treatments, and may even charge higher premiums for health status:
Even when a person is permitted to enroll, the arrangement typically excludes coverage for care related to any preexisting condition the enrollee may have. If the enrollee later receives care and files a claim, there could be an investigation into the enrollee’s health history to determine whether the claim can be traced to a preexisting condition (a practice known as postclaims underwriting). If it’s decided that the claim is related to a preexisting condition, payment will be denied, leaving the enrollee on the hook for the full cost and at risk of having their coverage retroactively canceled.
When you’re working with someone considering one of these plans, remind them to take their time and examine the coverage provided when considering health plans outside of the ACA Marketplace or Medicaid. Often, junk plans will encourage consumers to enroll in a short window. They may even promise coverage for pre-existing conditions that later may be denied. It’s important for consumers to be aware of their potential aggressive and misleading marketing tactics, and the importance of coverage compliant with ACA protections.
To support Medicaid enrollees with disabilities, it’s essential to learn more about the work and community engagement requirements that are being rolled out over the coming year. Legal Action Center has a series of reports for policymakers and advocates on how best to mitigate the impact of these requirements for individuals with substance use and mental health challenges, and those who were previously incarcerated. They cover high-level steps for navigating the exemption verification process for people with substance use disorder.
Policy Briefs on Health
- The United States of Care has released a set of five 1-pagers on 2026 health policy priorities to improve our health care system. These briefs cover hospital pricing, health care ownership transparency, and hospital accountability. Their policy agenda responds to long-standing issues of mistrust in our healthcare systems, which they documented in an annual Pulse Check report last fall.
- The Legal Action Center and Opioid Response Network offers a policy brief on Medicaid compliance under the Mental Health Parity and Addiction Equity Act. This is one of a broader suite of issue briefs and one-pagers aiming to mitigate the impact of HR 1 on enrollees.
- Kaiser Family Foundation released a brief retrospective on the state of Medicaid Home Care in 2025.
- The Century Foundation, Caring Across Generations, and the National Partnership for Women & Families have a new Care Research Hub with resources on direct care across the country.
Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities.