Breakthrough or Barrier? The ADA and State Health Reform
The question of how state and national health reforms affect people with disabilities was raised to public consciousness by the 1992 rejection by the Federal government of Oregon’s request to revise its Medicaid program on the grounds that the proposal might violate the Americans with Disabilities Act (ADA). In subsequently granting the request in March 1993, the Clinton Administration continued to cite concerns about possible violations of the ADA posed by Oregon’s proposal. That proposal would increase the numbers of persons served, but limit Medicaid reimbursement to those services identified as priorities on a ranking list. Based upon a January 19, 1993 opinion by the Department of Justice, Oregon was asked to make additional modifications in the rankings of priority services. The Justice Department opinion determined that Oregon could use medical effectiveness criteria in developing its rankings, but it could not condition coverage on whether the treatment completely eliminates a person’s symptoms for that condition or allows that person to perform certain functions. The opinion also state that Oregon should not be allowed to refuse funding for services such as infertility because the service is not highly valued by Oregonians. Because infertility, for example, is a disability under the ADA, refusal to cover it could be an intentional devaluation of treatment on account of disability.
| 1993.May_.breakthrough.barrier.ada_.state_.health.reform.pdf | 1.7 MB |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
