Spinal Cord Advocates

Medicare therapy caps have been put into effect that are starting to harm people who have chronic conditions and people with spinal cord injuries/disorders who need rehabilitation.

• Therapy limits in Medicare have taken affect due to health reform not passing
• After people reach the Medicare limit on therapy, they have to pay all the costs themselves
• Advocates and Congress are working on solving the problem

The therapy caps (which cover occupational, physical, and speech therapies) were put into place in 1997 as part of a budget balancing law. However, because of feedback from consumers and providers, the caps were never allowed to go into effect – until now. The caps allow Medicare beneficiaries to receive just over $1,800 a year in therapy. After that limit is reached, the person must pay for 100% of the therapy cost. As expected, it could be difficult for anyone to have to pay for the full costs of therapy on their own.

Provisions that would have stopped the therapy caps from going into effect are in the stalled healthcare reform proposals in Congress. Since health reform did not pass, the therapy caps went into effect. Even though we are only at the start of the second month of the year, people have started to reach the level of the therapy caps. For example, if a person has a stroke they will reach the cap in less than three weeks. What is going to happen to these people? Will they have to stop getting needed therapies and will their conditions worsen?

Fortunately, both Republicans and Democrats in Congress have recognized the importance of the issue and are working on ways to fix the problem so that people can get needed therapies. A number of different strategies are being looked at by advocates including having the “fix” put into a Medicare bill later this month or next, or pushing ahead with health reform efforts.

We are working with our disability colleagues to educate Congress and advocate for the issue to fixed.