Medicaid and State Children's Health Insurance Program: Medicaid and Individuals with Intellectual and Developmental Disabilities (ID/DD)
Waldman, H. Barry, Perlman, Steven P., The Exceptional Parent
"Americans with disabilities such as MR/DD [mental retardation/developmental disabilities] are some of the most vulnerable Medicaid recipients." (1)
In 2006, Congress passed legislation containing major changes to Medicaid, as well as trimming federal Medicaid spending by $4.7 billion over five years and $26.4 billion over ten years. The President's FY 2007 budget request included additional federal Medicaid cuts of billions of dollars. (1)
The combination of Medicaid and the State Children's Health Insurance Program (SCHIP) provides health coverage for one-in-four of our nation's children. Over 28 million children are enrolled in Medicaid, the country's major source of healthcare coverage for low-income people. SCHIP targets low-income uninsured children who do not qualify for Medicaid. It provides coverage for 6 million additional children for an annual cost of $7 billion. SCHIP is administered by the states within broad federal guidelines. States can create separate SCHIP programs, expand their Medicaid program, or adopt a combination approach.
Nevertheless, 9 million children remain uninsured. Uninsured children often are forced to have care delayed due to cost and are five times less likely than their insured counterparts to have a usual place of care. As a result, in a 2004 study, 14 percent of uninsured children had not visited a physician in more than two years. Similarly, 36 percent of uninsured children had not visited a dentist in more than two years.
Nearly three quarters (74 percent) of these uninsured children are eligible for health insurance coverage under Medicaid or SCHIP. Most low-income parents view Medicaid as a good program but have difficulties accessing care. For example:
* The Deficit Reduction Act of 2005 now requires residents to present proof of citizenship and identification when applying for or renewing Medicaid coverage.
* As of mid 2006, 35 states charge premiums or enrollment fees for children's coverage. In addition, 22 states charge co-payments for services, predominately in SCHIP programs.
* Extreme limited availability of providers.
In general, low-income uninsured children:
* Live in working households and have little contact with government assistance programs.
* Live in the South and the West regions of the country.
* Are native born citizens
* Include a significant proportion of minority children. Forty percent of all uninsured children are Hispanic. (2, 3)
Individuals with Intellectual and Developmental Disabilities
"... Medicaid serves almost 530,000 individuals with MR/DD spending $27.4 billion in fiscal year 2004 or almost $52,000 per person per year." (1)
Individuals with intellectual and developmental disabilities represent just 1.3 percent of the 41.3 million individuals enrolled in the Medicaid program but require 9.5 percent of the total $288 billion spent for Medicaid services. There are an estimated 1.8 to 2.0 million Medicaid beneficiaries with intellectual and other developmental disabilities (ID/DD). These children account for about 25 percent of all Medicaid beneficiaries who have disabilities.
* Only 19 states extend Medicaid eligibility to people with disabilities with incomes up to the federal poverty line ($9,750 in 2005).
* Nearly all Medicaid beneficiaries with ID/DD are poor. The maximum Supplemental Security Income benefit currently is pegged at 73 percent of the federal poverty level. This level of financial support is insufficient to meet daily living expenses.
* Neither Medicare nor the vast majority of private health insurance plans cover the types of ongoing long-term services that people with ID/DD need. It can only be obtained through Medicaid. (4)
Long term services: In 2004, nationally, more than 529,000 individuals with ID/DD received Medicaid long-term services (approximately twice the number as there were in 1994). …