Academic journal article Health Care Financing Review

Access to Medicaid and Medicare by the Low-Income Disabled

Academic journal article Health Care Financing Review

Access to Medicaid and Medicare by the Low-Income Disabled

Article excerpt

Access to Medicaid and Medicare by the low-income disabled


The horror of the acquired immunodeficiency syndrome (AIDS) epidemic has brought to public attention one of the most troubling shortcomings in our public health care system. Access to health care coverage is severely limited for many low-income persons with disabilities. Although the Medicare and Medicaid programs have made enormous progress in extending health care coverage to persons with disabilities, their eligibility requirements restrict coverage for many disabled persons living in poverty. For the Medicare program, these eligibility requirements are uniform nationwide and are federally determined. Eligibility for Medicaid, which is Federal-State program, can vary enormously from State to State.

The most pervasive eligibility-related problems encountered by low-income disabled persons in gaining access to Medicaid and Medicare are described in this article. Solutions to alleviate these problems, ranging from incremental changes to a major restructuring are proposed. Although impetus for this article came from concerns about the financing issues facing persons with AIDS, the issues that are addressed are generally common to all low-income persons with disabilities.

Definitions of disability can vary widely and must be age-related. Definitions of disabled children, disabled workers, and disabled elderly differ in accordance with expectations for "normal" capacities of individuals within various age groups. However, in determining eligibility for disability-related benefits, the Federal Government has adopted a relatively narrow definition which focuses on the ability of the applicant for benefits to perform productive work, because the inability to perform productive work creates a need for government financial assistance. The definition of disability employed in Medicare and Medicaid and in the cash assistance programs with which they are related. Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), is the same: the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.

Three important components of this definition are that: the disability must be total, not partial the disability must be expected to be long-term and the disability must prevent the individual from working at any substantial level. Short-term, temporary disabilities, no matter how severe, do not render an individual eligible for Medicaid or Medicare benefits.

The focus in this article is on Medicaid and Medicare coverage issues for persons who meet this definition of disability, and, therefore, pass the disability determination process as administered by the Social Security Administration and State Disability Determination Units (DDUs). Although there are a number of legitimate policy issues concerning the reliability, equity, and uniformity of the disability determination process, we do not include a discussion of these issues. Rather, the focus is on the barriers faced by disabled person who pass the disability screen (or who would pass if they applied) in gaining access to medicaid and Medicare coverage, because of other program eligibility requirements.

Further, we focus, on the subset of persons with disabilities who are low income. The high cost of medical care makes the problem of access to health care financing of special concern for disabled persons living in poverty. In defining low income, the Federal poverty standard is used. In 1989, the Federal poverty level for a single adult (under age 65) was $538 per month.

It should also be noted that we do not address problems related to the service benefit packages offered under Medicaid and Medicare. Instead, the focus is on eligibility rules and policy. …

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