Access to Care for Disabled Children under Medicaid
Long, Sharon K., Coughlin, Teresa A., Health Care Financing Review
Medicaid provides health care to one-third of all disabled children and 7 out of 10 poor disabled children (Bruen and Holahan, 2001). Not surprisingly, disabled children on Medicaid use significantly more health care services than healthy children. They also require services far beyond basic preventive and primary care, needing care from an array of providers including medical specialists, therapists and social service agencies. Consistent with their greater service use, caring for disabled children is much more costly. One recent study estimated that Medicaid costs for children with chronic disabilities were six times greater than other children on Medicaid and accounted for about 75 percent of total Medicaid expenditures on children (Allen and Croke, 2000). If recent trends persist, disabled children will likely account for a bigger share of the Medicaid costs in the future: Over the past decade, the disabled--both adults and children--were the fastest growing enrollment group in Medicaid (Bruen and Holahan, 2001).
While the challenges of accessing care under the Medicaid Program are well-documented for the overall Medicaid population, very little is known about access to care for children with special health care needs, including how access differs for children with mental and physical disabilities (Allen and Croke, 2000; Shalala, 2000). State administrative data provide little or no information on the beneficiary's disabling condition and surveys of Medicaid beneficiaries seldom include large enough samples of disabled children to provide information on their health care experiences. Given the vulnerability of children with special health care needs and their high costs under the Medicaid Program, a better understanding of the needs and experiences of these children is needed. This article uses data from a survey of blind and disabled Medicaid children riving in NYC to address that information gap. Specifically, it explores the health care experiences of children who are eligible for Medicaid by virtue of receiving Supplemental Security Income (SSI), the Federal program that provides cash assistance to needy aged, blind, and severely disabled individuals. We examine differences in access and use of care among children on Medicaid with physical disabilities, mental illness, and MR/DD. To our knowledge, this is the first article to document access and use within the population of disabled children on Medicaid.
Having some understanding of the health care experiences of disabled children is important. Among other things, this information can help identify gaps in the current Medicaid Program, specifically whether particular groups of children are having problems getting access to particular types of care. Further, knowing more about the population will help Medicaid policymakers as they develop managed care programs for disabled beneficiaries, an idea that is being pursued by a number of States (Regenstein and Anthony, 1998).
New York Survey of Disabled Medicaid Beneficiaries
Our sample of blind and disabled child SSI beneficiaries (hereafter referred to as disabled children) is obtained from the New York Survey of Disabled Medicaid Beneficiaries, which was fielded in NYC in 1999-2000. New York was selected for study because of plans by the State to implement mandatory capitated Medicaid managed care for disabled beneficiaries in the future. The survey will provide a baseline for evaluating the impacts of the planned shift to mandatory managed care on disabled beneficiaries. The randomly selected sample of Medicaid beneficiaries was identified through State enrollment records for the Medicaid Program, with information on the primary disabling condition under SSI obtained through a match with Social Security Administration records for the SSI program. (The primary disabling condition represents the disabling condition that most readily qualified the child for the SSI program. …