Access to Care among Disabled Adults on Medicaid
Long, Sharon K., Coughlin, Teresa A., Kendall, Stephanie J., Health Care Financing Review
Disabled individuals account for about one-sixth of the Medicaid caseload but more than one-third of program expenditures (Kaiser Commission on Medicaid and the Uninsured, 2001). Yet, little is known about the health needs of disabled Medicaid beneficiaries and their experiences under the Medicaid Program (Davis and O'Brien 1906; Hagglund et al., 1999; Meyer and Zeller, 1999; Hill and Wooldridge 2000; Center for Health Care Strategies Inc., 2000; Shalala, 2000). State administrative data provide little or no information on a beneficiary's disabling condition, health care needs, and barriers to care. Surveys of the disabled Medicaid population can provide more indepth information on how the disabled are faring, however, such surveys are rare. Until very recently, disabled Medicaid enrollees have not been the central subject of a major survey.
With State's growing efforts to move disabled Medicaid beneficiaries into managed care, interest in better understanding the needs and experiences of those individuals has escalated. Accordingly, CMS recently funded a survey that focuses on the health and health care experiences of disabled Medicaid beneficiaries in New York City. New York was selected for the study because of plans by the State to implement mandatory capitated managed care for disabled Medicaid beneficiaries in the future. Thus, in addition to providing important new information about the experiences of disabled Medicaid beneficiaries, the survey provides a baseline for a future evaluation of the impacts of the shift to mandatory managed care on disabled beneficiaries. In this article, we use that survey data to explore differences in access to and use of care among key subgroups of the disabled Medicaid population--adults with physical disabilities, mental illness, and MR/DD. We address three related questions:
* Does access and use under Medicaid vary for individuals with physical disabilities, mental illness, and MR/DD?
* Can the differences in their health care experiences be explained by their differing health care needs or, alternatively, are there persistent differences in access to care under Medicaid for some groups of disabled persons?
* Beyond disabling condition, what other characteristics of the disabled population (e.g., health status, functional limitations) predict greater difficulties with accessing care under the Medicaid Program?
We focus on the health care experiences of non-aged adults who are eligible for Medicaid by virtue of their receipt of Supplemental Security Income (SSI), the Federal program that provides cash assistance to needy age, blind, and disabled individuals. To qualify for SSI on the basis of disability, an individual must be severely disabled, such that he or she is "... unable to engage in any substantial gainful activity by reason of a medically determined physical or mental impairment expected to result in death or that has lasted, or can be expected to last, for a continuous period of at least 12 months" (U.S. House of Representatives, 2000).
By broadening our knowledge of the disabled population, we can better address the gaps in the current health care system, including identifying areas in which there may be opportunities for more effective and efficient delivery of care for key population subgroups. Further, this information will help States and managed care organizations in developing managed care programs that better meet the varied needs of vulnerable Medicaid beneficiaries.
DATA AND METHODS
We rely on a telephone survey of 816 disabled adult SSI beneficiaries fielded in New York City in 1999-2000. A comparable survey was also fielded in Westchester County, New York. Because the findings were broadly similar in both New York City and Westchester County, for simplicity in presentation we have limited this article to New York City. However, the consistency of the findings for New York City and Westchester County provides some support for the generalizability of these findings beyond New York City. …