Health Care Access, Use, and Satisfaction among Disabled Medicaid Beneficiaries
Coughlin, Teresa A., Long, Sharon K., Kendall, Stephanie, Health Care Financing Review
Medicaid provides health care coverage to more than 40 million people (Bruen and Holahan, 2001). In providing this coverage, the program serves a highly diverse population that includes low-income females and children, the elderly, and disabled. Each of these groups has distinct health care needs with their use of health care services reflecting these underlying health care needs: adults and children in low-income families rely on Medicaid largely for ambulatory and preventative care whereas disabled persons rely on Medicaid for ambulatory care as well as acute and long-term care services.
While considerable research has been done on health care access, use and satisfaction among low-income families and elderly Medicaid beneficiaries (Stein, 1997; Sisk et al., 1996; Rosenbach, 1995; Gold et al., 1997), less work has been completed on the non-elderly disabled Medicaid beneficiary (Davis and O'Brien, 1996; Hagglund et al., 1999; Meyer and Zeller, 1999; Hill and Wooldridge, 2000; Allen and Croke, 2000). The purpose of this article is to add to the limited baseline knowledge on working-age disabled Medicaid beneficiaries by providing descriptive information on the population--who they are, what types of services they use, and their satisfaction with the health care they receive under Medicaid.
Having such information on the disabled Medicaid population is important. The disabled Medicaid population is a vulnerable group, having very complex medical and health conditions. Developmental disabilities, serious mental illness, and acquired immunodeficiency syndrome (AIDS) are some of the conditions among the disabled Medicaid population. Given their typically low health and functional status, persons with disabilities are heavy users of health care and thus are costly to serve: While disabled Medicaid beneficiaries constitute only 17 percent of the Medicaid caseload, they accounted for approximately 43 percent of program spending in 1998 (Bruen and Holahan, 2001). Moreover, the disabled, with an average annual growth rate of 7.1 percent, was the fastest growing subgroup in the Medicaid population between 1990 and 1998 (Bruen and Holahan, 2001).
Having a clear understanding of the non-elderly disabled Medicaid beneficiaries has become especially important recently as many States have moved (or are considering moving) the disabled into managed care (Allen and Croke, 2000). Most States have limited experience in designing managed care programs that meet the specialized needs of persons with disabilities (U.S. General Accounting Office, 1996; Center for Health Care Strategies, 2000). Structuring high quality managed care programs for the disabled Medicaid population and--after the programs have been implemented--determining program impacts on beneficiaries, requires information on how the population is currently faring under the Medicaid fee-for-service (FFS) system. Further, having some knowledge about the population would be most helpful to States in setting appropriate capitation rates.
In a step toward filling this information gap, we present findings from a 1999-2000 survey of working-age disabled Medicaid beneficiaries living in two areas in New York State--New York City (NYC) and Westchester County (WC). The survey collected information on a range of topics including socioeconomic circumstances, health status and disability, as well as information on health care access, use, and satisfaction. The survey was conducted in the period proceeding New York's planned switch to mandatory Medicaid managed care for disabled beneficiaries and was designed to provide baseline information for future work which will assess how managed care affects care for disabled Medicaid recipients.
This article relies on a traditional analytic framework to examine health care access, use, and satisfaction within the working-age disabled Medicaid population (Andersen, 1968, 1995; Andersen and Aday, 1978; Andersen and Newman 1973). …