Performance Improvement 2008. How Prevalent In the Medicaid Population are Individuals With Special Health Needs; What Are These Needs; What Factors Determine Access to or Loss of Medicaid Eligibility?


Two studies examined the characteristics of working age adult Social Security Insurance recipients and the extent to which youth with chronic and disabling conditions lost Medicaid. SSI and SSDI programs provide cash benefits to people who are severely disabled. Applicants must show that their disabilities are total, will last at least 12 months or result in death, and prevent them from earning a living. But there are other groups with chronic and disabling conditions, and the Medicaid program serves numerous people with special health care needs who do not otherwise receive federal disability benefits.

Using Medicaid Analytic eXtract system data, researchers identified Medicaid beneficiaries with special health needs. For a sub-sample of enrollees identified as having a chronic or disabling condition, researchers obtained administrative records from the Social Security Insurance (SSI) and Social Security Disability Insurance (SSDI) programs to create a file of linked records that provided a rich source of data on the disabling conditions that qualified these people for federal disability benefits and chronic conditions for which they received treatment.

In the first study, researchers described the characteristics of working age adult SSI recipients and how age and other characteristics affected their ability to access Medicaid coverage before SSI benefits began or maintain Medicaid coverage after SSI benefits ended. A primary aim was to assess whether state implementation of the optional Medicaid eligibility categories for adults with disabilities enhanced access to benefits. Researchers also examined whether living in a state that required SSI applicants to apply separately for––rather than automatically enrolling them in––Medicaid upon award of SSI benefits, was related to the maintenance of Medicaid coverage after SSI benefits ended. A second study examined the extent to which youth with chronic and disabling conditions lost Medicaid coverage because of program age requirements. Specifically, the study tracked eligibility immediately after young adults reached their 18th, 19th, 20th, and 21st birthdays. Although youth with chronic and disabling conditions may be less vulnerable to aging out of Medicaid coverage compared to other enrollees of the same age, they still lose coverage at these birthdays (depending on State law) if they are not able to reestablish eligibility for Medicaid as adults or through categories for the disabled.

Researchers found that, in 2000, only 21 percent of children with chronic and disabling conditions were eligible for Medicaid on the basis of a disability; the other 79 percent were eligible because they met the criteria for low-income children. The most costly children were those designated as disabled ($1,116 per month enrolled) or in foster care ($774 per month enrolled), had a cerebrovascular condition ($2,220 per month enrolled), or had four or more conditions ($3,013 per month enrolled). Most Medicaid enrollees ages 21 through 64 with chronic and disabling conditions were eligible for Medicaid because they were designated as disabled, which means that most of these individuals met the disability criteria of the SSI and SSDI programs, but may or may not have met the financial criteria of the SSI program. The other 20 percent were eligible through other eligibility categories for adults.

Report Title: Medicaid Populations with Chronic and Disabling Conditions: A Compilation of Data on Their Characteristics, Health Conditions, Service Use, and Medicaid Payments.
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Bill Clark, 410-786-1484
Mathematica Policy Research, Inc.

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