Describing the patterns of multi-service utilization of disabled children was a primary goal of this study. At a time when eligibility for SSI will possibly be restricted, it is important to understand the extent to which SSI and other services have been supporting the population of children with disabilities. In addition, indicators of multi-service utilization over time can further illustrate the effects of the Zebley decision.
A point in time examination of multi-service utilization reveals that the majority of children participate in one of two services: special education or Medicaid services (Table 11). Over time however, multi-service use becomes more prevalent. In FY 1990, 5.3% of the children receiving service were multi-service users, while 15.2% of the children receiving services in FY 1994 were multi-service users. Although a small percentage of the total disabled population, the number of children using some combination of programs increase substantially over time. Only 2,747 children used AABD, special education, and Medicaid services within FY 1990. In FY 1994, this number had increased nearly four times to 10,031 children. The number of children participating in special education and the Medicaid program also increased from 5,501 in FY 1990 to 16,201 children in FY 1994. At the same time that these increases occurred, the nurnber of children participating in AABD or the Medicaid program only increased steadily while the number participating in special education only decreased over time.
By examining the incidence of multi-service utilization by program type, we see that the patterns of multi-service use do vary considerably (Table 12). Children in AABD programs have the highest incidence of multi-service utilization but it is not increasing over time. In FY 1990, 51.3% of the AABD children were in special education while only 42.3% were participating in FY 1994. As a percentage of all children in special education, multi-service use is rare but increasing over the fiscal years. Special education children utilizing Medicaid reimbursed services increased substantially from 3.6% of children in FY 1990 versus 13.3% of children in FY 1994. Similarly, special education children were more likely to participate in AABD. In FY 1990, 2.7% of children were participating in AABD while 9.4% were participating in FY 1994. Children receiving Medicaid services were slightly more likely to participate in either AABD or special education over time. In FY 1990, 13.8% of the Medicaid children were also participating in AABD while 19.8% were participating in both programs in FY 1994.
Although multi-service use increased overall and especially for children in special education and Medicaid, the impact of children new to disability programs (especially because of Zebley implementation) could not be assessed in the cross sectional analysis. New entry cohorts, defined by the first year of participation in any of the four services, were analyzed for FY 1991-1994. Although the overall number of disabled children identified from the four programs has grown, the overall number of new entrants to one of the four programs has decreased from 89,193 children entering in FY 1991 to 59,014 children entering in FY 1994 (Table 13). This trend is due primarily to the decrease in special education enrollment. None of the multi-service categories increased substantially over the fiscal years. Only a small percentage of the new entrants participated in more than one service during the fiscal year of entry. For example, 2.7% of the FY 1991 entry cohort participated in multiple services during FY 1991. In FY 1994, only 5.4% of the new entrants participated in multiple services. This was true despite the radically changing composition of the entry cohorts. In FY 1991, single service special education children made up 70.5% of the cohort. In FY 1994, only 23.8% of the entry cohort were single service special education children while 61.2% were single service children identified in the Medicaid reimbursed services data.
The trends seen by program type in the cross-sectional analysis are observed again for the new entrants. Over the new entry cohorts, children who began their service receipt in AABD became increasingly less likely to participate in multiple services within their first year of service (Table 14). New entrants participating in special education were slightly more likely to participate in multiple services, especially Medicaid. Children in the Medicaid program for the first time were slightly more likely to be multi-service users. Although the new entrants look similar to the cross-sections in terms of the trend in multi-service use, they contribute little to the overall incidence of multi-service use. In FY 1991, multi-service users that were new entrants made up approximately 1% of the 16,213 multi-service users observed in FY 1991. In FY 1994, new entrants using multiple services continued to represent I% of disabled children using multiple services in Illinois. It appears that although multi-service utilization has increased since FY 1990, the new entrants contributed little to the trend.
The time frame for this study allows us to follow the FY 1991 cohort of new entrants up to three years. This longitudinal analysis can illustrate the program participation of single service children in the future. As presented in table 15, each of the single service groups from each cohort was identified by multiple service use in the future. The patterns overall and by service type are not clear. Overall, an additional 8.1% of the FY 1991 cohort and 10.6% of the FY 1992 cohort was found to be multi-service users after 2 years. The percentage of multi-service users identified after one and two years appears to rise until except for a sharp decrease for the FY 1993 cohort. For children only participating in AABD in FY 1991, 16.9% became multi-service users after 1 year while only 10.8% of the children in the FY 1993 cohort became multi-service users. After 2 years, however, the percentage of children becorriing multi-service users rose slightly from 23.2% of the FY 1991 cohort to 26.2% of the FY 1992 cohort. Special education and Medicaid program single users were even less likely to become multi-service users in the future.