The number of children who were identified as being disabled from each of the four databases is presented below. The overall number of disabled children identified in this analysis has increased over time from 259,113 children in FY 1990 to 277,689 children in FY 1994. This growth represents approximately a 7% increase. This growth occurred over a time when the AABD and Medicaid program populations were increasing steadily while the special education population, the largest of the four, was decreasing. Under out selection criteria, this population of disabled children represents approximately 8% of all children in Illinois.3
|Database||Number of Children|
|FY 1990||FY 1991||FY 1992||FY 1993||FY 1994|
|Medicaid Paid Claims||34,541||39,225||45,038||56,063||87,764|
|All Disabled Children||259,113||263,758||279,608||272,779||277,689|
In Illinois, each of the four programs that we examined served very different populations in terms of race/ethnicity, sex, and age (Tables 3-6). Children in the state AABD programs were most often African-American children and were increasingly so over time. Because AABD program participation should mirror SSI participation, we see an increase in the number of children served after Zebley implementation. The post-Zebley time period in Illinois shows increased participation of children of all ages. Special education serves the largest number of children with disabilities in Illinois. Nearly 2/3 of the children in special education are boys. Approximately 70% of the children were white in fiscal year 1990 but were more likely to be of African American or Hispanic origin over time. Children identified with disabling conditions in the Medicaid service data were distinct from the special education and AABD populations. Medicaid program children had very similar percentages of white and African-American children over time. Boys were slightly more likely to have been identified in this population in each of the fiscal years. The growth in this population over time had its biggest affect on the age distribution of children with disabling conditions. In fiscal years 1990 and 1991, our selection criterion identified infants 25% of the time. After FY 1992, the percentage of infant children that we identified decreased. Conversely, the percentage of school age children began to rise. The DME inpatient population is the smallest population examined in this study. Boys were slightly more likely to be among children served in DMH facilities as were white children over time. Children served in DME inpatient facilities were more often children over age 9.
Type of Disability
The administrative data on each of the four programs offered few program generated descriptors of the participating child's type of disability. Moreover, disability categorizations were not uniform over time. In the special education program, an aggregation of the primary exceptional characteristic lead to a general categorization over the five fiscal years. Of the children in special education, approximately one half were identified as having learning disabilities. For example in FY 1994, approximately 49% were categorized as having learning disabilities, 25% as having speech or language disorders, 11% as severely emotionally disturbed, and 11% as mentally retarded. (Table 7). From the Medicaid services data, the ICD-9-CM diagnosis code was available for almost all children selected. Institutional claims records which primarily identify inpatient hospitalizations, could not be categorized by ICD-9-CM diagnosis codes. Table 8 presents the distribution of the ICD-9-CM diagnosis categories. The categorization was based primarily on the section headings contained within the ICD-9-CM, however, some particular diagnoses of interest were included in the distribution. While most of the diagnosis categories fluctuated little over the fiscal years, the percentage of children with mental disorders rose significantlyhrom 20.9% of Medicaid program children in FY 1990 to 40.7% of children in the Medicaid program in FY 1994.
Patterns of Program Participation
Because each of the four programs provide very different services to disabled children in Illinois, the duration of program participation varies considerably. We would expect AABD (SSI) program participation, for example, to be longer term given that it provides basic human services including income support and health insurance. Medicaid program identification, however, is not likely to be observed year to year unless a particular disabling condition requires constant treatment provided through Medicaid. Because our data did not allow for continuous time estimates of duration, discrete time service receipt histories were analyzed for new entrants to each of the programs by fiscal year. A new entrant to AABD in FY 1992, for example, was defined as a child not observed participating in AABD prior to the fiscal year 1992. Only children who were age 13 or younger at the end of the fiscal year of the first year of service, and thus would not reach age 18 during the observation period, were examined. The survival rates are presented in Table 9.
Both special education and AABD program participation were likely to last longer than Medicaid program or DMH inpatient participation. For children entering the AABD program in FY 1991, 70% were still participating after 4 years. Over time, children entering AABD programs were more likely to continue participation after 1 year. For example, 78% of the AABD children entering in FY 1991 were participating after 3 years while 86% of the children entering in FY 1992 were participating after 3 years. In special education over time, children were slightly less likely to continue participation for a second year. Of children entering special education in FY 1991, 75.7% were participating for a second year while only 71.9% of children entering in FY 1993 were participating. The length of participation in the Medicaid program increased substantially between the FY 1992 and FY 1993 cohorts. 32.2% of the FY 1992 entry cohort was found to be participating for a second year while 44.9% of the FY 1993 entry cohort was participating in the next year.
Table 10 presents indicators of the past year of service receipt for each program entry cohort. New entry is again defined by the first year of service in a particular program. Overall, AABD entrants are the most "known" to the system. In FY 1991, 47% of children entering AABD had participated in another service last year while just 3% of special education entrants and 14% Medicaid entrants had done so. An examination of the participation rates of AABD entrants over the fiscal years, however, reveals that the degree of participation in other services prior to AABD entry has decreased. By FY 1994, 39.3% of children entering AABD had prior service experience. For special education and Medicaid new entrants, we observe the opposite trend. Children in special education were more likely to have had prior service experience in both AABD and Medicaid. Entrants to the Medicaid program were also more likely to have received other services in the past year. Medicaid entrants who participated in special education in the past year increased from 12.7% of entrants in FY 1991 to 18.3% of entrants in FY 1994. Although these indicators can only approximate the pathways that children take, the trend in recent fiscal years suggests that frequency of transitions between other services to Medicaid and special education is increasing while the frequency of transitions from other services to AABD is decreasing.