This study shows very strikingly that the population of children served by public programs for disabilities in Illinois has changed dramatically over a five year period. The expansion due to Zebley to include more children with emotional disorders has opened a new door into services provided through the Medicaid program. The Medicaid program has been expanded simultaneously to address the needs of children with severe emotional disturbances by providing services in settings other than traditional health care settings. It also seems, however, that the new SSI population is slow to use additional services. In other words, children in the SSI population do not quickly become participants in multiple programs. The special education population is also decreasing as there is a move to bring children with handicapping conditions into the regular classroom; the poor fiscal condition of schools also provides little incentive to identify more children as requiring special education. This is our interpretation of the diverging trends in program eligibility and utilization between the SSI and Medicaid programs and the special education program.
We also found that multiple program participation reflected intuitions about how that might occur. In general, children with less severe conditions (language disorders or learning disabilities) were less likely to participate in multiple programs that children with more severe or chronic disabilities (e.g. severe emotional disturbance). This, however, may be due to the fact that we focused on public programs, which are primarily used by the poorer segment of the population; this means that the children with less severe conditions in special education would be less likely to appear in the Medicaid or SSI population.
Given the changes that have been made to SSI eligibility criteria in 1996 and the potential future changes in Medicaid and welfare programs in general, we hope that this study provides a baseline for future monitoring of participation in programs for disabled children. While we have not included every program for children with disabilities, we have included the major public programs which would reflect the trends in the service provision to the population. The addition of other programs into our analysis could provide important information on those programs. In particular, the addition of the new early intervention programs would be an important addition. Better tracking of these children from birth is also key to more complete and better monitoring.