Robert Goerge, Lucy Mackey-Bilaver, Bong Joo Lee, David Koepke and Allison Harris
University of Chicago, Chapin Hall Center for Children
September 30, 1996
This report was prepared under grant #94ASPE266A between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the University of Chicago. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The Project Officer was Kathleen Bond.
The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.
The objective of this research project is to describe the demographic characteristics and human service utilization of all children and adolescents who are identified as having a disability in Illinois, as well as to understand the stability of the care that they receive through childhood and adolescence. Given the recent changes in the Supplemental Security Income program for children and adolescents in the 1996 Welfare Reform legislation, the study can serve as a baseline to assess the impact of the changes on service provision to children and adolescents with disabilities.
This study is unique because the database that we used for this study was developed from statewide service data. All children in Illinois who are identified as having a disability by a set of agencies including the Department of Public Aid, the Illinois State Board of Education, and the Department of Mental Health and Developmental Disabilities will be tracked through the use of the Integrated Database on Children's Services in Illinois (IDB). In this study, we focused on those children identified as having a disability from July 1, 1989 through June 30, 1994.
The major findings of this study are:
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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. AABD (SSI) and Medicaid were responsible for the majority of this growth. During this period, the number of children receiving AABD (SSI) increased over two and a half times from 12,184 children in FY 1990 to 43,941 children in FY 1994. The number of children receiving Medicaid reimbursed services for a disabling condition increased from 34,541 children in FY 1990 to 87,764 children in FY 1994.
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In Illinois, each of the four programs that we examined served very different populations in terms of race/ethnicity, sex, and age. Children in the state AABD programs were most often minority children and were increasingly so over time. Among the children receiving Medicaid reimbursed services for disabilities, our study shows that the percentage of all children who were infants receiving services decreased from 25% in FY 1990 to 17% in FY 1994.
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As to type of disability, approximately one half of the special education children 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. Among children receiving Medicaid services for disabilities, the percentage of children with mental disorders rose significantly from 20.9% in FY 1990 to 40.7% in FY 1994.
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Because each of the four programs provide very different services to disabled children in Illinois, the duration of program participation varies considerably. Both special education and AABD program participation are likely to last longer than Medicaid service or DMH inpatient participation. Over time, children in AABD and Medicaid reimbursed services were more likely to participate beyond one year of service. 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.
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Overall, AABD entrants are the most "known" to the aggregate of all of the disability services. In FY 1991, 47% of children entering AABD had participated in another service last year while just 3% of special education entrants and 14% of 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, only 39% of children entering AABD had prior service experience. For special education and Medicaid new entrants, we observe the opposite trend.
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A point in time examination of multi-service utilization reveals that it has become more prevalent over time. In FY 1990, 5.3% of the children receiving a disability service were using multiple programs while 15.2% of the children receiving a disability service in FY 1994 were multi-service users.
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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 special education children, multi- service use is rare but increasing over the fiscal years. Children using Medicaid services for disabilities were slightly more likely to participate in multiple services 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.
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Although the new entrants look similar to the point in time populations in terms of the trend in multi-service use, they contribute little to the overall incidence of multi-service use. Over the fiscal years, multi-service users that were new entrants made up approximately 1% of disabled children using multiple services in Illinois.
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In each of the fiscal years, the majority of children participating in both special education an d AABD within a fiscal year were mentally retarded. Over time, however, learning disabled and severely emotionally disturbed children were increasingly likely to participate in AABD and special education simultaneously.
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By FY 1994, the majority of children participating in Medicaid reimbursed services and either special education or AABD were being treated for mental disorders.
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When controlling for demographic factors, it appears that the very young and teenage children participating in AABD were less likely to be using multiple services during a fiscal year. In FY 1991 and FY 1992, children in AABD were nearly two times more likely to be multi-service users than children in AABD in FY 1990. In FY 1993, however, children in this program were slightly less likely to be multi-service users than children participating in FY 1990.
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Of children participating in special education, the mentally retarded, the physically disabled, and children with other disabilities were approximately 2 times more likely to be multi-service users than were severely emotionally disturbed children holding all other factors constant. Children with learning disabilities and. speech or language disorders were nearly 70% less likely to be multi- service users during a fiscal year than were severely emotionally disturbed children.
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When controlling for all other factors, children receiving Medicaid reimbursed treatment for mental diagnoses or a combination of mental and non-mental diagnoses were more likely to be multi-service users during a fiscal year than were children selected because of one or more non-mental diagnoses.
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Females receiving Medicaid reimbursed services in FY 1990-1992 were nearly 20% less likely than males to participated in AABD within three years. Hispanic and African American children were approximately 1.3 times more likely than white children to participate in AABD. In terms of age, children over the age of 7 were more likely to become AABD participants within 3 years than were children ages 6 and 7. Children receiving Medicaid services for complex conditions, including a combination of mental and non-mental diagnoses, were nearly three and a half times more likely to become AABD participants than children receiving Medicaid services for one or more non-mental disorder diagnoses.