Medi-Cal/Medicaid Managed Care

“It Takes More than Ramps to Solve the Crisis of Health Care for People with Disabilities” – Rehabilitation Institute of Chicago, September, 2004, 76 p. Judy Panko Reis, M.A., M.S., Mary Lou Breslin, M.A., Lisa I. Iezzoni, M.D., M.Sc., and Kristi L. Kirschner, M.D.

Attempting to challenge the general health care system of the U.S., this study provides information, resources and recommendations for integrating people with disabilities into our health care systems. Topics include:

  • defining disability, populations, access issues, scope and nature of quality of care issues, and the need for fundamental restructuring
  • disability civil rights laws and health care, including the ADA
  • the role of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF)
  • embracing the ADA as a model for culturally competent, patient-centered care
  • recommendations for each stakeholder group in the health care system
  • descriptions of promising programs and best practices

Resource information is included in the appendices, along with examples of accessible examination tables, mammography projects, clinical services for women with disabilities, research and training centers, clinics, legal and advocacy services, and references. Tables include population by age, gender, and disability, race and disability, and instances of discrimination. Excellent publication for all involved in health care policy-making and decision-making.

“Understanding the Health Care Needs of People with Disabilities: Findings from a 2003 Survey” – Kaiser Family Foundation, December, 2003, 27 p. Kristina Hanson, Tricia Neuman, and Molly Voris

This report details the results of a national telephone survey of 1,505 non-elderly adults (18-64) with permanent physical and/or mental disabilities, including a detailed description of survey methods and results. The goal was to describe health care experiences across a broad array of disability types and sources of health insurance, specifically those receiving SSI or SSDI income and those not receiving payment from either of those two programs. Key findings were that people with disabilities are at “significant socio-economic and health-related disadvantages when compared to the non-elderly U.S. population as a whole.” Numerous tables and graphs detail the numeric findings of this large survey. Conclusions and policy implications included recommendations for both improved health care systems and strengthened funding coverage for those without insurance or who are under-insured.

“The California Working Disabled Program: Lessons Learned, Looking Ahead” – Medi-Cal Policy Institute, California HealthCare Foundation, April, 2003, 83 p. Joanne Jee and Joel Menges, The Lewin Group

Based upon the relatively new “Californians Working Disabled Medi-Cal Buy-In Program (CWD),” this study examines the factors affecting enrollment in the program and to estimate enrollment and cost impacts of potential program changes. Enrollment as of June 2002 was 652 people, far lower than state officials had anticipated. Two analyses were conducted: a quality review of stakeholders’ experience with the program; and a gathering (by survey, telephone, teleconference, interview) of the experiences of the CWD enrollees, those eligible but not enrolled, and county eligibility workers to gain insight and suggestions for improvement. Chapters cover:

  • introduction and context
  • characteristics of existing CWD enrollees
  • modeling of alternative policy options
  • enrollee, non-enrollee, and eligibility worker feedback
  • lessons learned

Themes emerging from this feedback include: increase program outreach to potential users; improve eligibility worker knowledge; improve program attractiveness; and eliminate barriers to employment for people with disabilities. Authors also recommend that:

    1. raise the income limit to 450% of FPL
    2. eliminate asset level restrictions
    3. combination of the two options above.