Physical Disabilities

Better integration of physical and behavioral health is a critical component of improving outcomes and reducing costs for Medicaid beneficiaries, especially those with high levels of need. This report profiles four examples where the safety net community – health plans, community health centers, community mental health centers, and the centers’ primary care and behavioral health clinicians – have collaborated to develop programs to integrate care for this population.

This report describes the different strategies that four states are utilizing to improve the integration and coordination of care for individuals with mental health and substance use disorders. These strategies include introducing new managed care arrangements and care coordination mechanisms, enhanced payment to providers to deliver comprehensive services, and the full integration of physical and behavioral health services in managed care contracts.

Recent interest among policymakers in helping Social Security Disability Insurance (SSDI) beneficiaries return to work has increased the desire for knowledge about the employment activities of people with disabilities before they apply for benefits. This brief summarizes results from a working paper, conducted through the Social Security Administration's Disability Research Consortium, on the experiences of SSDI applicants before they apply for SSDI.

The Non-Elderly Disabled Category 2 (NED2) Housing Choice Voucher Program aimed to increase access to affordable housing for non-elderly people (age 62 and under) with disabilities currently residing in institutions, such as a nursing home. This evaluation examined the program's implementation in a subset of communities that received NED2 vouchers and estimated the impact of the program on the change in the rate of community transitions among the eligible population.

Despite states' rebalance of long-term care (LTC) systems with greater emphasis on home and community-based services (HCBS), many low-income elderly, persons with physical disabilities, and persons with intellectual/developmental disabilities continue to reside in institutions. Through an analysis of Medicaid enrollment and LTC claims data, this report provides information on the characteristics of institutionalized enrollees, their stays, and the interaction of institutional services and HCBS.

To answer questions on what services and barriers people with psychiatric disorders face, the authors conducted two targeted literature reviews: (1) employment programs and outcomes for people with psychiatric disorders; and (2) employment programs for people with other disabilities. The authors also examined literature and policy documents that outlined funding options for employment services for people with psychiatric disorders and other disabilities.

Shifting the balance in publicly-funded long-term care provision away from institutional care toward greater reliance on home and community-based services has been a federal goal for the past three decades -- a goal often referred to as "re-balancing" state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, in terms of institutional and non-institutional services, and also by Medicaid LTC users' age and type of disability.

This report is a comprehensive account of the number of individuals in each state who received Medicaid-funded LTSS in calendar year 2010 based on the Medicaid Analytic eXtract (MAX). The MAX data source is a set of Medicaid administrative data files designed to facilitate Medicaid research. The report identifies the number of people by population group who received institutional and non-institutional services. With some exceptions, State and national data are included.

This report shares findings from an investigation with 400 people with disabilities who have experienced poverty. Their experiences identified six major factors that limit the ability of people with disabilities to gain employment and contribute to a disproportionate number living in poverty.

Access to affordable health insurance is essential to the ability of people with disabilities to seek and maintain employment. As their income fluctuates, people may migrate between Medicaid and Marketplace coverage, and they may face changes in their benefits and out-of-pocket responsibilities as a consequence. This issue brief uses hypothetical examples of working people with disabilities to illustrate the experiences they might have with Medicaid and Marketplace coverage in four states.