Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts Medicaid program

• Published in: Disability and health journal 2011-10, Vol.4 (4), p.209-218
• Main Authors: Henry, Alexis D., Sc.D., OTR/L, Long-Bellil, Linda, Ph.D., J.D, Zhang, Jianying, M.D., M.P.H, Himmelstein, Jay, M.D., M.P.H
• Format: Article
• Language: English
• Subjects: Adult; Attitude to Health; Disability; Disabled Persons - statistics & numerical data; Employment; Female; Health care needs; Health Care Surveys; Health Services - statistics & numerical data; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand - statistics & numerical data; Humans; Internal Medicine; Logistic Models; Male; Massachusetts; Medicaid; Middle Aged; Odds Ratio; Rrehabilitative services; United States; Work; Young Adult
• ISSN: 1936-6574; 1876-7583
• DOI: 10.1016/j.dhjo.2011.05.003

Abstract Background The employment rate among adults with disabilities is significantly lower than that among adults without disabilities. Ensuring access to rehabilitative and other health care services may help to address health-related barriers to employment for working-age people with disabilities. This study examined the relationship of unmet need for 6 disability-related health care services to current employment status among working-age adults with disabilities enrolled in the Massachusetts Medicaid (MassHealth Standard) program. Methods Study participants included 436 MassHealth Standard members aged 19 to 64 who responded to the 2005/2006 MassHealth Employment and Disability Survey. Variables included members’ demographic characteristics; Medicaid health plan and Medicare enrollment; members’ self-report of potentially disabling conditions and current health status; access to health care as well as need and unmet need for 6 specific disability-related health care services (medications, mental health services, substance abuse services, medical supplies, durable medical equipment, personal assistance services); and current employment status. Results Fifteen percent of members reported currently working. Logistic regression analysis showed that (controlling for demographics, disability, health status, and other factors) members with greater unmet need were significantly less likely to be working (odds ratio = 0.58; 95% confidence interval = 0.33 to 0.99). Members’ experience of unmet need was significantly greater for physical health services (supplies, durable medical equipment, personal assistance services) than for behavioral health services (mental health and substance abuse services) or medications. Working members generally rated services as important to work. Approximately 10% to 22% of nonworking members thought they would be able to work if needs were met. Conclusions Meeting unmet needs for disability-related health care services may result in modest increases in employment among certain working-age adults with disabilities enrolled in the Massachusetts Medicaid program.