Delivering Care to Working-Age Beneficiaries with a Disability or Chronic Illness

One of the greatest challenges facing the Medicaid program is to deliver care effectively to working-age beneficiaries who have a disability or chronic illness. There are approximately nine million such individuals in the U.S. In addition to facing substantial limitations in their daily life, they often require complex, expensive, and substantial amounts of care to maintain their health and functioning. Care may be delivered by multiple providers in numerous settings, including clinics, hospitals, offices, and individuals’ homes.

Effective care plans can help people with disabilities or chronic illnesses manage their conditions reasonably well. But Medicaid programs generally have not delivered comprehensive care this group as a whole. Medicaid managed care is seen as one way to improve this situation. In fact, more than 70 percent of states use managed care to serve adult Medicaid beneficiaries who receive Supplemental Security Income. However, even after a decade of experimentation and study, we still know little about how well people with disabilities or chronic illnesses are faring in these plans.

In response to this situation, we reviewed the literature and proposed a research agenda to guide program and policy development. We focused on four key groups: (1) working-age Medicaid beneficiaries who have disabilities or chronic illnesses, (2) state working-age Medicaid programs, (3) managed care organizations that accept Medicaid risk contracts, and (4) providers who deliver care. We also examined two critical research issues: (1) the need for widely accepted and accurate outcome measures specific to this population, and (2) the design and implementation of evaluations that can produce accurate estimates in the face of constantly changing programs and considerable state variation.  

This study was funded by the the Office of the Assistant Secretary for Planning and Evaluation.

Back to Top