Some adults with disabilities covered by Medicaid have significant out-of-pocket health expenses
Research Activities, April 2011, No. 368
Many adults with disabilities who are not institutionalized have their health care covered by Medicaid. In fact, 17 percent of the Medicaid population consists of adults with disabilities, who also account for nearly half (46 percent) of all Medicaid spending. Despite Medicaid coverage, 10 percent of adults with disabilities not living in institutions have annual out-of-pocket medical expenses of $1,200 or more. This can result in a significant financial burden for these individuals.
The researchers analyzed data from the Medical Expenditure Panel Surveys (MEPS) from 2001 to 2004. These surveys report on health care use, prescriptions, provider visits, and the costs of other services and equipment. The researchers looked at a sample of individuals aged 18 to 64 who were covered by Medicaid and participating in Supplemental Security Income (SSI). This is a cash assistance program for individuals with physical or mental disabilities that limit their ability to work. To qualify, they cannot have more than $2,000 in assets (except for car, home, etc.) or income higher than 75 percent of the Federal poverty line ($6,983 in 2004).
During 2001 to 2004, there were 1.8 million non-institutionalized adults with disabilities receiving benefits from Medicaid. Annual Medicaid expenditures for this group were approximately $11.6 billion. The total annual out-of-pocket expenses amounted to approximately $873 million. Of this amount, prescription drugs accounted for $637 million; ambulatory care accounted for another $151 million. The majority (82 percent) of these Medicaid enrollees reported having out-of-pocket expenses during any given year. Most of these expenses (80 percent) were for prescription drugs, followed by ambulatory care (11 percent). The researchers conclude that policymakers need to consider this vulnerable group of Medicaid enrollees when contemplating any type of benefit reductions in the program. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00032).
See "Why some disabled adults in Medicaid face large out-of-pocket expenses," by Marguerite Burns, Ph.D., Nilay Shah, Ph.D., and Maureen Smith, M.D., in Health Affairs 29(8), pp. 1517-1522, 2010.