Medicaid managed care and individuals with disabilities: status report

Translating policy principles into practice to improve health care access for adults with intellectual disabilities: A research review of the past decade

This article extracts principles from two Surgeon General reports, Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation (2002) and Call to Action to Improve the Health and Wellness of Persons with Disabilities (2005), and combines them with the Objectives from Chapter 6 of Healthy People 2010 to create a policy framework. This framework is used to review literature from the past decade on access to health care and health promotion for persons with intellectual and developmental disabilities (IDD). Review of the literature indicates an emerging evidence base for health promotion programs for persons with IDD. Research in health care and health promotion access requires improvements in surveillance and measurement of quality of life, as well as increased participation of persons with IDD and their families in its implementation. While international guidelines for primary health care have been developed for people with IDD, US guidelines are specialty focused and address specific conditions. Despite its recognized importance, there is surprisingly little information on training programs for health care providers to improve care of persons with IDD. Financing of health care continues to threaten access to comprehensive care for persons with IDD, particularly regarding coordination of care and availability of providers who accept Medicaid patients. Community-based sources of health care have been slow to emerge, and there is clear need for assumption of responsibility for providing care to persons with IDD. Future US policy should include consideration of environmental factors in health care access.

Disability, chronic condition, and iatrogenic illness 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

People with disabilities and chronic conditions are disadvantaged by the US health care system. Some people receive too few of the services they need; others receive too many services from practitioners who do not understand their disability-related needs and thus subject them to iatrogenic illnesses (health problems arising from the health care process). We explore this deprivation and excess and focus on 3 categories of iatrogenic illness that can harm this patient population and impede their ability to live independently. Empirical studies of iatrogenic illness in people with disabilities and chronic illnesses are needed. Physiatrists must play a central role in conducting such studies and in helping these persons access needed care while avoiding potential health problems associated with such care.

Medicaid managed care meets developmental disabilities: proceed with caution

This article examines Medicaid managed care's potential impact on people with developmental disabilities. The authors discuss how the philosophy behind the skills/functional model of service provision for people with developmental disabilities is incongruent with the medical model of managed care. They discuss the policy issues that various states have had to face concerning Medicaid managed care's administration of health benefits for people with developmental disabilities. They extrapolate from the research on managed care to formulate potential models that states might use to administer the health benefits for people with developmental disabilities. Finally, the authors propose policy and research agendas to begin investigating Medicaid managed care's potential impact on people with developmental disabilities.