Medicaid Eligibility Pathways among Adults and Children with Intellectual and Developmental Disabilities

• In Event: Developmental Disability Services and Policy

Abstract

Background:
As the predominant payer for long-term services and supports (LTSS) in the United States, Medicaid plays an outsized role in the health and well-being of people with intellectual and developmental disabilities (I/DD). More than half of adults with I/DD are covered by Medicaid, either alone or alongside Medicare or private insurance. Many people with I/DD automatically qualify for Medicaid by meeting Supplemental Security Income (SSI) eligibility requirements, comprising nearly one-quarter of all adult and two-thirds of all child SSI enrollees. However, Medicaid eligibility determination and coverage of disability services vary substantially by state, and little is known about the proportion of individuals with I/DD enrolled through SSI versus other pathways.
Objective
To assess the primary Medicaid eligibility pathways for people with I/DD at the national level.Methods: We used Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files from 2022 to describe Medicaid eligibility pathways among children (N = 172,643) and adults with I/DD (N = 539,054), stratifying by age, among other demographic characteristics, and use of LTSS.
Findings
Among a sample of individuals with I/DD who use Medicaid waiver services, nearly half of adults with I/DD between the ages of 18 – 64 (45.1%) were eligible for Medicaid on the basis of receiving SSI. An additional 20% of non-elderly adults with I/DD were eligible for Medicaid under the Special Home and Community-Based Services (HCBS) Waiver Group, which allows states to disregard family income and expand financial eligibility up to an income level of 300% of the Federal Benefit Rate for SSI for individuals who require an institutional level of support and receive Medicaid HCBS waiver services. Older adults with I/DD aged 65 and older were most commonly enrolled in Medicaid through the Special HCBS Waiver Group. Most Children with I/DD were eligible for Medicaid through the SSI (23.9%), Medically Needy Aged Blind or Disabled (22.8%), Infants and Children under Age 19 (17.9%), and the Special HCBS Group (13.5%) pathways. Medicaid expansion-related pathways accounted for a relatively small share of enrollees across all age groups.
Conclusions & Policy Implications
While many children with I/DD were able to qualify for Medicaid on the basis of age or medical needs, adults with I/DD most commonly obtained Medicaid coverage through eligibility pathways related to SSI and other disability benefits, including Medicaid HCBS waivers, which have enrollment caps and lengthy waiting lists in many states. In addition to administrative burdens that may hinder access to these benefits, states have substantial discretion in determining and expanding eligibility for both SSI and Medicaid HCBS waivers, further shaping access to full Medicaid coverage for people with I/DD.

Author

• Lauren Andren Peterson, Boston University
  Presenting Author