Each year, our team reviews data on health care coverage for consumers with an intellectual and developmental disability (I/DD). Our new analysis, The Intellectual & Developmental Disability Consumer Health Insurance Market: An OPEN MINDS Market Intelligence Report, found that over the past decade (from 2010 to 2019), the proportion of consumers with I/DD insured by employer and commercial insurance plans rose while the proportion in Medicaid declined. Over the same time period, the proportion of insured consumers with I/DD enrolled in managed care plans for their health benefits increased. From 2010 to 2019, the number of individuals with I/DD in managed care increased by eight percentage points. In 2019, approximately 8.7 million, or 54%, of individuals with I/DD received services in managed care. In 2010, only 6.7 million, or 46%, of I/DD beneficiaries were in managed care.
While the increased use of managed care plans for coverage didn’t surprise me, the shift to commercial coverage did. The key trends in health coverage for these consumers noted in our analysis include:
- While Medicare has remained the largest payer for the I/DD population, the second largest payer over the years was commercial. The number of individuals with I/DD enrolled in commercial health plans has increased by 52% from 2010 to 2019.
- Although Medicare has been the largest payer for the I/DD enrollees, the number of managed care enrollees in Medicare has decreased by 13.6% from 2010 to 2019. Commercial managed care I/DD enrollment has remained the same over time and 99% of the commercial I/DD population is in managed care.
- Over time, the number of individuals with I/DD covered by insurance has increased by 17.7% to 13.7 million in 2019 and only 2.4 million were uninsured. As a result, approximately 85% of the I/DD population was insured and only 15% of the I/DD population was uninsured.
But as we look ahead, what issues and changes arise for consumers with I/DD in the current crisis? The pandemic’s required social changes affect consumers with an I/DD in some very specific ways. Many adults with I/DD rely on daily assistance from others to meet basic needs. This means that social distancing might not just be inconvenient or lonely but could affect basic care needs like food or assistance with hygiene. In addition, some individuals with I/DD thrive best in structured environments and communicate in non-traditional forms (see People Who Have Been Overlooked During COVID-19: Adults With Disabilities). The current emergency orders have affected the living environments that make this possible.
Also important, many people with I/DD have underlying medical needs—45% have three or more chronic conditions and 35% have cooccurring mental illness, as noted by Michael J. Hammond, MSW, vice president, product strategy and partnership development at OptumHealth, during the 2019 OPEN MINDS Executive Leadership Retreat (see The Future Of Medicaid Managed Care: Building A Comprehensive Care Solution For The Complex Consumer Population). The specter of discrimination against people with disabilities during the response to acute distress caused by COVID-19 has been raised (see 5 Things To Know About Coronavirus And People With Disabilities and Stemming The Risk Of Disability Bias During The COVID-19 Pandemic).
The Trump administration warned states and health care providers not to discriminate against people with disabilities as coronavirus spreads in the Bulletin: Civil Rights, HIPAA, and the Coronavirus Disease 2019 The bulletin points out that the Americans with Disabilities Act, Section 504 of the Rehabilitation Act and other laws prohibit discrimination in federally-funded health programs remain in effect. “As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities…. Decisions by covered entities concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient based on the best available objective medical evidence.”
In addition, the U.S. Equal Employment Opportunity Commission (EEOC) issued updated guidance related to disability discrimination laws. Information includes what information employers can request when employees call in sick, when an employee’s temperature can be taken, and more. Check out this EEOC guidance with these resources – EEOC Answers Questions About The Pandemic And Antidiscrimination Laws In Recorded Webinar, What You Should Know About COVID-19 And The ADA, The Rehabilitation Act, And Other EEO Laws, and Pandemic Preparedness In The Workplace And The Americans With Disabilities Act. Even with these specific regulations, concerns about discrimination in access to health care during the crisis for consumers with disabilities remain (see Disability Discrimination Complaint Filed Over COVID-19 Treatment Rationing Plan In Washington State and Americans With Disabilities Are Terrified).
Whether the pandemic will change the current trend in health care coverage for the population with I/DD conditions remains to be seen. But we will continue tracking the trends that are shaping this sector for the field. For more information, check out these resources in the OPEN MINDS Industry Library:
- COVID-19 Prevention Recommendations
- ACI Coronavirus Guide For People With I/DD
- The Case For Inclusion
- Using Data To Support The I/DD Population—OPEN MINDS Releases The First Report In A Two-Part Series On The Latest I/DD Market Metrics
- Adults With Intellectual And Developmental Disabilities: A Unique Population
- For Success With The I/DD Population, Employment Matters
- Managing Care For Complex Consumers: The Importance Of Community Inclusion
- Who’s Waiting & Why?
- The Evolving Market For Consumers With Intellectual & Developmental Disabilities: An OPEN MINDS 2020 Market Intelligence Report
- Making Managed Care Work For Complex Consumers
For even more, join us on May 5 for the web briefing Caring For Vulnerable Populations In A Social Distance World: Autism Service Providers Implement Virtual Care Delivery, by OPEN MINDS Senior Associate Deb Adler.