Publication

Medi-Cal for Non-Elderly People with Disabilities

Fact Sheet No. 13

While Medi-Cal is typically thought of as providing health care coverage to low-income mothers and children, nearly 44% of the program's expenditures go toward services for non-elderly beneficiaries with disabilities. This fact sheet provides a snapshot of non-elderly people with disabilities in the Medi-Cal program, including: demographics; eligibility and enrollment; program expenditures; delivery of health care; and issues for the future.

In July 2002, roughly 13% of the Medi-Cal population (767,314 people) were non-elderly people who qualified for the program due to a disability. An indeterminate number of additional people with disabilities qualify for Medi-Cal due to a factor other than their disability, such as being part of a low-income family.

The disabled population includes people with a wide variety of conditions. Physical disabilities may entail loss of limb, paralysis, congenital conditions, organ dysfunction, blindness, or deafness. Developmental disabilities are severe, long-term impairments (such as mental retardation, cerebral palsy, or autism) that begin at an early age and are expected to last indefinitely. Mental disabilities include schizophrenia and bi-polar disorder. HIV/AIDS, cancer, and multiple sclerosis are examples of long-term or episodic conditions.

Medi-Cal faces major challenges and opportunities in addressing the health needs of people with disabilities, including:

• Under the U.S. Supreme Court's Olmstead decision, states must develop comprehensive plans to avoid unnecessary institutionalization and enable people with disabilities to live in their communities. Community-based services are potentially less costly, but the ruling could increase the overall demand for publicly funded services.
• The federal Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) provides new state Medicaid options for workers with disabilities and provides infrastructure grants to states to help them support people with disabilities who work. Through TWWIIA, California has implemented the 250% Working Disabled Program; however, it is not well known and current enrollment is only 10% of what was anticipated.

Containing future health care costs will require action that may impact the delivery of care to this vulnerable population. One option under consideration is the expansion of managed care for people with disabilities. This approach will necessitate an examination of the adequacy of capitation rates; a review of provider networks in the current Medi-Cal managed care system; and an assessment of HMO infrastructure capacity to serve and access the health care needs of people with disabilities.

The complete fact sheet is available under Document Downloads.