Risk of Losing Insurance During the Transition into Adulthood Among Insured Youth with Disabilities
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To compare insured youth (age 15–25 years) with and without disabilities on risk of insurance loss. We conducted a cross-sectional study using data from the Survey of Income and Program Participation (SIPP) 2001. Descriptive statistics characterized insured youth who maintained or who lost insurance for at least 3 months over a 3-year time frame. We conducted logistic regression to calculate the association between disability and insurance loss. Adjustment variables were gender, race, ethnicity, age, work or school status, poverty status, type of insurance at study onset, state generosity, and an interaction between disability and insurance type. This study includes 2,123 insured youth without disabilities, 320 insured youth with non-severe disabilities, and 295 insured youth with severe disabilities. Thirty-six percent of insured youth without disabilities lost insurance compared to 43% of insured youth with non-severe disabilities and 41% of insured youth with severe disabilities (P = .07). Youth with non-severe disabilities on public insurance have an estimated 61% lower odds of losing insurance (OR: 0.39; 95% CI: 0.16, 0.93; P = .03) compared to youth without disabilities on public insurance. Further, youth with severe disabilities on public insurance have an estimated 81% lower odds of losing insurance (OR: 0.19; 95% CI: 0.09, 0.40; P < .001) compared to youth without disabilities. When examining youth with private insurance, we find that youth with non-severe disabilities have 1.63 times higher odds (OR: 1.63; 95% CI: 1.03, 2.57; P = .04) of losing health insurance compared to youth without disabilities. Insurance type interacts with disability severity to affect odds of insurance loss among insured youth.
KeywordsDisability Youth with special health care needs Insurance Transition Adolescent health
- 1.Steinmetz, E. (2006). Americans with disabilities: 2002. Current Population Reports, p70–107, http://www.census.gov/sipp/p70s/p70-107.pdf. Last accessed November 18, 2008.
- 2.Havercamp, S. M., Scandlin, D., & Roth, M. (2004). Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Reports, 119(4), 418–426. doi:10.1016/j.phr.2004.05.006.CrossRefPubMedCentralPubMedGoogle Scholar
- 4.Okumura, M. J., McPheeters, M. L., & Davis, M. M. (2007). State and national estimates of insurance coverage and health care utilization for adolescents with chronic conditions from the National Survey of Children’s Health, 2003. The Journal of Adolescent Health, 41(4), 343–349. doi:10.1016/j.jadohealth.2007.04.008.CrossRefPubMedGoogle Scholar
- 8.Hanson, K. W., Neuman, P., Dutwin, D., et al. (2003). Uncovering the health challenges facing people with disabilities: The role of health insurance. Health Affairs (Project Hope), W3, 552–565.Google Scholar
- 9.Collins, S. R., Schoen, C., Kriss, J. L., et al. (2006). Rite of passage? Why young adults become uninsured and how new policies can help. http://www.commonwealthfund.org/usr_doc/Collins_riteofpassage2006_649_ib.pdf?section=4039. Last accessed May 16, 2008.
- 10.U.S. Department of Health and Human Services. (2005). Overview of the uninsured in the United States: An analysis of the 2005 Current Population Survey. http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm#age. Last accessed May 19, 2008.
- 12.Klein, K., Glied, S., & Ferry, D. (2005). Entrances and exits: Health insurance churning, 1998–2000. Issue Brief (Commonwealth Fund), 855, 1–12.Google Scholar
- 15.Schwartz, K., & Schwartz, T. (2008). Uninsured young adults: A profile and overview of coverage options. http://www.kff.org/uninsured/upload/7785.pdf. Last accessed September 8, 2008.
- 17.Williams, B., & Tolbert, J. (2007). Aging out of EPSDT: Issues for young adults with disabilities. The Kaiser Commission on Medicaid and the Uninsured Issue Paper, http://www.kff.org/medicaid/upload/7491.pdf. Last accessed February 27, 2008.
- 18.U.S. Census Bureau. (2006). Survey of Income and Program Participation (SIPP). http://www.sipp.census.gov/sipp/index.html. Last accessed April 25, 2007.
- 19.The Urban Institute. (2008). The welfare rules database. http://anfdata.urban.org/WRD. Last accessed April 14, 2008.
- 20.Archer, K., & Lemeshow, S. (2006). Goodness-of-fit test for a logistic regression model fitted using survey sample data. The Stata Journal, 6, 97–105.Google Scholar
- 21.Social Security Administration. (2008). Benefits for children with disabilities. SSA Publication No. 05-10026, http://www.ssa.gov/pubs/10026.html. Last accessed May 5, 2008.
- 22.Social Security Administration. (2006). Disability evaluation under social security. http://www.ssa.gov/disability/professionals/bluebook/. Last accessed May 5, 2008.
- 24.Centers for Medicare and Medicaid Services. (2005). Medically needy. http://www.cms.hhs.gov/MedicaidEligibility/06_Medically_Needy.asp. Last accessed September 3, 2008.
- 25.The Henry J Kaiser Family Foundation. (2003). Medicaid medically needy program enrollment, FFY 2003. http://www.statehealthfacts.org/comparemaptable.jsp?ind=209&cat=4. Last accessed September 3, 2008.
- 27.Pilling, D. S. (2002). Early employment careers of people with disabilities in the National Child Development Study. Work (Reading, Mass.), 18(1), 75–87.Google Scholar
- 28.Randolph, D. S. (2004). Predicting the effect of disability on employment status and income. Work (Reading, Mass.), 23(3), 257–266.Google Scholar
- 29.Ireys, H. T., Davis, S. R., & Andrews, K. L. (2007). The interaction of policy and enrollment in the Medicaid Buy-In Program, 2005. http://www.mathematica-mpr.com/publications/pdfs/interaction.pdf. Last accessed March 1, 2008.
- 30.Committee on Disability in America and Board on Health Sciences Policy. (2007). In M. J. Field & A. M. Jette (Eds.), The future of disability in America. Washington, DC: The National Academies Press.Google Scholar
- 32.Kronstadt, J., Mojerie, S., & Schwartz, S. (2007). State efforts to extend dependent coverage for young adults. State Health Policy Monitor, http://www.nashp.org/Files/shpmonitor_dependentcoverage.pdf. Last accessed September 9, 2008.
- 33.Sulewski, J. S., Gilmore, D. S., & Foley, S. M. (2006). Medicaid and employment of people with disabilities: Findings from the National Survey of State Systems and Employment for People with Disabilities. Journal of Disability Policy Studies, 17(3), 158–165. doi:10.1177/10442073060170030401.CrossRefGoogle Scholar
- 34.Mathematica Policy Research Inc. Extending Medicaid to Workers with Disabilities: The Medicaid Buy-In Program. http://www.mathematica-mpr.com/disability/medicaidbuy-in.asp. Last accessed March 1, 2008.
- 35.Centers for Medicaid and Medicare Services. (2008). Ticket to Work—Work Incentives Improvement Act (TWWIIA). http://www.cms.hhs.gov/TWWIIA/. Last accessed March 1, 2008.
- 37.Zwerling, C., Whitten, P. S., Sprince, N. L., et al. (2002). Workforce participation by persons with disabilities: The National Health Interview Survey Disability Supplement, 1994 to 1995. Journal of Occupational and Environmental Medicine, 44(4), 358–364. doi:10.1097/00043764-200204000-00017.CrossRefPubMedGoogle Scholar