Maternal and Child Health Journal

, Volume 18, Issue 7, pp 1583–1590 | Cite as

Risk of Losing Insurance During the Transition into Adulthood Among Insured Youth with Disabilities

Article

Abstract

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.

Keywords

Disability Youth with special health care needs Insurance Transition Adolescent health 

References

  1. 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. 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
  3. 3.
    Dejong, G., Palsbo, S. E., Beatty, P. W., et al. (2002). The organization and financing of health services for persons with disabilities. The Milbank Quarterly, 80(2), 261–301. doi:10.1111/1468-0009.t01-1-00004.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 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
  5. 5.
    Young, N. L., Steele, C., Fehlings, D., et al. (2005). Use of health care among adults with chronic and complex physical disabilities of childhood. Disability and Rehabilitation, 27(23), 1455–1460. doi:10.1080/00222930500218946.CrossRefPubMedGoogle Scholar
  6. 6.
    Hadley, J. (2007). Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition. Journal of the American Medical Association, 297(10), 1073–1084. doi:10.1001/jama.297.10.1073.CrossRefPubMedGoogle Scholar
  7. 7.
    Sommers, A. S. (2006). Access to health insurance, barriers to care, and service use among adults with disabilities. Inquiry, 43(4), 393–405.PubMedGoogle Scholar
  8. 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. 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. 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.
  11. 11.
    Short, P. F., & Graefe, D. R. (2003). Battery-powered health insurance? Stability in coverage of the uninsured. Health Affairs (Project Hope), 22(6), 244–255. doi:10.1377/hlthaff.22.6.244.CrossRefGoogle Scholar
  12. 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
  13. 13.
    Fishman, E. (2001). Aging out of coverage: Young adults with special health needs. Health Affairs (Project Hope), 20(6), 254–266. doi:10.1377/hlthaff.20.6.254.CrossRefGoogle Scholar
  14. 14.
    Callahan, S. T., & Cooper, W. O. (2006). Access to health care for young adults with disabling chronic conditions. Archives of Pediatrics & Adolescent Medicine, 160(2), 178–182. doi:10.1001/archpedi.160.2.178.CrossRefGoogle Scholar
  15. 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.
  16. 16.
    Callahan, S. T., & Cooper, W. O. (2007). Continuity of health insurance coverage among young adults with disabilities. Pediatrics, 119(6), 1175–1180. doi:10.1542/peds.2006-1881.CrossRefPubMedGoogle Scholar
  17. 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. 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. 19.
    The Urban Institute. (2008). The welfare rules database. http://anfdata.urban.org/WRD. Last accessed April 14, 2008.
  20. 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. 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. 22.
    Social Security Administration. (2006). Disability evaluation under social security. http://www.ssa.gov/disability/professionals/bluebook/. Last accessed May 5, 2008.
  23. 23.
    Carbaugh, A. L., Elias, R., & Rowland, D. (2006). Aid to people with disabilities: Medicaid’s growing role. Annual Review of Public Health, 27, 417–442. doi:10.1146/annurev.publhealth.27.021405.102145.CrossRefPubMedGoogle Scholar
  24. 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. 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.
  26. 26.
    Davidoff, A. J., Yemane, A., & Hill, I. (2004). Public insurance eligibility and enrollment for special health care needs children. Health Care Financing Review, 26(1), 119–135.PubMedGoogle Scholar
  27. 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. 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. 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. 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
  31. 31.
    Schur, L. A. (2003). Barriers or opportunities? The causes of contingent and part-time work among people with disabilities. Industrial Relations, 42(4), 589–622. doi:10.1111/1468-232X.00308.Google Scholar
  32. 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. 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. 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. 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.
  36. 36.
    Geenen, S. J., Powers, L. E., & Sells, W. (2003). Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs. The Journal of Adolescent Health, 32(3), 225–233. doi:10.1016/S1054-139X(02)00396-8.CrossRefPubMedGoogle Scholar
  37. 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
  38. 38.
    Anderson, C. J., & Vogel, L. C. (2002). Employment outcomes of adults who sustained spinal cord injuries as children or adolescents. Archives of Physical Medicine and Rehabilitation, 83(6), 791–801. doi:10.1053/apmr.2002.32742.CrossRefPubMedGoogle Scholar
  39. 39.
    Beers, N. S., Kemeny, A., Sherritt, L., et al. (2003). Variations in state-level definitions: Children with special health care needs. Public Health Reports, 118(5), 434–447.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Goel, N. L., & Keefe, R. H. (2003). Medicaid managed care meets developmental disabilities: Proceed with caution. Journal of Health & Social Policy, 16(3), 75–90. doi:10.1300/J045v16n03_06.CrossRefGoogle Scholar
  41. 41.
    McPherson, M., Arango, P., Fox, H., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102, 137–140. doi:10.1542/peds.102.1.137.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Institute for Public Health GeneticsUniversity of WashingtonSeattleUSA
  2. 2.Department of Health ServicesUniversity of WashingtonSeattleUSA

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