Skip to main content

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

Maternal and Child Health Journal volume 18, pages 1583–1590 (2014)Cite this article

An Erratum to this article was published on 11 June 2009

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  7. Sommers, A. S. (2006). Access to health insurance, barriers to care, and service use among adults with disabilities. Inquiry, 43(4), 393–405.

    PubMed  Google 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.

  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.

    Article  Google Scholar 

  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. 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.

    CAS  Article  Google Scholar 

  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.

    Article  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.

  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.

    Article  PubMed  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

  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.

    PubMed  Google Scholar 

  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.

  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. 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.

    Article  Google 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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by: Grant Number 1 TL1 RR025016-02 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research.

Author information

Authors and Affiliations

  1. Institute for Public Health Genetics, University of Washington, Box 357236, Seattle, WA, 98195-7236, USA

    Grace Wang

  2. Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195-7660, USA

    David Grembowski & Carolyn Watts

Authors
  1. Grace Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Grembowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carolyn Watts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Grace Wang.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wang, G., Grembowski, D. & Watts, C. Risk of Losing Insurance During the Transition into Adulthood Among Insured Youth with Disabilities. Matern Child Health J 18, 1583–1590 (2014). https://doi.org/10.1007/s10995-008-0429-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-008-0429-y

Keywords

  • Disability
  • Youth with special health care needs
  • Insurance
  • Transition
  • Adolescent health