In July, we recognize Disability Pride Month, marking the anniversary of the landmark Americans with Disabilities Act (ADA) and celebrating the contributions and diverse identities of people with disabilities. While the ADA prohibits discrimination on the basis of disability and establishes protections and requirements for employers, state, and local governments, and other areas of public life, many people with disabilities still face barriers.

At the Commonwealth Fund, we recently reviewed the barriers disabled people continue to face in the health care sector, what research may be needed to identify the extent of these challenges and possible solutions, and where there may be opportunities for the Fund to support this work. We spoke with other foundations with a disability focus, researchers, organizations representing people with disabilities, and disability policy experts. We also reviewed recent grants and program strategies to see how our work was already touching some of these issues or incorporating a focus on individuals with disabilities. Below are some of the challenges we identified, our approach to addressing research gaps, and lessons learned for other funders exploring work to improve health and health care for people with disabilities.

Challenges and Issues

Staff from the Fund led a landscape review and interviews with experts, being mindful that issues raised were not ignored and were aligned across the Fund, beyond our own immediate scope of work and priorities. We gathered data on sources of health insurance coverage for people with disabilities, affirming that Medicare and Medicaid were the primary sources of coverage for this group, while also showing the distribution across ages and the importance of commercial insurance for part of the population.

The following coverage challenges emerged in our conversations:

  • Services that help people with disabilities remain in their homes are not universally accessible or affordable. Medicaid Home and Community-Based Services (HCBS) have waiting lists and wide variations across states, since state Medicaid programs are not required to cover the benefit. The Medicare home health benefit is not designed as long-term care, and the services included in the benefit are often difficult for people on Medicare to access. Gaps in both programs can lead to high out-of-pocket spending and the inability to get needed care.
  • Individuals covered by both Medicaid and Medicare (dual eligibles) often have difficulty navigating which program is the primary payor on certain benefits, as well as a cumbersome appeals processes, which can result in care delays.

Read the full article about strengthening health care access for disabled people by Akeiisa Coleman, Faith Leonard, Gretchen Jacobson, and Andrea C. Landes at Grantmakers In Health.