Health: Access to Care
People with disabilities tend to be in poorer health and experience a higher prevalence of secondary conditions while also using preventative services at lower rates than people who do not have disabilities.
People with disabilities experience more problems accessing health care than other groups, and these difficulties increase for those with the most significant disabilities and who are in the poorest health.
Problems with accessing health care stem in part from barriers to care including:
Barriers unique to people with disabilities in minority populations as documented in DREDF's brief, Health and Health Care Disparities Among People with Disabilities
Limited medical facility accessibility
Lack of accommodations
Lack of provider education and disability awareness
Disability stereotypes and misconceptions
Lack of insurance or insurance coverage limits
Lack of care coordination
WHAT'S NEW?
State Demonstrations to Integrate Medicare and Medicaid
Update on Affordable Care Act implementation.
Threat of Managed Care for all People with Disabilities and Seniors on Medicaid in California
California's disability community opposes plans by the State Department of Health Care services (DHCS) to seek approval for a Medicaid 1115 waiver from the federal Department of Health and Human Services, Center for Medicare and Medicaid to move seniors and people with disabilities into mandatory managed care within a twelve month period following HHS approval of the request.
The mandatory and precipitous enrollment of people with disabilities into the state’s established managed care infrastructure will put thousands and thousands in our community at grave risk.
Both DHCS and managed care plans are not fully aware of the extent to which current provider networks fail to comply with the physical and programmatic access requirements of federal and state disability rights laws. Neither can present evidence of having significant or long-term successful experiences with medical homes or the degree of care coordination required to maintain maximum health and function for some people with disabilities who have complex medical and chronic conditions.
The State’s Plan
Terms and conditions of the approved waiver, November 2010
Waiver Implementation Plan, June 2010
Waiver Submission letter, June 3, 2010
Waiver proposal, "A Bridge to Reform," June 10, 2010
Required State Legislation
Disability, Senior and Low Income Organizations Opposition Letters
Western Center on Law & Poverty letter, June 24, 2010
Disability Rights California letter, June 24, 2010
Corporation for Supportive Housing letter, July 1, 2010
Health Resources and Services Administration (HRSA) Solicitation of input on defining "Medically Underserved Population"
Follow the links to read more
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DREDF Healthcare Access Analyses
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Selected Readings and Resources
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California Disability Health Coalition
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California Legislation on Durable Medical Equipment
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Performance Standards for California Managed Care Organizations
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The Barrier Free Healthcare Initiative
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For more information about our healthcare work, contact us at info@dredf.org
Healthcare Reform
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The Patient Protection and Affordable Care Act
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The Health Care and Education Reconciliation Act of 2010
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An Overview of Health Care Reform – A Power Point presentation developed by The ARC, UCP, AAIDD, AUCD and others
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Summary of New Health Reform Law and Implementation Timeline by the Henry J. Kaiser Family Foundation
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Get the Facts: Health Reform and Medicare, March 2010 and Health Reform and Medicare: A Timeline of Implementation by the Medicare Rights Center.
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Healthcare Reform Update - May 2010 eNews
DREDF Healthcare Access Analyses
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A Statement of the Problem
Disability Healthcare Access Brief, by Silvia Yee, April, 2007
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Promoting Programmatic Access
What does programmatic access mean in healthcare settings?
DREDF's short summary explanation
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Using the ADA and Section 504 of the 1973 Rehabilitation Act to Increase Architectural and Programmatic Access and Accommodations
DREDF Legal Position Paper on Medicaid Healthcare Accessibility for People with Disabilities, by Silvia Yee
Short visual representation of the theories or legal responsibility for healthcare access presented in the DREDF legal position paper
Selected Readings and Resources
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DREDF led a team that authored The Current State of Health Care for People with Disabilities, released in November, 2009 by the National Council on Disability
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Access to Medical Care for People with Mobility Disabilities US Department of Justice, May 2010
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Structural Impairments that Limit Access to Health Care for Patients with Disabilities, by Kristi L. Kirschner, MD, Mary Lou Breslin, MA, Lisa I. Iezzoni, MD, MSc, in the Journal of the American Medical Association (JAMA), March 14, 2007, Vol. 297, No.10 (subscription required)
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The Future of Disability in America, by the Committee on Disability in America, Marilyn J. Field and Alan Jette, editors, Institute of Medicine of the National Academies, ISBN: 0-309-10795-4, 2007
This insightful report states, "The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities."
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It Takes More than Ramps to Solve the Healthcare Crisis for People with Disabilities, by Judy Panko Reis, Rehabilitation Institute of Chicago, Mary Lou Breslin, DREDF, Lisa Iezzoni, M.D., Harvard Medical School, and Kristi L. Kirschner, M.D., Rehabilitation Institute of Chicago. Published by the Rehabilitation Institute of Chicago. February 2004
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Healthy People 2010, an initiative of the U.S Department of Health and Human Services
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The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities
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The Health and Health Care of People with Intellectual Disabilities
Research conducted by Special Olympics found disturbing evidence that individuals with intellectual disabilities face widespread health problems, while physicians, dentists and other health professionals are not receiving adequate training in order to treat them.
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Access to Medical Care: Adults with Physical Disabilities
A 22 minute video produced by the Oakland-based World Institute on Disability about mobility, vision, hearing and communication impairment in outpatient settings; a training curriculum and initial consultation is included
California Disability Health Coalition
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Ensuring that Disability Issues are a Part of Healthcare Reform in California
Disability groups in the state have formed the Disability Health Coalition to advocate for specific healthcare principles that will affect all people with disabilities
The California Disability Health Coalition
Disability Health Coalition Contact InformationLetter to David Maxwell-Jolly, Director
California Department of Health Care Services
Section 1115 Waiver Renewal Process — Concerns and Principles
March 31, 2010
California Legislation to Remove Benefit Limits on Durable Medical Equipment
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Every year since 2007, DREDF has sponsored California legislation to remove benefit limits imposed by private health plans on durable medical equipment. The first year, our bill was passed by the Senate and Assembly with bi-partisan support, but the Governor failed to sign it. The bill introduced by Assemblymember Wesley Chesbro (D—Arcata) in 2009 died in the Assembly Appropriations Committee, as did numerous other bills, due to the state's budget crisis.
This year—2010—Assemblymember Chesbro again introduced a bill, which would require private group and individual health plans to cover Durable Medical Equipment (DME) and to do so without limiting the annual DME benefit. (Many private health plans in California now limit DME coverage to around $2000 annually.)
DME can change the lives of people with disabilities by fostering independence, self-reliance and community participation, reducing or eliminating preventable pain, and warding off additional disabilities. When such equipment cannot be obtained, people with disabilities can face increased medical problems, a loss of autonomy, and confinement in their homes or even in institutions.
If you live in California and have had problems acquiring needed DME because your private health plan limits your annual benefit or your plan does not offer DME coverage at all, we would like to hear from you.
We've created a brief survey on the Survey Monkey website to collect information about DME coverage. Our experience has been that Survey Monkey has made its survey tool accessible, but if you have any difficulty accessing or using the survey, please contact us at info@dredf.org to let us know.
(See the archive for more information on the history of the fight for DME coverage in California.)
Training Parents and Providers on School-Based Healthcare Services for California Children with Chronic Health Conditions
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DREDF, along with the American Diabetes Association, has developed a Sample 504 Plan and a Sample Health Plan for parents to use as a model when creating individualized plans for their own children
Performance Standards for California Managed Care Organizations
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DREDF urges the California Department of Health Services to adopt performance standards for Medicaid MCO's that were identified by diverse stakeholders and submitted to the Department in November, 2005. These standards would improve access to healthcare services and programs for people with disabilities, if adopted.
Read the California Department of Health Services response to the proposed performance standards.
For more information about our healthcare work contact us at info@dredf.org



