Randall Owen

Parity of participation in liberal welfare states: human rights, neoliberalism, disability and employment

Governments continue to face challenges in implementing effective strategies to increase social and economic participation of people with disabilities. In a recent OECD high-level policy forum on Sickness, Disability and Work, the main policy message was the need for a culture of inclusion; with a dual focus on short-term active policy interventions and long-term structural reform. This paper examines policies in liberal welfare states that encourage people receiving disability benefits to participate in the labor market. Examples from the United States, the United Kingdom and Australia of active labor market programs aimed at moving people with disabilities from workfare are analyzed in the context of international disability rights and neoliberal discourse. The paper explores the extent to which new approaches to activation policies are facilitating parity of participation and factors that impact the effectiveness of these policies.

Make Measurable What Is Not So: National Monitoring of the Status of Persons with Intellectual Disability.

Abstract Background Statistics are critical in holding governments accountable for the well-being of citizens with disability. International initiatives are underway to improve the quality of disability statistics, but meaningful ID data is exceptionally rare. Method The status of ID data was evaluated in a review of 12 national statistical systems. Recurring data collection by national ministries was identified and the availability of measures of poverty, exclusion, and disadvantage was assessed. Results A total of 131 recurring systems coordinated by 50 different ministries were identified. The majority included general disability but less than 25% of the systems screened ID. Of these, few provided policy-relevant data. Conclusions The scope of ID data was dismal at best, though a significant statistical infrastructure exists for the integration of ID data. Advocacy will be necessary. There is no optimal form of data monitoring, and decisions regarding priorities in purpose, targeted audiences, and the goals for surveillance must be resolved.

Care coordination experiences of people with disabilities enrolled in medicaid managed care

Abstract Purpose: To understand the impact of experience and contacts with care coordinators on Medicaid Managed Care (MMC) enrollees with disabilities. Method: Primary data was collected from a random sample of 6000 out of the 100,000 people with disabilities enrolled in one state’s mandatory MMC program. Surveys were conducted through the mail, telephone, and Internet; 1041 surveys were completed. The sample used for analysis included 442 MMC enrollees who received care coordination. Regression analyses were conducted with the outcomes of number of unmet health care needs and enrollee appraisal of the health services they received. Race, age, gender, and disability variables controlled for demographic differences, and the independent variables included enrollee experience with a care coordinator (coordinator knowledge of enrollee medical history and whether the coordinator took into account enrollee wishes and input) and frequency of contact with a care coordinator. Results: Positive enrollee experiences with care coordinators significantly related to more positive enrollee health service appraisals and fewer unmet health care needs; frequency of contact did not have any significant impacts. People with mental health disabilities and intellectual/developmental disabilities had significantly lower health service appraisals. People with mental health disabilities had significantly more unmet needs. Conclusions: Quality of care coordination, but not frequency of contact alone, is associated with better health outcomes for MMC enrollees. Implications for rehabilitation Care coordination is a core component of managed care and facilitates effective healthcare management for people with complex chronic conditions and disabilities. Better experiences with care coordinators is related to fewer unmet healthcare needs and more positive health care service appraisals for Medicaid managed care enrollees. The continuous development of person-centered care coordination strategies and training programs emphasizing quality relationships between coordinators and consumers should be prioritized.

Perceptions of Health and Healthcare of People With Intellectual and Developmental Disabilities in Medicaid Managed Care.

This study examined perceptions of health and healthcare of people with intellectual and developmental disabilities (IDD) receiving Medicaid Managed Care. Exploratory, semistructured interviews were conducted with 23 participants. Findings indicate that participants generally expressed being in good health and defined good health as (a) absence of pain, disease, and symptoms; (b) adherence to or not requiring treatment; (c) physical self-care; (d) mental or spiritual self-care; and (e) ability to perform the activities one wants to do. Participants conceptualized healthcare as (a) ensuring needs are met through access to services, (b) obtaining quality services, (c) navigating the healthcare system successfully, and (d) receiving humanizing healthcare. This study has implications for improving healthcare and communications between people with IDD and healthcare providers.

Equality through Difference: Policy Values, Human Rights, and Social Justice in the Employment Participation of People with Disabilities

Since the postwar period, conceptions of disability have shifted from a status involving isolation and segregation to one that recognizes equal rights and participation. An integral factor in participation, the right to work, is recognized as a fundamental human right by the United Nations Convention on the Rights of Persons with Disabilities (CRPD 2006). However, people with disabilities continue to be impeded by a disabling society embedded in structural and attitudinal barriers. People with disabilities are denied equal citizenship, which has been exacerbated in recent years as governments continue to face challenges in increasing the social and economic participation of people with disabilities. Particularly in liberal welfare states, contemporary disability employment policy embraces a neoliberal discourse and focuses on the development of workfare programs that encourage labor force participation as the principle means of achieving equality. This has resulted in a limited policy focus that fails to account for all the economic and cultural steps needed to ensure parity of participation of people with disabilities. This chapter uses examples from the United States, United Kingdom, and Australia of active labor market programs aimed at moving people with disabilities from welfare to work.

Does workfare policy in the United States promote the rights of people with disabilities

BACKGROUND: Policymakers in the United States continue to face challenges in implementing effective strategies to encourage people with disabilities receiving disability benefits to participate in the labor market. Ticket to Work is one such strategy that has undergone considerable scrutiny. However, the experience of people with disabilities within welfare reform is an area that has been under-researched. OBJECTIVE: To explore how this contentious issue affects the provision of Vocational Rehabilitation services. Following the implementation of Ticket to Work, does workfare policy allow people with disabilities to pursue full and equal participation in the labor market, and do they have equality of opportunity to achieve employment? METHODS: This research takes a qualitative approach to social policy, using empirical data from focus groups with people with disabilities and interviews with policymakers, employment service providers and employers. RESULTS: Three themes emerged from an analysis of data framed within the United Nations Convention on the Rights of Persons with Disabilities in relation to disability rights and workfare policy: the rights of people with disabilities; the expectations of people with disabilities; and the practices associated with policy reform. The findings suggest that a collaboration of government actors, community organizations and the business community is necessary in order to achieve human rights.

Impact of Medicaid Managed Care on Illinois's Acute Health Services Expenditures for Adults With Intellectual and Developmental Disabilities

States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on costs by tracking Illinoiss Medicaid acute health services expenditures for adults with intellectual and developmental disabilities (IDD) living in the community ( n = 1,216) before and after their transition to MMC. Results of the difference-in-differences (DID) regression analysis using an inverse propensity score weight (IPW) matched comparison group ( n = 1,134) design suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and

Aging With a Physical Disability in Medicaid Managed Care

228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

'No Rights without Responsibilities': Disability Rights and Neoliberal Reform under New Labour

This study examines health services appraisal (HSA) and unmet health-care needs for adults (age 50 and over) with physical disabilities in Medicaid managed care (MMC) versus Medicaid fee for service (FFS). Surveys from 309 individuals in MMC and 349 in FFS 2 years after MMC implementation included demographics, MMC processes, HSA, and unmet health-care needs. Regression analyses with HSA and unmet health-care needs as outcomes included demographics and group status (MMC or FFS) for the entire sample, and demographics and MMC processes (continuity of care, experience with care coordinators and primary care physicians) as independent variables for only MMC enrollees. Group status was not associated with HSA or unmet needs. Among MMC enrollees, better health and more positive MMC processes related to higher HSA and lower unmet needs. It is important to consider the perspectives of people aging with disabilities in MMC to better serve their needs.