Abstract
State Medicaid waivers have fostered innovative health delivery systems for persons with special needs. Yet their overall cost effectiveness remains poorly understood. Changes were recently analyzed in Medicaid health services and costs for persons newly enrolled in the Kansas Physical Disability (PD) Waiver and found that ambulatory services increased, consistent with meeting enrollees' unmet medical needs and their access to enriched services. Home health, transportation, and personal care services also rose. Though not significant, hospital inpatient, outpatient, and long-term care services declined. This movement towards community-based service use in the short term reflects improved self-directed care and possible long-term cost savings.
IN THE ABSENCE OF widespread social and environmental accommodations, people with disabilities have frequently had to improvise to ensure their receipt of needed health and medical services. The medical model that drives most health services addresses the needs of the individual and is largely curative in nature, based upon a person's functional limitation or psychological losses. 1-6 In this scenario, biological deficits can confer social deficits and inequalities to persons with disabilities. 4 This approach has not always fostered independence or optimal health outcomes among this disparate group. 7 As Zola 8 states, "medicalization has led to the expansion of medical influence in areas of care where its implications are questionable at best and are a detriment at worst."(p.371) Though persons with disabilities are often fairly healthy, to receive some services that help maintain this health, individuals must frequently represent themselves as sick, injured, or affected in some other way. 5,9