Employment-Related Health Insurance and Service Delivery Needs of Persons With Disabilities

The health care reforms underway in the United States will benefit persons with disabilities; however, the reforms may not fully support the employment-related needs of persons with disabilities. Secondary health insurance to wrap around primary coverage may be a viable policy solution to meet the needs. This article identifies and examines the employment-related health insurance, health care, and service delivery needs of employed and potentially employed persons with disabilities. We conducted six focus groups with 54 working-age, insured, employed, and potentially employed persons with disabilities in Massachusetts. Participants reported unmet needs, high out-of-pocket costs, or a burden to manage their health care, disability, and employment. The needs included services currently limited by insurance plans, long-term services and supports, other disability services, care coordination, and cost protections. The data suggest that the combined needs are highest for persons working full-time or near full-time, and the unmet needs are lower for persons with Medicaid secondary coverage. The results suggest that full-time or near full-time workers are an important subgroup for wrap-around coverage; such coverage could potentially alleviate costs and increase work incentives among this subgroup. Additional research is needed to quantify the needs and to assess the design options for a wrap-around program.