The Pathway to SSA Disability Program Entry Among Medicaid Enrollees 2007-2011: The Role of Serious Mental Illness, Multiple Impairments, and Recent Healthcare Utilization

We studied a random sample of Medicaid enrollment and claims data from 2007-2011 to identify low-income adults who moved between non-disabled and disabled eligibility, and between state benefits and SSA disability benefits (SSI/DI). We also examined the role of serious mental illness (SMI), co-occurring chronic medical conditions (CC), and other factors associated with these movements between eligibility type and benefit status. Working age adult Medicaid beneficiaries with SMI, and especially those with SMI and co-occurring CC (SMI&CC), were significantly more likely than those without SMI to convert from non-disabled to disabled Medicaid eligibility, and from non-SSI/DI to SSI/DI status between 2007 and 2011. Other predictors of conversion to disabled or SSI/DI status included being older, male, Black/African American, and living in the Southern region of the U.S. Conversion was less likely among those who were Hispanic, residents of the Midwest, and eligible for Medicaid due to 1115 waivers. While beneficiaries with higher total Medicaid payments were more likely to convert to disabled or SSI/DI status, those who used potentially preventative outpatient and prescription health services were less likely to convert to disabled or SSI/DI status. Compared to all working age adults, higher proportions of women on Temporary Aid to Needy Families (TANF) converted to disabled and SSI/DI status. Among female TANF recipients, those with SMI or SMI&CC were significantly more likely to convert to disabled and SSI/DI status than those without SMI. Almost half of those eligible for Medicaid due to disability were dual Medicaid and Medicare beneficiaries. Dually covered persons were more likely to be older, male, Black/African American, and users of outpatient or prescription services, and less likely to be Hispanic, covered under an 1115 waiver, and have high Medicaid costs. SMI and SMI&CC appear to be pathways to disability and SSI/DI beneficiary status among low-income working age adults receiving Medicaid. People with conditions, including women on TANF and dual Medicaid/Medicare eligibles, might benefit from early intervention efforts.