Burns Marguerite E, O'Hara Brett J, Huskamp Haiden A, Soumerai Stephen B
Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 133 Brookline Ave., 6th Floor, Boston, MA 02215, USA.
J Health Care Poor Underserved. 2012 Nov;23(4):1630-46. doi: 10.1353/hpu.2012.0197.
States must offer Medicaid coverage to low-income adults with disabilities; however, they have discretion in the design of eligibility criteria and enrollment processes. Using the American Community Survey, we examined the health insurance status of adults enrolled in the Supplemental Security Income (SSI) disability program including (1) the national rate of health insurance coverage; (2) state rates of uninsurance and Medicaid; and (3) the correlates of uninsurance. Uninsurance and Medicaid rates varied across states from 1% to 12% and from 63% to 91%, respectively. Nationally, 5% of the SSI population was uninsured; 77% was enrolled in Medicaid. Limited English proficiency, Black race, lack of U.S. citizenship, and residence in a state that used an enrollment process and/or eligibility criteria distinct from the SSI program were associated with uninsurance. As states streamline Medicaid enrollment processes to meet requirements of the Affordable Care Act, they should consider the needs of this vulnerable population.
各州必须为低收入残疾成年人提供医疗补助保险；然而，它们在资格标准和参保流程的设计上有一定的自主权。利用美国社区调查，我们研究了参加补充保障收入（SSI）残疾项目的成年人的健康保险状况，包括：（1）全国健康保险覆盖率；（2）各州的未参保率和医疗补助保险率；以及（3）未参保的相关因素。未参保率和医疗补助保险率在各州之间分别从1%到12%以及从63%到91%不等。在全国范围内，5%的SSI人口未参保；77%参加了医疗补助保险。英语能力有限、黑人种族、没有美国公民身份以及居住在采用与SSI项目不同的参保流程和/或资格标准的州，都与未参保有关。随着各州简化医疗补助保险参保流程以满足《平价医疗法案》的要求，它们应该考虑这一弱势群体的需求。
