Identifying persons with disabilities to improve access and coverage under the affordable care act

The Affordable Care Act (ACA) will change the role of the disability determination process in persons' with disabilities access to Medicaid. Currently, a disability determination is required to establish disability-based eligibility and the disability determination process can be burdensome for some and hinder access. Under the ACA, low-income persons with disabilities will be able to access Medicaid without a disability determination; however, persons who meet the disability standard and access Medicaid through the disability determination process will likely receive more comprehensive coverage and incur lower costs compared to persons who forgo a disability determination. States are facing the challenge of designing eligibility processes that ensure persons with disabilities receive the most favorable coverage without unduly burdening applicants with excess disability determinations. There is a lack of information available to states on how best to do this. In this study, we describe the ACA changes that affect Medicaid eligibility and the need for disability determinations; and, we assess potential approaches for identifying persons with disabilities who would benefit from a disability determination. We leverage the Massachusetts healthcare reform experience and describe the current Massachusetts approach. We conducted a qualitative analysis that included interviews with stakeholders and advocates and captured their knowledge and opinions of potential approaches. Finally, we describe approaches that will effectively identify persons with disabilities who will benefit from a disability determination.