Strategic insights from a Delphi study: enhancing employment for multiply marginalized people with disabilities.

Introduction: The employment landscape for multiply marginalized people with disabilities presents significant challenges, exacerbated by intersecting identities such as race/ethnicity, sexual orientation, gender identity, poverty, and geography. Recent studies highlight the compounded employment disparities faced by this group, including discriminatory hiring practices, inadequate accommodations, and uneven gains in employment during the COVID-19 public health emergency.

Methods: Our study employed a three-round Delphi process with 20 diverse experts across 14 states across the United States (U.

Experiences of patients with disabilities and sexual or gender minority status during healthcare interactions.

Aim: The purpose of this study was to examine the lived experiences of lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) people with disabilities when interacting with healthcare professionals related to their gender identity, sexuality, and disability.

Subject And Methods: Historically marginalized groups face many inequities in health care. However, little is known about the intersectional experiences of LGBTQ+ people with disabilities when receiving health care given their likelihood to encounter multiple marginalizations.

Counting everyone: evidence for inclusive measures of disability in federal surveys.

The US Census Bureau has used the American Community Survey six-question set (ACS-6) to identify disabled people since 2008. In late 2023, the Census Bureau proposed changes to these questions that would have reduced disability prevalence estimates by 42%. Because these estimates inform funding and programs that support the health and independence of people with disabilities, many disability researchers and advocates feared this change in data collection would lead to reductions in funding and services.

Long COVID Among People With Preexisting Disabilities.

To document the prevalence of long COVID among a sample of survey respondents with long-term disabilities that existed before 2020 and to compare the prevalence among this group with that among the general population. We conducted a cross-sectional, descriptive study using data from the 2022 National Survey on Health and Disability (n = 2262) and comparative data for the general population from the federal Household Pulse Survey (HPS). The prevalence of long COVID was higher among people with preexisting disabilities than in the general population (40.

Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone Care Because of COVID-19.

This study explored the impact of delayed and foregone care due to COVID-19 on well-being among disabled and gender diverse adults. Using data from the 2021 National Survey on Health and Disability and logistic regression modeling we assessed the impact of delayed or foregone care due to COVID-19 on well-being among disabled people ( = 1638), with comparisons between cisgender ( = 1538) and gender diverse ( = 100) people with disabilities. We report odds ratios (OR) and confidence intervals (CI).

Injury-related emergency department use among people with intellectual and developmental disabilities insured by Medicaid from 2010 to 2016.

Objectives: Data on non-fatal injuries and visits to the emergency department (ED) for injuries are not readily available. The objective of this paper is to describe injury-related ED visits for people with intellectual and developmental disabilities who are covered by the Medicaid insurance programme.

Methods: We aggregated 2010-2016 Medicaid claims data from eight states.

Health Care Disparities Among Autistic LGBTQ+ People.

Background: Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people.

Objectives: The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people.

Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy.

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18-64, uses both question sets and contains other disability questions.

Association of Inadequate Provider Networks with Unmet Need for Health Services and Self-Employment among People with Disabilities.

People with disabilities (PWD) make up over a quarter of the U.S. population and often have complex medical needs.

Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States.

Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities.

Assessing factors associated with social connectedness in adults with mobility disabilities.

Background: People with mobility disabilities are likely to report limitations in community participation and social connectedness for a variety of reasons, including inaccessible physical environments, health issues, transportation barriers, and limited financial resources. Improving social connectedness is a public health issue and research shows its relation to overall health and life expectancy.

Objective: The purpose of this study was to (1) assess social activity, isolation, and loneliness among people with mobility disabilities compared to those with non-mobility disabilities and (2) understand factors associated with social connectedness among people with mobility disabilities.

Comparative Health Status and Characteristics of Respondents of the 2019-2020 National Survey on Health and Disability by Sexual and Gender Minority Status.

We examined the health of sexual and gender minority (SGM) adults with disabilities compared with their non-SGM peers. The National Survey on Health and Disability is an internet-based survey fielded October 2019 through January 2020. We performed bivariate analyses to compare sociodemographic factors, disability type, and health behaviors between SGM and non-SGM adults.

Evaluating MTurk as a recruitment tool for rural people with disabilities.

Background: Recruitment of people with disabilities often occurs through disability organizations, advocacy groups, service providers, and patient registries. Recruitment that relies exclusively on established relationships can produce samples that may miss important information. The MTurk online marketplace offers a convenient option for recruitment.

Health Disparities Among Sexual and Gender Minorities with Autism Spectrum Disorder.

We explored the health and health care experiences of people with autism spectrum disorder (ASD) who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) using data from a national, internet-based survey of adults with disabilities supplemented by focused interviews. LGBTQ+ respondents had significantly higher rates of mental illness, poor physical health days per month, and smoking compared to straight, cisgender respondents with ASD. LGBTQ+ respondents also reported much higher rates of unmet health care need, inadequate insurance provider networks, and rates of being refused services by a medical provider.

Medicaid managed care: issues for enrollees with serious mental illness.

Objectives: To inform state Medicaid programs and managed care organizations, as well as to build their capacity to serve enrollees with complex needs related to serious mental illness (SMI).

Study Design: Quantitative and qualitative analyses of survey results from a sample of Medicaid enrollees with SMI in Kansas in 2016 and 2017 (N = 189).

Methods: Surveys were conducted by telephone or in person at community mental health centers.

Perspectives of adults with disabilities on access to health care after the ACA: Qualitative findings.

Background: Although health insurance gains are documented, little is known about personal experiences of adults with disabilities in accessing health care after coverage expansions of the Affordable Care Act (ACA) in 2014.

Objective/hypothesis: We interviewed 22 adults across the U.S.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness.

Introduction: Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable.

Medicaid Expansion as an Employment Incentive Program for People With Disabilities.

Before the Patient Protection and Affordable Care Act (ACA), many Americans with disabilities were locked into poverty to maintain eligibility for Medicaid coverage. US Medicaid expansion under the ACA allows individuals to qualify for coverage without first going through a disability determination process and declaring an inability to work to obtain Supplemental Security Income. Medicaid expansion coverage also allows for greater income and imposes no asset tests.

Availability of Medicaid home- and community-based services for older Americans and people with physical disabilities.

This article provides an overview of Medicaid home- and community-based services (HCBS) for older adults and individuals with physical disabilities by describing eligibility criteria, availability, and types of services. All 50 state Medicaid programs provide supplementary HCBS in addition to mandatory services. The amount, type, and eligibility for HCBS varied widely between states.

Underrepresentation of adolescents with respiratory, mental health, and developmental disabilities using American Community Survey (ACS) questions.

Background: Disability prevalence estimates are used to identify populations, establish priorities and allocate funding for a broad range of federal, state, and local initiatives. Increasingly, these estimates are based on a set of six questions developed and tested for use in the American Community Survey (ACS). A key assumption about the ACS disability screeners is that they sufficiently capture the entire population of people with disabilities, but some studies indicate that certain disability groups are underrepresented.

Impact of ACA Health Reforms for People With Mental Health Conditions.

Objective: This brief report explores the impact of health reform for people with mental illness.

Methods: The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used.

Effect of Medicaid Expansion on Workforce Participation for People With Disabilities.

Objectives: To use data from the Health Reform Monitoring Survey (HRMS) to examine differences in employment among community-living, working-age adults (aged 18-64 years) with disabilities who live in Medicaid expansion states and nonexpansion states.

Methods: Analyses used difference-in-differences to compare trends in pooled, cross-sectional estimates of employment by state expansion status for 2740 HRMS respondents reporting a disability, adjusting for individual and state characteristics.

Results: After the Affordable Care Act (ACA), respondents in expansion states were significantly more likely to be employed compared with those in nonexpansion states (38.

Medicaid managed care: issues for beneficiaries with disabilities.

Background: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care.