1. Supportive Service Needs of Children with Disabilities Elaine Maag The Urban Institute

2. Questions To what extent do children with disabilities need various supportive health services? Does unmet need vary across type of disability or income level? How does insurance affect unmet need?

3. Presentation outline Definitions of disability Identifying service needs in the NHIS-D Unmet service needs Estimated impact of having insurance on unmet service needs

4. Defining disability in children ages 5 - 17 Definition developed by Hogan, et. al.Definition developed by Hogan, et. al. Based on functional limitation inBased on functional limitation in –Self care –Learning –Communication –Mobility Children with multiple identifiers in any one category are considered to have a more severe disabilityChildren with multiple identifiers in any one category are considered to have a more severe disability

5. Modifying the definition for a better fit with the Disability Follow-back Survey Children with only moderate or severe learning and communication limitations are excluded –Over 20 percent not included in the DFS Final sample consists of 2,617 children with disabilities representing 3.9 million children

6. Type of limitations children have Source: Urban Institute Calculations from 94/95 NHIS-D. Millions

7. Identifying Service Need Grouped into five categories –Family Services (respite care, social worker) –Therapy Services (recreational therapist, physical therapist, occupation therapist) –Communication Services (audiologist, speech therapist, special education speech services) –Daily Living Services (reader or interpreter, independent living services, transportation) –Intensive Medical Services (doctor home visits, personal care attendant, respiratory therapist, visiting nurse)

8. To what extent do children with disabilities need these services? Source Urban Institute Calculations Using the 1994/95 NHIS-D.

9. Distribution of service use and unmet need Source: Urban Institute calculations using the 94/95 NHIS-D Thousands of Children

10. Percent of Children with Disabilities with Unmet Service Needs by Type of Limitation Source: Urban Institute calculations using the 94/95 NHIS-D

11. Percent of children with disabilities who have unmet service needs by income Source: Urban Institute calculations using the 94/95 NHIS-D

12. Percent of Children with Disabilities who have Unmet Service Need by Insurance Status Source: Urban Institute calculations using the 94/95 NHIS-D

13. Estimated Impact of Insurance on Probability of Having an Unmet Need Source: Urban Institute calculations using the 94/95 NHIS-D

14. Conclusions Most supportive service needs of children with disabilities are being met Children with self-care limitations have greater needs for services than other children Policies focused on low-income families with reach a majority of children with disabilities who have unmet service needs

15. Conclusions (cont.) A greater proportion of children with public insurance have unmet needs than other children –However, children with public insurance also use more services than other children Controlling for socio-demographic factors and type of disability, type of insurance does not appear to affect the probability that a child will have an unmet need