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  • A recent study published in Health Affairs examined state Medicaid programs and found that many states may not cover all of the preventive care services recommended by the US Preventive Services Task Force. Under the Affordable Care Act (ACA), Medicaid offered to individuals who are newly eligible as a result of the expansion, plans offered through Medicare and plans offered through private insurance are required to cover certain preventive care services such as screenings and counseling. However, state Medicaid plans are not required to cover these preventive care services for adults who received Medicaid before the expansion (also known as “existing beneficiaries”). The Kaiser Family Foundation states that beneficiaries with disabilities made up 15% of total Medicaid enrollees in FY 2010. Because many enrollees with disabilities are characterized as existing beneficiaries, they may be exempt from the requirement for preventive care coverage.

    This study prompted us to look at NCI data and what they show about preventive care received specifically by the population of adults with intellectual and developmental disabilities (ID/DD). We looked at results of the Adult Consumer Survey of 2011-12. The Adult Consumer Survey is a face-to-face interview with adults with ID/DD receiving state-funded services.  The total sample was comprised of 10,147 adults from 29 states and 23 sub-state entities. Information regarding health care is collected in the background information section of the Adult Consumer Survey.

    The vast majority of individuals included in the Adult Consumer Survey sample receive Medicaid benefits.

    In the Adult Consumer Survey, we ask about receipt of the following preventive health care:

    • Whether the individual has a primary care doctor
    • Whether the individual had a complete, annual, routine physical exam within the past year
    • Whether the individual had a dentist visit within the past year
    • Whether the individual had an eye exam/vision screening within the past year
    • Whether the individual had a hearing test within the past five years
    • Whether the individual received a flu vaccination within the past year
    • Whether the individual has ever received a pneumonia vaccination.
    • If the individual is female, whether she had a Pap test within the past 3 years
    • If the individual is female and age 40 or above, whether she had a mammogram in the past two years
    • If the individual is age 50 or above, whether he/she had a colorectal cancer screening in the past year.


     

    The following tables demonstrate the results. These results exclude people with “Don’t Know” responses from the denominator:

    Does Individual Have a Primary Care Doctor?

    Doesn’t have a primary care doctor

    6.8%

    Has a primary care doctor

    93.2%

     

    Has Individual had a Routine Physical Exam in the Past Year?

    No, not in the past year

    9.0%

    Yes, in the past year

    91.0%

     

    Has Individual had a Dentist Visit in the Past Year?

    No, not in the past year

    17.9%

    Yes, in the past year

    82.1%

     

    Has Individual had an Eye Exam/Vision Screening in the Past Year?

    No, not in the past year

    38.9%

    Yes, in the past year

    61.1%

     

    Has Individual had a Hearing Test in the Past 5 Years?

    No, not in the past 5 years

    30.5%

    Yes, in the past 5 years

    69.5%

     

    Has Individual had a Flu Vaccination in the Past Year?

    No, not in the past year

    21.9%

    Yes, in the past year

    78.1%

     

    Has Individual Ever had a Pneumonia Vaccine?

    No, never

    58.1%

    Yes

    41.9%

     

    If the Individual is Female, Has she had a Pap Test Within the Past 3 Years?

    No, not within the past 3 years

    26.4%

    Yes, in the past 3 years

    73.6%

     

    If the Individual is Female and Age 40 or over, Has she had a Mammogram in the Past 2 Years?

    No, not within the past 2 years

    17.5%

    Yes, in the past 2 years

    82.5%

     

    If the Individual is age 50 or Above, has he/she had a Colorectal Cancer Screening in the Past Year.

    No, not within the past  year

    82.9%

    Yes, in the past year

    17.1%


    As is evident from the above tables, not all Adult Consumer Survey respondents are receiving preventive care screenings within the recommended time periods.  When looking at these data, it is important to remember that preventive care utilization rates for people with ID/DD can be influenced by many factors, including race/ethnicity, place of residence, age, etc. Previous blog posts and publications that used NCI data[1] have documented the influence of some of these factors.

    The study in Health Affairs found that states will vary in whether they will cover specific preventive care services to existing Medicaid beneficiaries. Individuals with ID/DD already face many barriers to adequate health care such as lack lack of disability competency and awareness among health care providers, communication barriers, and transportation difficulties. We hope that the possible limitations in Medicaid coverage will not serve as additional barriers to adequate preventive healthcare for individuals with ID/DD.

     



    [1] Bershadsky, J., Taub, S., Bradley, V., Engler, J., Moseley, C., Lakin, K. C., Stancliffe, R. J., Larson, S., Ticha , R. & Bailey, C. (2012). Place of residence and preventive health care for developmental disabilities services recipients in twenty states. Public Health Reports, 127, 475-485.

     

  • The Journal of Preventative Medicine recently published a study that found that nearly 42.0% of American adults with disabilities are obese and 9.0% are extremely obese. Comparatively, the study stated that about 29.0% of adults without disabilities were obese, and 3.9% were extremely obese.  This study’s findings on the obesity rates of adults with disabilities are much higher than previous estimates.  

    These findings on the prevalence of obesity among adults with all disabilities prompted us to look at what NCI data show regarding obesity specifically among the population of adults with intellectual and developmental disabilities.

    For this blog, we examined data on body mass index (BMI) from the Adult Consumer Survey of 2011-12. The Adult Consumer Survey is a face-to-face interview with adults with IDD receiving state-funded services.  The total sample was comprised of 10,147 adults from 29 states and 23 sub-state entities.

    Information used to calculate the BMI of the individual being surveyed is collected in the background information section of the Adult Consumer Survey.

    We use the following table from the CDC to categorize BMI. Please note that this categorization does not include the category: “extremely obese,” as was used in the study cited above:

    BMI

    Weight Status

    Below 18.5

    Underweight

    18.5-24.9

    Normal

    25.0-29.9

    Overweight

    30.0 and Above

    Obese

     
    The table below displays the findings from the Adult Consumer Survey:

     

    Percent of Total

    Underweight

    9.3%

    Normal

    30.3%

    Overweight

    28.1%

    Obese

    32.3%

     

    As can be seen in the above table, 39.6% of the population surveyed was either underweight or normal weight. The majority, however, were overweight or obese (combined 60.4%).  

    The data are very interesting when examined by residence type.

     

    Institution

    Community-based residence

    Independent home/apt

    Parent/relative’s home

    Foster care/host home

    Underweight

    8.6%

    6.6%

    8.0%

    12.3%

    10.3%

    Normal

    46.4%

    31.6%

    23.9%

    29.0%

    34.4%

    Overweight

    27.0%

    31.3%

    26.4%

    24.6%

    30.1%

    Obese

    17.9%

    30.5%

    41.6%

    34.0%

    25.2%

     

    As can be seen in the above table, almost 42.0% of individuals surveyed who lived in an independent home/apt were obese. Those living in a parent or relative’s home had a lower obesity rate (34.0%), followed by those living in community-based residences (30.5%). Individuals living in institutional settings had the lowest obesity rate at 17.9%. It is also worth noting that 12.3% of individuals living with a parent or relative were underweight.

    It is important to remember that there are other factors (such as state, level of disability, type of disability, etc) besides type of living arrangement that may influence rates of obesity. We plan investigate these and other potential factors in a future NCI data brief.