View Research by Author - Stephanie J. Kendall

Publications

Although disabled individuals account for a disproportionate share of Medicaid expenditures, little is known about their health care needs and experiences. This paper explores differences in access and use among key disability subgroups—adults with physical disabilities, mental illness, and mental retardation/development disabilities. We find that disabled Medicaid beneficiaries with mental illness and those with greater health and functional limitations face more difficulties in obtaining care. This suggests a need for changes in the system of care under Medicaid, including targeting efforts to improve access to individuals with specific types of disabilities. (Health Care Financing Review 2002 Summer; 23(4): 159-174).

Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of access to care—unmet need for health care services—using a 1998 survey of rural Minnesota Medicaid beneficiaries. We find that rural Medicaid beneficiaries face high levels of unmet need: more than one in three reported unmet need for doctor, specialist, or hospital care. While the study lacks direct measures of the consequences of unmet need, there is evidence that greater emergency room use is associated with unmet need. The findings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs. (Journal of Rural Health 2002 Summer; 18(3): 437-446).

Minnesota hasn't made big changes in its health care system. Minnesota continues to build on the strong system that it has in place by expanding coverage to new populations and by refining its service delivery strategies. Most notably, Minnesota has efforts underway to expand health care coverage for elderly and disabled persons, to reshape its long-term care system to meet the needs of an aging population at lower costs, to control prescription drug costs for elderly and disabled persons, and to implement quality initiatives for health plans participating in public programs. Minnesota's health care efforts have been bolstered by high levels of employer-sponsored health insurance coverage, a substantial tobacco settlement, and a commitment from elected officials and the public to the state's considerable health care system.

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