Purpose: Existing research on the health care access of disabled women is extremely limited – very little is known about their receipt of health care services, particularly low-income women with disabilities. However, adequate health care access is vitally important to disabled women, who are at risk of developing secondary conditions if their health care needs are not met. The present study compared the health care access of disabled and nondisabled women Medicaid beneficiaries. Medicaid is the most prevalent form of insurance for disabled women who have health insurance. To devise appropriate policies, there is a fundamental need to understand the health care access of low-income disabled women who are reliant on public health insurance.

Methods: Data were analyzed from the 1997 and 1999 waves of the National Survey of America's Families (NSAF). The NSAF is a nationally representative household survey that oversampled low-income families. Multivariate logistic regression models of health care access were estimated for 2,371 disabled and 3,523 nondisabled working-age women who self-reported their health care. The sample represented 3.1 million disabled and 7.5 million nondisabled women living in U.S. households with total income below 200% of the federal poverty level. Six indicators of health care access measured both potential access and realized care. The models controlled a number of factors associated with health care access and satisfaction, including: respondent's age, years of education, marital status, race, household income, and a measure of utilization of care.

Results: Adjusted for all covariates, no differences were found between disabled and nondisabled women's likelihood of having a usual source of care or receiving breast exams in the last year. Disabled women were significantly more likely to have postponed needed care and necessary medications, and were substantially less likely to be satisfied with the health care they received. Trend level differences were found in the rates of having had a Pap smear test, with disabled women less likely than nondisabled women to have received one in the previous year.

Implications: For disabled women Medicaid recipients, potential health care access (having insurance, having a usual source of care) does not necessarily translate into realized access, or receipt of care when needed. This finding is at odds with previous research on the nondisabled general population, in which potential for care predicts better rates of realized care when needed. Disabled women appear to have different patterns of health care access than nondisabled women, and to fare quite poorly on some measures.

Fruitful policy targets to improve disabled women Medicaid beneficiaries' health care access may include the use of Medicaid reimbursement mechanisms that increase provider payments when client satisfaction and receipt of care objectives are achieved. Advocacy for such policies could be useful from all social workers, whether they work in health care or not.

Social workers in health care settings could play a valuable role by expanding and targeting patient education for disabled women, monitoring patients for timely receipt of preventive and primary care services, and leading assessment efforts designed to improve disabled women's health care.