Greater Unmet Health Care Needs Among Children with Disabilities in Transition to Adulthood

Background: For children with disabilities, transitioning from childhood to young adulthood is challenging, partly because they may have greater unmet health care needs as a result of this transition. They are less likely than when they were younger to receive support from public programs such as SSI and Medicaid, and their labor force participation rates are low. All of this may add to their chances of being uninsured despite provisions in the Affordable Care Act, such as dependent coverage by parents, that have increased their health insurance coverage rate. Previous research suggests that individuals with disabilities are more likely than their counterparts without disabilities to lose insurance coverage when transitioning to adulthood. This study aims to investigate the transition of individuals with disabilities from childhood to young adulthood, with a focus on their unmet health care needs.  

Methods: A repeated cross-sectional design is used with data appended from the 2011-2015 National Health Interview Survey (NHIS). The study sample includes low-income individuals ages 13-26 with a household income below the 200% poverty line (N=213,650). Their health care needs are measured by two dichotomous variables as responses to questions of whether the respondent (1) delayed health care and/or (2) did not get health care in the last 12 months due to cost. Two independent variables are disability status and transition into adulthood. A binary variable of disability (1=with, 0=without a disability) is assessed by presence of any functional limitation. Transition to adulthood is measured by age: Those ages between 13-17 are assigned a value of “0”, and others are assigned a value of “1”. Logistic regression is run to predict the probability of having unmet health care needs using disability status, transition to adulthood and the interaction term of these two variables, controlling for other socioeconomic and demographic covariates.   

Results: About nine percent of this sample report having  disabilities.  The odds for children with disabilities to report delayed health care is 1.33 times that for those without disabilities. Similarly, young adults with disabilities have a greater likelihood to report having delayed health care than those without disabilities (odds ratio = 3.09). The interaction term of disability status and transition to young adulthood is significant (p<.001), indicating a statistical difference between the two odds ratios. The model yields similar results when using the second outcome measure indicating not getting health care needed, with the two odds ratios being 1.33 and 3.60, respectively.

Implications: Children with disabilities, compared to those without disabilities, have greater unmet health care needs as they transition to young adulthood. This is likely to negatively affect their physical health and other health-related outcomes. It is important for future research to identify risk factors associated with access to health care and to understand how these factors interact with different insurance programs. Such knowledge would be immensely important for developing interventions specific to this population.