Mobility limitations negatively impact work outcomes among Medicaid enrollees with disabilities

Abstract

INTRODUCTION: Fear of losing health insurance is believed to be a significant work barrier for people with disabilities in the US. We examined the relationship of different types of daily activity limitations to work outcomes among adults with a variety of disabling conditions for whom the risk of losing health insurance has been removed by enrolling in a Medicaid buy-in (MBI) program. METHODS: 1093 working-age adults with disabilities in the Massachusetts MBI program responded to the MassHealth Employment and Disability Survey, which provided data on the types of disabling conditions and activity limitations members experienced as well as three work outcomes--work status of members; annual earnings above substantial gainful activity of working members; and plans to work in the future of non-working members. RESULTS: Among different types of activity limitations, mobility limitations were generally associated with poorer work outcomes, regardless of disabling condition. Across members in three disability groups--psychiatric; physical; and co-occurring psychiatric and physical--those reporting mobility limitations were significantly less likely to be working or, if non-working, to be planning work than those reporting no or other types of limitations. There was an exception to this pattern with respect earnings among working members. Overall, work outcomes among members with co-occurring psychiatric and physical disabilities were most consistently negatively impacted by mobility limitations. CONCLUSIONS: Rehabilitation providers aiming to promote entry into the workforce need to be aware of the varied ways in which mobility limitations may create barriers for people with all types of disabilities.