Access to Medical Care for Adults with Intellectual Disabilities

Recent news stories point to the decreased access to medical care because of less availability of primary care practitioners, especially those willing to take on Medicaid and Medicare because of reduced reimbursement rates.

This from an article in the New York Times today:

“In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists.”

“Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut their Medicare fees. In many states, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid.”

Some people might not be aware that most severely intellectually disabled people, such as those with severe autism, usually are dependent on Medicaid for their health care as well as for many other services (such as residential).  Many are also “dual eligible”, using both Medicare and Medicaid.

It is almost impossible right now to find adult primary care for those adults transitioning from their pediatricians to adult health care services.  Many stay with their pediatricians or utilize the Emergency Department for any health care needs that they might have.  Routine health maintenance is not done and there is no primary prevention.

When I asked a hospital group about ordering and performing mammograms on women with intellectual and developmental disabilities they were stunned because they really had not considered this problem.  Once it was pointed out, however, they were very interested in exploring solutions.  And this was a group specifically set up to examine and address access problems for the disabled.

Our adults with severe disabilities due to autism are facing discrimination above and beyond what the merely physically disabled face.  And the tsunami has not yet arrived.

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