Author(s): Carli Friedman, Director of Research for The Council on Quality and Leadership (CQL) at the University of Washington; Laura VanPuymbrouck, Assistant Professor of Occupational Therapy at Rush University

Article Type: Peer-reviewed journal

This peer reviewed article summarizes findings from a quantitative study exploring the association between ableism in the U.S. and Medicaid spending on long term services and supports. It begins with historical context about deinstitutionalization of people with disabilities and the history of Medicaid as both a primary payer for long-term care and an insurer for people with disabilities. Despite research indicating community living has more benefits than institutions, investments in home and community-based services vary state to state; authors hypothesize that an association exists between stereotypical attitudes toward people with disabilities (i.e., as dependent, a drain, not capable) and state decision making. Using CMS expenditure data and survey data from the Disability Attitudes - Implicit Association Test, authors found a negative association between state prejudice scores and state funding of home health and community-based services. While causality cannot be assumed, authors conclude by stressing the importance of understanding how disability prejudice is embedded into our society, and how it may influence Medicaid and other policy decisions. These findings are a call to advocate for increased investment in community services and to promote advocacy for the health and well-being of people with disabilities.

Author(s): Emmalise Earl, Seton Hall University, Judicial Law Clerk in New Jersey Court System

Article Type: Peer-reviewed journal

This article discusses long-standing systemic issues with having accessible health care tools and equipment for people with physical disabilities. Despite the passage of the American Disabilities Act in 1973, which requires hospitals and clinics to have physically accessible equipment for care for all individuals regardless of mobility status, the Act has gone loosely enforced for decades according to the author. Lack of accessible equipment for routine checkups, such as scales and exam tables, results in incomplete examinations, later and more severe diagnoses due to inability to screen those with mobility related disabilities, as well as an exacerbation of current diagnoses due to incomplete or less effective treatment. The author states that “without more aggressive enforcement, these circumstances are not likely to change”. The author uses the Department of Veterans Affairs (VA) hospitals as an exemplar for what is needed to uphold accessibility standards. The VA requires all new medical equipment to be approved as accessible by their Access Board. The author also describes specific program actions that the Center for Medicare and Medicaid Services needs to take in enforcing equitable access to medical equipment. For Medicaid in particular, the author suggests that state Medicaid agencies adopt and enforce standards that facilities and providers must follow in order to participate in the Medicaid program. The authors also suggest leveraging tax incentives to overcome financial barriers to accessibility.

Author(s): Rupa S. Valdez, the Departments of Public Health Sciences and Engineering Systems and Environment, University of Virginia; and Bonnielin Swenor, the Disability Health Research Center, Bloomberg School of Public Health, Johns Hopkins University

Article Type: Peer-reviewed journal perspective

This article discusses the details of systemic ableism and its effects on those with intellectual and/or physical disabilities. The authors maintain that this underlying factor of health inequities is often ignored in health care and research spaces. In addition, more attention is needed on the ways structural ableism interacts with other forms of oppression. The core purpose of this article is to highlight achievable and actionable solutions for alleviating bias and discrimination of those with disabilities. Proposed solutions include establishing measures of structural ableism within research and providing accessibility options within physical environments (e.g.  streets & roadways, buildings, neighborhoods, and cities). The authors also emphasize a need for the adaptation of measures of structural racism plus the addition of new measurement domains. Of particular importance for the authors is measuring both the funding allocated for home and community based services within the Medicaid program as well as measuring the rate of violations of the Olmstead decision, which entitles those with disabilities to community integration and community-based services. Consideration of qualitative methods and community partnership in this work is also crucial for creating actionable and effective solutions to issues of systemic ableism.