Modernizing Medicaid eligibility criteria for children with significant disabilities: moving from a disabling to an enabling paradigm

Children with significant disabilities may qualify for Medicaid benefits, regardless of household income, if their state elects to offer the Tax Equity Fiscal Responsibility Act (TEFRA) option. However, a significant number of children with serious medical problems presently are being denied eligibility for, or terminated from, this Medicaid program. This Article describes the ways in which the existing health insurance system inadequately meets the needs of children with significant disabilities, recounts the history and development of the TEFRA Medicaid coverage option, and analyzes the eligibility criteria used by the various states. It proceeds to consider how disability should be legally defined in the health care context and proposes reforms to modernize the eligibility standards so that these benefits can be more effectively, efficiently, and fairly allocated. To accomplish this goal, the federal statute and regulation that define disability, as well as corresponding state laws, must be reformed so that the law can keep pace with advances in modern medical science, and people with disabilities are not, in effect, penalized for receiving currently accepted preventative care that maintains health but will never cure the underlying disease.     

Suggestibility and children with mild learning disabilities: The use of the cognitive interview

Abstract

The aims of this paper were firstly to identify any differences in the level of suggestibility between 20 7–9-year-old children with mild learning disabilities and 20 children with average academic ability using the Gudjonsson Suggestibility Scale 2 (GSS2) and, secondly, to note the impact of the cognitive interview on the response patterns of children with mild learning disabilities.

On the GSS2, average academic ability children recalled significantly more correct details than children with mild learning disabilities. There was no significant difference between the two groups of children on distortions, fabrications, total confabulations or on any of the four measures of suggestibility.

In the second part of the study, 38 children with mild learning disabilities watched a filmed event and then were interviewed using either a standard or a modified version of the cognitive interview. Following this, all participants were asked specific questions, some of which incorporated misleading information. One week later each participant was re-questioned. This time critical questions were included about the truth of the presuppositions introduced in the initial interview session. It was found that the cognitive interview elicited significantly more correct and incorrect details than a standard interview with no significant difference in fabrications. Use of the cognitive interview did not significantly affect susceptibility to subsequent misleading suggestions.     

Narrating genetic disabilities: social constructs, medical treatment, and public policy

The article compares three memoirs of genetically based disability: Lisa Roney's sweet, invisible body, Georgina Kleege's Sight Unseen, and Alice Wexler's Mapping Fate. The essay explores the tension between the narrow and the broad construction of disability, as demonstrated by the 1999 Supreme Court rulings on the ADA and as experienced by these three memoirists. It concludes that the approach of narrative bioethics, as exemplified by such a study of disability and illness narratives, can offer the medical and public policy community a valuable alternative perspective on genetic disability not as an incapacity, but as a set of social relations and practices.     

EEO issues in the health-care field: a roundup of recent developments.

The rapidly expanding health-care field, like other service areas, has experienced its share of controversy over employment discrimination issues. Recent cases fall into two categories: claims involving traditional EEO questions and claims that reflect the unique nature of the health-care institution. A survey of cases in an array of key areas offers guidance for health-care employers in handling common problems.     

Treating sexual offenders with learning disabilities in the community: a critical review

This study offers a critical review of a treatment group for sexual offenders with learning disabilities. The participants were diverted from criminal proceedings due to their level of cognitive functioning and attended a 7-month treatment program comprising of four main components: sex education, cognitive distortions, offending cycle, and relapse prevention. A number of psychometric assessments were administered immediately before and after intervention. Although no significant differences were found in attitudes toward sexual offending following treatment, the trend was for improvements in sex knowledge and honesty of sexual interest. Improvements in socialization skills (leisure time and interpersonal skills) were significant. No further incidents of sexual offending have been reported during a 12-month follow-up. A number of explanations for the nonsignificant improvement in attitudes are considered and recommendations for future treatment evaluation studies are made. The development of specific questionnaires and treatment programs for sexual offenders with learning disabilities is discussed.     

Achieving justice for children: public defenders in Israel's juvenile courts

In 1999, public defender (PD) representation of defendants appearing before Israel's juvenile courts began to be phased in. This article reports some of the major findings of a study that examined the impacts of the introduction of PDs. Analysis of interviews with 14 PDs yielded four major themes concerning the impact of the "arrival" of PDs, nature of the court, PDs' role, and PDs' interactions with other court actors. Analysis of interviews with eight prosecutors yielded seven themes concerning the need for PDs, PD as state agent, PDs' role, harms of legalization, disruption of the court, compromising the therapeutic value of the court hearing, and changes in court process. More generally, both PDs and prosecutors placed uncritical store in the value of rehabilitation alternatives. Indeed, the welfare model continues to shape their roles. The findings can largely be explained in terms of Eisenstein and Jacob's courtroom workgroup model.     

Title I--improving the academic achievement of the disadvantaged; Individuals with Disabilities Education Act (IDEA)--assistance to states for the education of children with disabilities. Final regulations

The Secretary amends the regulations governing programs administered under Title I of the Elementary and Secondary Education Act of 1965 (ESEA), as amended by the No Child Left Behind Act of 2001 (NCLB) (referred to in these regulations as the Title I program) and the regulations governing programs under Part B of the Individuals with Disabilities Education Act (IDEA) (referred to in these regulations as the IDEA program). These regulations provide States with additional flexibility regarding State, local educational agency (LEA), and school accountability for the achievement of a small group of students with disabilities whose progress is such that, even after receiving appropriate instruction, including special education and related services designed to address the students' individual needs, the students' individualized education program (IEP) teams (IEP Teams) are reasonably certain that the students will not achieve grade-level proficiency within the year covered by the students' IEPs.     

Assistance to states for the education of children with disabilities. Office of Special Education and Rehabilitative Services, Department of Education. Final regulations; preamble amendment

The Department of Education published in the Federal Register on March 12, 1999 (64 FR 12406), the final regulations for Assistance to States for the Education of Children with Disabilities and Early Intervention Program for Infants and Toddlers with Disabilities. The preamble to the final regulations did not include information concerning the biennial performance report. This document supplements the preamble of that document by adding the necessary information.     

Mental disabilities under the ADA: a management rights approach

While numerous sources have focused on employee rights and employer obligations under the Americans with Disabilities Act, this article will emphasize employer rights with respect to mental disabilities under the ADA. Specifically, it addresses the ADA's definition of "mental disability," the right of employers to screen job applicants in spite of the ADA, the conditions under which an employer may require an employee to undergo a "fitness for duty" examination, and the limits of the duty to "reasonably accommodate" an employee with a mental disability.     

An examination of the questioning styles of police officers and caregivers when interviewing children with intellectual disabilities

Purpose. This research provided a detailed analysis of the types of questions and verbal strategies used by police officers and caregivers when interviewing children with intellectual disabilities about events. Method. Twenty eight children aged 9 to 13 years with a mild or moderate intellectual disability participated in a staged event at their school. Each child was then interviewed on separate occasions by the child's primary caregiver and by a police officer who was authorized to conduct investigative interviews with children. Results. While the approach used by the police officers was broadly consistent with best‐practice recommendations (i.e. their interviews contained few leading, coercive or negative strategies), they frequently interrupted the child's account and used relatively few minimal encouragers and other strategies designed to keep the child talking. The caregivers used a high proportion of direct, leading and coercive strategies to elicit information from their children. Even when caregivers used open‐ended questions, their children provided less event‐related information than they did to the police interviewers. Conclusion. The quality of evidence obtained from children with intellectual disabilities is likely to be dependent (albeit in part) on the degree to which police interviewers adhere to best‐practice guidelines, as well as the children's general experience with an open‐ended style of communication.     

Learning disabilities and delinquency: a study of Israeli prison inmates

Research consistently illustrates that several intellectual disabilities--namely, learning disabilities (LD), low intelligence, challenging behavior, and inadequate adaptive behavior, as well as attention deficit hyperactivity disorder (ADHD)--are considered risk factors for antisocial and criminal behavior. Although much attention has been paid to the relationship of LD, ADHD, and criminal behavior, three research topics have been overlooked: the frequency of LD with ADHD among inmates, the relationship between LD and/or ADHD and level of education among prisoners, and the connection between LD and/or ADHD and age of criminal onset. The present study examined the frequency of LD and ADHD in a sample of Israeli-born prisoners, in addition to the frequency of each category by itself, and it investigated the relationship of LD and/or ADHD, school dropout age, and onset of criminal activity.     

Enrolling children in public insurance: SCHIP, Medicaid, and state implementation

The Balanced Budget Act of 1997 established federal grants to the states to create the State Children's Health Insurance Program (SCHIP). This presented the states with a number of implementation choices concerning administrative models for the new programs, as well as choices about eligibility standards, enrollment simplification, crowd-out, and cost sharing requirements. At the same time, the states were also implementing welfare reform. We describe the most important of these implementation choices, and using data from the Current Population Survey, we estimate the impacts of state policy on enrollment in this multiprogram environment. The results indicate that SCHIP programs that are administered as Medicaid expansions are more successful than either separate SCHIP plans or combination programs in enrolling children. States that remove asset tests and implement presumptive eligibility and self-declaration of income have higher enrollment levels. Continuous eligibility and adoption of mail-in applications have no effect on overall enrollment. Waiting periods and premiums reduce enrollment. Stringent welfare reform reduces children's enrollment, despite federal policy that was intended to protect children from the consequences of welfare reform. The negative impacts of a number of these policy reforms substantially reduce enrollment, potentially offsetting the more favorable impacts of other policy choices. We estimate that if all states adopted the policy options that facilitate program use, enrollment for children with family incomes less than 200 percent of the poverty line could be raised from the current rate of 42 percent to 58 percent.