Use of preventive health services among female Medicaid beneficiaries with and without physical disability

Objective: Women with disabilities face many barriers to health care. Preventive services, (e.g., pelvic exams, mammograms), can be difficult to obtain. Literature suggests that women with disabilities receive fewer preventive services than other women. However, research has not focused on vulnerable populations. We examined receipt of preventive services among Medicaid beneficiaries with and without physical disability.

Methods: Retrospective analysis of eligibility and claims files of female beneficiaries of Florida Medicaid over past 5 years. Women were 18-65 years with at least one outpatient visit during study period. We excluded women who were 1) not continuously enrolled in Medicaid during study period; 2) dually eligible for Medicaid and Medicare; and 3) eligible for limited benefits only. Using ICD-9 codes for physically disabling conditions and CPT codes for mobility-assistive devices (canes, walkers, wheelchairs), we categorized women into 3 groups: 1) no disability; 2) mobility-limiting condition, NOT using mobility-assistive device; and 3) mobility-limiting condition AND using a device. Outcome services included receipt of physical exam, screening for cervical, breast, and colorectal cancer, and flu vaccination according to national guidelines. We estimated prevalence of disability and examined service use using Chi-square and regression analysis. Analysis controlled for demographics and co-morbid conditions.

Findings: 74,851 women met inclusion criteria. 47% had been diagnosed with one or more mobility-limiting conditions; of those, 3,943 used one or more mobility-assistive devices. More than half of ALL women had obtained a recent physical exam, but only one-third complied with guidelines for cervical and breast cancer screening, and fewer had colorectal cancer screening. Rates of preventive service use were overall higher among women with mobility-limiting conditions than their able-bodied counterparts, but a gap was noted between rates of physical exams and rates of cancer screening. So while 80% of women with a mobility-limiting condition had received a check-up, less than half had been screened for breast and cervical cancer, and only one-fourth had been screened for colorectal cancer. Same trend was observed among women who used mobility-assistive devices.

Conclusions: Close to 1 in 2 women had a mobility-limiting condition. Rates of preventive service use were low overall but higher among women with mobility-limiting conditions than able-bodied women. There were missed opportunities for delivering screening services to women who had contact with the healthcare system. Medicaid addresses the financial barrier to care, but beneficiaries face other obstacles. We make recommendations for facilitating access and capitalizing on outpatient visits to deliver screening services.