Intensive and irregular service use as possible barriers to employment for people with psychiatric and other disabilities

People with psychiatric and other disabilities frequently cite ‘health' as a barrier to employment. This paper examines patterns of health care utilization, one health-related issue that might make commitment to a work schedule difficult. 2007 North Carolina Medicaid claims for individuals with psychiatric and other disabilities (n=185,000) are used to describe intensive and irregular patterns of service use. Graphical analyses and descriptive statistics characterize patterns and their prevalence across disability groups. Rates of intensive and irregular patterns of service use are compared to state data on employment rates by disability type to assess predictive validity. Medicaid recipients with disabilities had 44 total days of services on average, but 10% had over 125 days. People had 21 periods of consecutive days of service, on average. Ten percent of the population had 3 or fewer service periods, while 10% had 44 or more. Most periods of service use were only 1 or 2 days, but 5% of people had periods of nearly 2 weeks or more. Recipients with psychiatric disability have more irregular patterns of care than others and their days of care increase with multiple disabilities. Findings raise questions about equity of access to work for people with psychiatric disability and highlight problems with access and continuity of care. Findings may help to explain why state programs extending Medicaid benefits to working adults with disabilities have enrolled fewer than 3% of potential participants on average.