Study: Component in Affordable Care Act can improve quality of life for those with disabilities

LAWRENCE — For years Medicaid recipients were forced to live in poverty or near poverty to maintain their eligibility for the program. University of Kansas researchers have authored a study showing that when asset caps are lifted — a key provision of the Affordable Care Act —  for adults with disabilities, their health outcomes and quality of life improve.

The authors surveyed more than 440 competitively employed adults with disabilities in Kansas. The state has a Medicaid Buy-In program, which allows them to accumulate assets in excess of the standard $2,000 cap. Respondents who had accumulated more than $2,000 in cash assets reported significantly higher quality of life and better physical and mental health.

The study was authored by Jean Hall, director of the Institute for Health and Disability Policy Studies in KU’s Center for Research on Learning; Noelle Kurth, senior research assistant at the Center for Research on Learning; Ellen Averett of the Department of Health Policy and Management at the KU Medical Center; and Allen Jensen of the Center for Health Policy Research at George Washington University. The researchers presented their findings this month at the American Public Health Association Annual Meeting in Boston.

Survey respondents reported that being able to accumulate more cash assets improved their quality of life in numerous ways. It allowed them to keep their jobs when paying for unexpected expenses such as car repairs, and those with seasonal employment were able to rely on savings when they were out of work. Others reported it improved their health outcomes by helping them afford all medications they were prescribed.

Those taking the survey had a range of disabilities including mental illness and physical disabilities, and had not accumulated assets of more than $15,000.

“The effect was not associated with income,” Hall said of the higher quality of life and better health found in respondents. “It was found for individuals who had accumulated assets and was not necessarily those with higher incomes.”

The researchers found that individuals with intellectual disabilities, those under the age of 30 and men were more likely to have accumulated assets of more than $2,000. They hope to examine why those trends appeared in future research.

Not only do the findings suggest that lifting asset caps can lead to better health and quality of life, but it can help reduce dependence on government assistance. The Affordable Care Act considers individuals’ income levels but not assets in determining eligibility for Medicaid expansion coverage.

“We’re hypothesizing, and the data seems to support this, that allowing more asset accumulation is another way that people can become healthier and have more stability,” Kurth said.

Researchers measured respondents’ quality of life using the World Health Organization’s Quality of Life Instrument and SF-12, a standardized, normed scale widely used to measure physical and mental health.

While the findings show that lifting asset caps and Medicaid expansion are helpful to individuals with disabilities, they hope to continue studying how the Affordable Care Act affects their health care.

“The expansion is allowing people with disabilities a real opportunity to accumulate assets in a way that they haven’t been able to in the past and that’s showing a positive outcome on health,” Hall said. “We also want to see what happens to people with disabilities as the marketplace goes live and see if those programs meet their needs.”