Research compiled by KFF has identified how many Medicaid members are living with disabilities in each state across the nation. This report also included Medicare-eligible members in its data, regardless of whether or not these individuals are also receiving Medicare. This data provides a wealth of information not only regarding the needs of Medicaid members but also offers critical insight into how enrollees may use health care services.
For starters, KFF researchers determined the nationwide average disability prevalence is 22.4%. The remainder of the data, gathered in 2023, found the following five states had the highest disability prevalence rates among all Medicaid members:
- Maine (30.8%)
- West Virginia (29%)
- North Dakota (27.6%)
- Vermont (27.2%)
- Arkansas (27%)
Rural States and Disability Prevalence
These top states all have one major commonality: they each have a large amount of sparsely populated rural areas. This valuable network intelligence is critical when deciding to enter a new market, and an example of the network contract negotiation guardrails TOG Network Solutions compiles to ensure data-backed market-specific service rates designed to increase profitability.
Unsurprisingly, most of the bottom five states identified as having the lowest disability prevalence rates are more heavily settled. The lowest on this list was California (18.4%), followed by New Jersey at 19.3%, Minnesota at 19.5%, and Maryland at 20.6%. The only outlier in the bottom five states was fifth-ranked Colorado (20.7%), which is known for having several counties with very low population densities.
Traditionally, disabilities are considered medical conditions that majorly affect cognition, ambulation, vision, hearing, self-care skills, and/or someone’s ability to live independently. Insurers looking to use this data to inform provider network decisions should also keep in mind that these figures are only inclusive of non-institutionalized individuals who live within the community. Therefore, ratings do not count individuals who are imprisoned, hospitalized, or reside in skilled nursing or long-term care facilities.
Challenges Health Insurers Face Serving Rural Communities with High Disability Rates
Smaller and more dispersed populations traditionally mean limited risk pools, making it harder to accurately predict health care costs, and can result in higher premiums. Health insurers also face higher administrative costs related to network management, marketing, and customer service when serving areas with low population density.
The limited number of health care providers, particularly specialists, in rural areas makes it both challenging and costly for insurers to build adequate provider networks. This also creates leverage for providers to drive up reimbursement rates, making it critical for health insurers to have accurate price transparency data.
Meeting the Needs of Rural Communities While Maintaining Profitability
Addressing the complexities of serving rural communities with high disability rates requires a strategic and multifaceted approach. To meet the needs of these populations while safeguarding profitability, health insurers can consider the following key strategies:
- Implement robust risk adjustment models that accurately account for the higher health care needs and potential costs associated with a population that has high disability rates. This will also ensure fairer premiums and more predictable financial outcomes.
- Actively participate in any state or federal reinsurance programs designed to protect insurers from high-cost claims, particularly those related to chronic conditions and disabilities.
- Aggressively expand the use of telehealth services to provide convenient and cost-effective access to specialists, therapists, and routine follow-ups for individuals with disabilities who may face transportation barriers in rural areas.
- Shift towards value-based payment models with local providers, rewarding them for quality outcomes and cost efficiency rather than the volume of services. This can incentivize providers to deliver effective care for the disability population.
- Develop tiered networks that offer different levels of access and cost-sharing, ensuring at least a core network of providers who are experienced in managing the health care needs of individuals with disabilities.