care organizations or that set federal program participation conditions should consider a facility’s level of compliance with federal accessibility standards and guidelines in their accreditation and participation decisions. In addition, the Architectural and Transportation Barriers Compliance Board (Access Board) should develop standards for accessible medical equipment to be supported with technical assistance, dissemination, and enforcement by appropriate federal agencies.


Reduce barriers to health insurance for people with disabilities.


Although people with disabilities are slightly more likely than others to have health insurance, especially through public programs, access to insurance is not universal, especially among working-age individuals. To reduce the hardships facing many working-age people who have newly qualified for Social Security Disability Insurance (SSDI), the U.S. Congress should reduce or eliminate the waiting period between the time SSDI benefits start and eligibility for Medicare. The U.S. Congress and federal administrative agencies should also continue to test modifications in SSDI and Supplemental Security Income rules that would encourage people who are able to return to work to do so without losing Medicare or Medicaid coverage.

One persistent problem with government efforts to promote competition among managed care and other health plans and to enroll people with disabilities in such plans is that the methods that Medicare and Medicaid use to pay health plans have overpaid for individuals with few health conditions and underpaid for people with serious health conditions or disabilities. Despite recent improvements in Medicare’s method for the risk adjustment of health plan payments, it remains financially more attractive for health plans to seek low-risk beneficiaries than to provide efficient, high-quality care to people with chronic health conditions and disabilities. The U.S. Congress should continue to support the research needed to improve risk adjustment methods.


Make needed assistive services and technologies more available to people with disabilities.


Research suggests that assistive technologies are playing important and increasingly prevalent roles in the lives of people with disabilities. Research agencies should further investigate strategies that can counter the current weak incentives for developing better assistive technologies and bringing them to market.

The committee recommends that policy makers eliminate or modify the “in-home-use” requirement for Medicare coverage of durable medical equipment and revise coverage criteria to consider the contribution of a



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