Individuals with disability are a diverse group with varying characteristics. Among individuals dually eligible for Medicare and Medicaid, those with disability experience a higher prevalence of chronic conditions and poorer overall health compared to dually eligible individuals without disability.1 They are also less likely to receive recommended care and health screenings (e.g., for breast cancer, colorectal cancer, or diabetes).2 Services and care must also incorporate and support the individual’s expectations of independence and autonomy, as well as his or her participation in work, school, and community or social activities.
Disability-competent care (DCC) is a participant-centered model that focuses on providing care and supports for maximum function and addressing the barriers to integrated, accessible care for individuals with disability. DCC responds to the participant’s physical and clinical requirements, while also considering emotional, social, intellectual, and spiritual needs. DCC requires that health plans and providers understand the participant’s disability experience, the clinical diagnosis of the disability, and the functional limitations that individuals with disability may experience.
Applying the DCC model requires an understanding and appreciation of three core values:
1) Participant-centered approach recognizes the participants’ preferences, goals, and choices.
2) Respect for the participant’s choice and the dignity of risk,3 which honors and respects the participant’s choices even if they are inconsistent with health care recommendations.
3) Elimination of medical or institutional bias that may impede providers and plans from addressing the individual as a whole.
These three core values are supported by seven functional area pillars that form the foundational structure of the DCC model: 1) understanding DCC and disability; 2) participant engagement; 3) access; 4) primary care; 5) care coordination; 6) long-term services and supports (LTSS); and 7) behavioral health. These pillars are described in more detail below.
Resources for Integrated Care features resources to support providers and health plans in their efforts to apply the DCC model and deliver more integrated, coordinated care to dually eligible individuals with disability.
Understanding Disability-Competent Care (DCC) & Disability
Long-Term Services and Supports (LTSS)
Physical Disability & Autism
1 Latterner, M., Carpenter, R., and Haile, E. (2019). How Does Disability Affect Access to Health Care for Dual Eligible Beneficiaries? Centers for Medicaid & Medicare Services, Office of Minority Health. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Data-Highlight_How-Does-Disability-Affect-Access-to-Health-Care-for-Dual-Eligible-Beneficiaries.pdf.
2 Office of the Assistant Secretary for Planning and Evaluation. (2016). Report to Congress: Social Risk Factors and Performance under Medicare’s Value Based Purchasing Programs. Retrieved from https://aspe.hhs.gov/pdf-report/report-congress-social-risk-factors-and-performance-under-medicares-value-based-purchasing-programs.
3 “Dignity of Risk” refers to the participant’s right to identify the need to be able to make an informed choice to experience life and take advantage of opportunities for learning, developing competencies and independence and, in doing so, take a calculated risk.