Michael H. Fox

The objective of this study was to assess the impact of a major disaster on county-level preparedness for persons with mobility disabilities. The authors surveyed 30 randomly selected Federal Emergency Management Agency (FEMA) disaster sites between 1998 and 2003 to determine disability surveillance capacity, the extent to which the disaster experience influenced changes in policies and practices, whether persons with disabilities were involved in the planning process, what factors appeared to drive the planning process, and whether current policies and procedures could be “best practices.” They found that people with disabilities were poorly represented in emergency planning; federal training on the needs of people with disabilities appeared useful, although only 27% of emergency managers reported completing the training; 20% of emergency managers reported having disability guidelines in place; and county-level surveillance systems were ineffective. Sixty-six percent of counties had no intention of modifying their guidelines to accommodate the needs of persons with mobility impairments, citing limitations from (a) costs, (b) limited staffing, (c) lack of awareness, (d) other security demands, and (e) broader responsiveness to all “special needs individuals.” The authors suggest that improved training, awareness, and surveillance are needed so communities can better respond to the needs of persons with disabilities before, during, and after local disasters. Possible techniques include developing improved technology assistance, providing environmental modifications to improve access for persons with disabilities during disasters, and ensuring far greater participation of persons with disabilities in all phases of the disaster planning and response process.

State Medicaid waivers have fostered innovative health delivery systems for persons with special needs. Yet their overall cost effectiveness remains poorly understood. Changes were recently analyzed in Medicaid health services and costs for persons newly enrolled in the Kansas Physical Disability (PD) Waiver and found that ambulatory services increased, consistent with meeting enrollees' unmet medical needs and their access to enriched services. Home health, transportation, and personal care services also rose. Though not significant, hospital inpatient, outpatient, and long-term care services declined. This movement towards community-based service use in the short term reflects improved self-directed care and possible long-term cost savings.

American Journal of Public Health (AJPH) from the American Public Health Association (APHA) Changes in Reported Health Status and Unmet Need for Children Enrolling in the Kansas Children’s Health Insurance Program, an article from American Journal of Public Health, Vol 93 Issue 4