About the report
This study on disability extra costs in India, led by CIP’s Meenakshi Balasubramanian, documents what families in Tamil Nadu actually spend on goods and services, from assistive devices to personal assistance, so persons with disabilities can participate on equal terms. The study, published in June 2024, finds families absorb between 70% and 80% of these costs themselves, while government programs cover a small fraction of what’s actually needed.
A wheelchair. A personal assistant. A round trip to the city for therapy that isn’t available at home. This study on disability extra costs in India, led by Meenakshi Balasubramanian for the Center for Inclusive Policy (CIP), puts real numbers on what families in Tamil Nadu actually spend to get their family members with disabilities the goods and services they need, and how much of that spending the state doesn’t cover.
How Much Are Families Actually Spending?
For many families, disability-related costs run to several times their monthly income. Families of children with high support needs reported costs 3 to 6 times larger than their household income; for adults with high support needs, that figure climbed as high as 2 to 10 times larger. Complex medical conditions like haemophilia and thalassemia carried the highest costs of all, driven largely by ongoing health care.
What Are Families Paying For?
Human assistance, personal care, help with daily tasks, tops the list across nearly every disability type, especially for people with high support needs. Assistive devices come next, followed by health and rehabilitation services. The specific mix shifts by disability type: for children with complex medical conditions, healthcare dominates regardless of level of support needs.
How Much Does the Government Actually Cover?
Not much. Government programs cover somewhere between 0% and 30% of the goods and services families need, with the highest coverage for physical and visual impairments, and essentially nothing for several other groups, including people with psychosocial disabilities, autism, and specific learning disabilities. Overall, families shoulder 70 to 80% of these costs themselves, out of pocket.
Why Do Official Statistics Undercount This?
Tamil Nadu’s own disability data is thin: the 2011 Census puts disability prevalence at just 1.6% of the state’s population, well below both the national average and global estimates, a strong signal that current data collection is missing people. A 2018 national survey found that 61.7% of people with disabilities in Tamil Nadu receive no aid or support at all, and only 35.4% even hold a disability certificate, the document needed to access most government programs in the first place.
Why Isn't the System Built for This?
The report points to a structural cause: disability assessment in Tamil Nadu still follows a medical model, evaluating impairment rather than the actual goods, services, and support a person needs to participate fully. That approach produces a one-size-fits-all set of programs that can’t account for how radically needs differ, not just between disability types, but within them, based on how much support a person requires and how they participate in daily life.
What Does CIP Recommend?
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