healthcare for workers with disabilities supporting and encouraging employment april 29, 2009 mig...

Healthcare for Workers with Disabilities

Supporting and Encouraging Employment

APRIL 29, 2009

MIG and DMIE Employment SummitServices and Strategies that Sustain Employment Innovative Research in MIG ProgramsSan Francisco, California

David Mancuso, PhDSenior Research SupervisorWashington State Department of Social and Health ServicesPlanning, Performance and Accountability AdministrationResearch and Data Analysis Division

Medicaid Infrastructure GrantDemonstration to Maintain Independence and Employment

Our focus today

Evaluation of Washington’s Healthcare for Workers with Disabilities Program shows that enrollees are:

• Working more hours

• Earning more money

• Paying health insurance premiums

• Contributing more in taxes

• Relying less on food stamps

Washington’s Healthcare for Workers with Disabilities Program

The state’s version of Medicaid Buy-In, authorized under the Ticket to Work and Work Incentives Improvement Act of 1999:

• Provides health insurance coverage for individuals moving from government support to paid employment

• Provides medical coverage to working age individuals 16-65 meeting disability requirements and with incomes/assets disqualifying them from conventional Medicaid

• Distinct in that enrollees pay a monthly premium (sliding scale) in exchange for full Medicaid coverage

• Monthly net income must be at or below 220 percent of FPL—$1,908 per month, for a single person in 2008

• Eligibility disregards gross earned income, so income threshold is 450 percent FPL for those not on cash assistance—close to $4,000 in gross earned income per month for a single person in 2008

Study DesignKey challenges:

• Different eligibility rules for HWD/MBI systematically separate clients into groups on the basis of earned income

• Potential for selection bias in quasi-experimental designs

Analytical approach:

• Use propensity score based 1:1 matching to select comparison groups

• Leverage rich administrative data for matching:

— Demographics— Earnings history— Eligibility history— Medical risk level— Behavioral health risk factors

Matched Comparison GroupsFour Matched-Pair Study Groups:

• Stratified clients enrolling in HWD/MBI into two groups with strikingly different employment trajectories:

— Clients with no prior Medicaid in year before HWD/MBI entry

— Clients with prior Medicaid in year before HWD/MBI entry

• Separate comparison groups matched from historical and contemporaneous time periods to assess robustness

• Index quarter is first quarter on HWD/MBI for treatment group, and is “randomly” assigned for comparison group

TIMELINE

“Historical” “Contemporaneous”

7/99 12/00 1/02 6/07

Prior to HWD/MBI HWD/MBI group first enrolled 1/2002 to 6/2007

Individuals with Medicaid Coverage in Prior 12 Months

Individual averages following 1:1 match

Descriptive SummaryContemporaneous Match

TOTAL= 2,260Historical Match

TOTAL = 2,410

HWD Participantsn = 1,130

Non-Participantsn = 1,130

HWD Participantsn = 1,205

Non-Participantsn = 1,205

DEMOGRAPHICS

Average age 43 43 43 43

Female 49% 51% 49% 49%

White 87% 86% 87% 88%

HEALTH AND RISK INDICATORS

Average chronic illness risk score (post period) 1.0 1.1 — —

Average Medicaid medical costs (post period, constant 2008 dollars, pmpm) — — $427 $422

Percent with schizophrenia/bipolar affective disorder (post period)

23 25 — —

Percent using Mental Health Division services (post-period)

— — 49 49

Percent with prior indication of need for treatment (alcohol or other drug)

5 5 5 5

AVERAGE NUMBER OF MONTHS OF MEDICAID ELIGIBILITY

Prior Categorically Needy Medicaid 5 5 4 4

Prior Dual Medicaid-Medicare 7 7 8 8

PRIOR EARNINGS AND HOURS

Total earnings prior quarter (constant 2008 dollars) $1,558 $1,601 $1,591 $1,661

Total hours prior quarter 143 145 149 152

Individuals without Medicaid Coverage in Prior 12 Months

Individual averages following 1:1 match

Descriptive SummaryContemporaneous Match

TOTAL = 802Historical Match

TOTAL = 920

HWD Participantsn = 401

Non-Participantsn = 401

HWD Participantsn = 460

Non-Participantsn = 460

DEMOGRAPHICS

Average age 47 48 47 47

Female 52% 53% 49% 49%

White 87% 85% 87% 88%

HEALTH AND RISK INDICATORS

Average chronic illness risk score (post period) 1.0 1.0 — —

Average Medicaid medical costs (post period, constant 2008 dollars, pmpm) — — $736 $791

Percent with schizophrenia/bipolar affective disorder (post period)

13 12 — —

Percent using Mental Health Division services (post-period)

— — 27 28

Percent with prior indication of need for treatment (alcohol or other drug)

3 2 2 2

AVERAGE NUMBER OF MONTHS OF ELIGIBILITY

Prior Medicare 1 1 1 1

PRIOR EARNINGS AND HOURS

Total earnings prior quarter (constant 2008 dollars) $2,357 $2,320 $2,337 $2,418

Total hours prior quarter 183 182 186 191

1 year prior 1 year after

INDEX QUARTER

-5 -4 -3 -2 -1 INDEX QUARTER 1$0

$1,000

$2,000

YEARS YEAR

Quarterly Earnings


Annual Earnings | HWD participants versus comparison group

Earnings in constant 2008 dollars, prior to regression adjustment

5 years prior


Contemporaneous Comparison

$0

$1,000

$2,000

$0

$1,000

$2,000


INDEX QUARTER

-5 -4 -3 -2 -1 INDEX QUARTER 1YEARS YEAR

Quarterly Earnings





Historical Comparison

2 years prior





$0

$1,000

$2,000

$3,000


INDEX QUARTER

5 years prior

Quarterly Earnings Healthcare for Workers

with Disabilities

Contemporaneous Comparison





$0

$1,000

$2,000

$3,000


INDEX QUARTER

Quarterly Earnings Healthcare for Workers

with Disabilities

Historical Comparison

2 years prior


Total Annual Dollars Earned

Point Estimate Standard Error p value

$1,990 208 <.0001

Total Annual Dollars Earned


$5,269 478 <.0001

+39%

Non-Participants

Average earnings in year after enrollment

HWD Participants


Regression adjusted

$5,136

$7, 126

n = 1,130 n = 1,130

+136%

Non-Participants


HWD Participants


Regression adjusted

$3,860

$9, 129

n = 401 n = 401

Individuals with Prior Medicaid Coverage

Individuals without Prior Medicaid Coverage

Earning more moneyEarnings in constant 2008 dollars, CPI adjusted • Contemporaneous cohort

Total Annual Hours Worked


193 17 <.0001

Total Annual Hours Worked


238 17 <.0001

+42%

Non-Participants

Average hoursin year after enrollment

HWD Participants


Regression adjusted

459

652

n = 1,130 n = 1,130

+135%

Non-Participants


HWD Participants


Regression adjusted

306

720

n = 401 n = 401



Working more hoursContemporaneous cohort

Medicaid Coverage (Member Months)


1.7 0.1 <.0001

Medicaid Coverage (Member Months)


0.8 0.1 <.0001

+17%

Non-Participants

Average months of Medicaid coveragein year after enrollment

HWD Participants


Regression adjusted

9.7

11.4

n = 1,130 n = 1,130

+65%

Non-Participants


HWD Participants


Regression adjusted

6.7

11.1

n = 401 n = 401



Having medical coverage longerContemporaneous cohort

Basic Food Participation (Months)


—2.7 0.1 <.0001

Basic Food Participation (Months)


—3.2 0.3 <.0001

— 61%

Non-Participants

Average monthsin year after enrollment

HWD Participants


Regression adjusted

4.4

1.7

n = 1,130 n = 1,130

— 75%



Relying less on Food StampsContemporaneous cohort

Non-Participants


Average monthsin year after

Regression adjusted

4.2

1.0

n = 401 n = 401

HWD Participants

Healthcare for Workers with Disabilities:

Supporting and Encouraging EmploymentFEBRUARY 2009

For full report, visit us at:

http://publications.rda.dshs.wa.gov/1374/

Summing it all up

HWD participants:

Work more hours ● Earn more money

Pay health insurance premiums

Contribute more in taxes ● Rely less on food stamps

http://publications.rda.dshs.wa.gov/1374/

healthcare for workers with disabilities supporting and encouraging employment april 29, 2009 mig...

Documents

hwdmbi hwdmbi group

prior medicaid

hwdmbi entryclients

health insurance coverage

health servicesplanning

hwd participantsn

average medicaid medical

mental health division