/
Healthcare for Workers Healthcare for Workers

Healthcare for Workers - PowerPoint Presentation

mitsue-stanley
mitsue-stanley . @mitsue-stanley
Follow
387 views
Uploaded On 2016-03-08

Healthcare for Workers - PPT Presentation

with Disabilities Supporting and Encouraging Employment APRIL 29 2009 MIG and DMIE Employment Summit Services and Strategies that Sustain Employment Innovative Research in MIG Programs San Francisco California ID: 247633

year prior participants medicaid prior year medicaid participants hwd average coverage earnings individuals quarter months total comparison hours dollars 2008 130 401

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Healthcare for Workers" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Healthcare for Workers

with Disabilities

Supporting and Encouraging Employment

APRIL 29, 2009

MIG and DMIE Employment Summit

Services 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 DivisionMedicaid Infrastructure GrantDemonstration to Maintain Independence and EmploymentSlide2

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 premiumsContributing more in taxesRelying less on food stampsSlide3

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 MedicaidDistinct in that enrollees pay a monthly premium (sliding scale) in exchange for full Medicaid coverageMonthly net income must be at or below 220 percent of FPL—$1,908 per month, for a single person in 2008Eligibility 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 2008Slide4

Study Design

Key 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 designsAnalytical approach:

Use propensity score based 1:1 matching to select comparison groupsLeverage rich administrative data for matching: DemographicsEarnings historyEligibility historyMedical risk levelBehavioral health risk factorsSlide5

Matched Comparison Groups

Four 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 entryClients with

prior Medicaid in year before HWD/MBI entrySeparate comparison groups matched from historical and contemporaneous time periods to assess robustnessIndex quarter is first quarter on HWD/MBI for treatment group, and is “randomly” assigned for comparison groupTIMELINE

Historical

Contemporaneous

7/99

12/00

1/02

6/07

Prior to HWD/MBI

HWD/MBI group first enrolled 1/2002 to 6/2007Slide6

Individuals

with

Medicaid Coverage in Prior 12 Months

Individual averages following 1:1 match

Descriptive Summary

Contemporaneous MatchTOTAL= 2,260Historical MatchTOTAL = 2,410HWD Participants

n = 1,130

Non-Participants

n = 1,130

HWD Participants

n = 1,205

Non-Participants

n = 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

152Slide7

Individuals

without

Medicaid Coverage in Prior 12 Months

Individual averages following 1:1 match

Descriptive Summary

Contemporaneous MatchTOTAL = 802Historical MatchTOTAL = 920HWD

Participants

n = 401

Non-Participants

n = 401

HWD

Participants

n = 460

Non-Participants

n = 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

191Slide8

1 year prior 1 year after

INDEX QUARTER

-5 -4 -3 -2 -1

INDEX QUARTER

1

YEARS

YEAR

Quarterly Earnings

Individuals

with

Medicaid Coverage in Prior 12 Months

Annual Earnings

|

HWD

participants

versus comparison group

Earnings in constant 2008 dollars, prior to regression adjustment

5

years prior

Healthcare for Workers with Disabilities

Contemporaneous ComparisonSlide9

1 year prior 1 year after

INDEX QUARTER

-5 -4 -3 -2 -1

INDEX QUARTER

1

YEARS

YEAR

Quarterly Earnings

Individuals

with

Medicaid Coverage in Prior 12 Months

Annual Earnings

|

HWD

participants

versus comparison group

Earnings in constant 2008 dollars, prior to regression adjustment

Healthcare for Workers with Disabilities

Historical Comparison

2 years prior

-5 -4 -3 -2 -1

INDEX QUARTER

1

YEARS YEARSlide10

Individuals

without

Medicaid Coverage in Prior 12 Months

Annual Earnings

| HWD participants

versus comparison groupEarnings in constant 2008 dollars, prior to regression adjustment

1 year prior 1 year after

INDEX QUARTER

5 years prior

Quarterly Earnings

Healthcare for Workers with Disabilities

Contemporaneous Comparison

-5 -4 -3 -2 -1

INDEX QUARTER

1

YEARS YEARSlide11

Individuals

without

Medicaid Coverage in Prior 12 Months

Annual Earnings

| HWD participants versus comparison groupEarnings in constant 2008 dollars, prior to regression adjustment

1 year prior 1 year after

INDEX QUARTER

Quarterly Earnings

Healthcare for Workers with Disabilities

Historical Comparison

2 years prior

-5 -4 -3 -2 -1

INDEX QUARTER

1

YEARS YEARSlide12

Total Annual Dollars Earned

Point Estimate

Standard Error

p value

$

1,990

208

<.0001

Total Annual Dollars Earned

Point Estimate

Standard Error

p value

$

5,269

478

<.0001

+39

%

Non-Participants

Average earnings

in year after enrollment

HWD Participants

Average earnings

in year after enrollment

Regression adjusted

$5,136

$7, 126

n = 1,130

n = 1,130

+136

%

Non-Participants

Average earnings

in year after enrollment

HWD Participants

Average earnings

in year after enrollment

Regression adjusted

$3,860

$9, 129

n = 401

n = 401

Individuals

with

Prior Medicaid Coverage

Individuals

without

Prior Medicaid Coverage

Earning more money

Earnings in constant 2008 dollars, CPI adjusted

• Contemporaneous cohortSlide13

Total Annual Hours

Worked

Point Estimate

Standard Error

p value

193

17

<.0001

Total Annual

Hours Worked

Point Estimate

Standard Error

p value

238

17

<.0001

+42

%

Non-Participants

Average hours

in year after enrollment

HWD Participants

Average hours

in year after enrollment

Regression adjusted

459

652

n = 1,130

n = 1,130

+135

%

Non-Participants

Average hours

in year after enrollment

HWD Participants

Average hours

in year after enrollment

Regression adjusted

306

720

n = 401

n = 401

Individuals

with

Prior Medicaid Coverage

Individuals

without

Prior Medicaid Coverage

Working more hours

Contemporaneous cohortSlide14

Medicaid Coverage

(Member

Months)

Point Estimate

Standard Error

p value

1.70.1

<.0001

Medicaid Coverage

(Member

Months)

Point Estimate

Standard Error

p value

0.8

0.1

<.0001

+17

%

Non-Participants

Average months of Medicaid coverage

in year after enrollment

HWD Participants

Average months of Medicaid coverage

in year after enrollment

Regression adjusted

9.7

11.4

n = 1,130

n = 1,130

+65

%

Non-Participants

Average months of Medicaid coverage

in year after enrollment

HWD Participants

Average months of Medicaid coverage

in year after enrollment

Regression adjusted

6.7

11.1

n = 401

n = 401

Individuals

with

Prior Medicaid Coverage

Individuals

without

Prior Medicaid Coverage

Having medical coverage longer

Contemporaneous cohortSlide15

Basic Food Participation

(Months)

Point Estimate

Standard Error

p value

—2.7

0.1

<.0001

Basic Food Participation

(Months)

Point Estimate

Standard Error

p value

—3.2

0.3

<.0001

61

%

Non-Participants

Average months

in year after enrollment

HWD Participants

Average months

in year after enrollment

Regression adjusted

4.4

1.7

n = 1,130

n = 1,130

75

%

Individuals

with

Prior Medicaid Coverage

Individuals

without

Prior Medicaid Coverage

Relying less on Food Stamps

Contemporaneous cohort

Non-Participants

Average months

in year after enrollment

Average months

in year after

Regression adjusted

4.2

1.0

n = 401

n = 401

HWD ParticipantsSlide16

Healthcare for Workers with Disabilities:

Supporting and Encouraging Employment

FEBRUARY 2009

For full report, visit us at:

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

Summing it all upHWD participants:Work more hours ● Earn more money Pay health insurance premiums Contribute more in taxes ● Rely less on food stamps