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
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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