MEDICAID BUY IN FORMEDICAID BUY IN FOR

WORKERS WITH DISABILITIESWORKERS WITH DISABILITIES

(MBIMBIWD)

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What is MBIWD?What is MBIWD?

MBIWD is an Ohio Medicaid MBIWD is an Ohio Medicaid

program that was created to program that was created to

enable Ohioans with disabilities to enable Ohioans with disabilities to

work and still keep their health work and still keep their health

care coveragecare coverage

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Who is Eligible?Who is Eligible?

Answer the following 5 Answer the following 5 questions to determine who questions to determine who should consider applying for should consider applying for

MBIWDMBIWD

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1.1. Are you between the Are you between the ages of 16 and 64?ages of 16 and 64?

If yes, continueIf yes, continue

If no, you are not eligibleIf no, you are not eligible

You can age out of MBIWDYou can age out of MBIWD

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2.2. Do you have a job that Do you have a job that pays you regularly?pays you regularly?

If yes, you may be eligibleIf yes, you may be eligible The amount you work doesn’t The amount you work doesn’t

mattermatter

Having FICA and either state or Having FICA and either state or federal taxes withheld does matterfederal taxes withheld does matter

Self employed? You must be Self employed? You must be reporting to the IRS or have last reporting to the IRS or have last year’s tax returnyear’s tax return

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3. Do you have a disability that3. Do you have a disability thatmeets the Social Security meets the Social Security

standard?standard?

Yes, if: Yes, if:

You are eligible for Medicaid due You are eligible for Medicaid due to disabilityto disability

You receive an SSDI or SSI checkYou receive an SSDI or SSI check

You You cancan earn wages at or above earn wages at or above Substantial Gainful Activity (SGA)Substantial Gainful Activity (SGA)

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4. Is Your Income < 4. Is Your Income < $2,256 a Month $2,256 a Month ($27,072/Year)?($27,072/Year)?

Medicaid counts total income:Medicaid counts total income: benefit checksbenefit checks earned incomeearned income

* * MBIWD also has a MBIWD also has a $20,000 $20,000 annual earnings disregard if needed **

http://codes.ohio.gov/oac/5101:1-41-30

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5. Do You Have more 5. Do You Have more than $10,580 in than $10,580 in

Resources?Resources?If no, you may be eligibleIf no, you may be eligible

Resources that don’t count:Resources that don’t count: the house you live inthe house you live in 1 car1 car term life insuranceterm life insurance PASS plan PASS plan

Resources that do count:Resources that do count: Cash, savings accounts, certificates of Cash, savings accounts, certificates of

deposit, anything you own that could be deposit, anything you own that could be converted to cashconverted to cash

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PremiumsPremiums

Replace spenddown and patient Replace spenddown and patient liabilityliability

Based on family income over 150% of Based on family income over 150% of Federal Poverty Level (10% of the Federal Poverty Level (10% of the difference)difference)

Other health insurance premiums can Other health insurance premiums can be deducted from MBIWD premiumbe deducted from MBIWD premium

The 2009 Federal Poverty Levels

Persons in Family

Poverty Level150% of

FPL250% of FPL

1 $10,830 $16,245 $27,075

2 $14,570 $21,855 $36,425

3 $18,310 $27,465 $45,775

4 $22,790 $34,185 $56,975

5 $22,050 $33,075 $55,125

6 $25,790 $38,685 $64,475

7 $33,270 $49,905 $83,175

8 $37,010 $55,515 $92,525

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Premium Calculations For aPremium Calculations For aSingle AdultSingle Adult

Monthly gross income $2,500Less 150% FPL for single

person-

$1,354=

$1146Multiplied by 10% x .10

= $114.6

Other medical premiums-

$96.4

Total monthly premium=

$18.2

MBIWD Eligibility and Premium Scenarios

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For an adult, (unmarried) disabled person with less than $10,580 in

resources and monthly health insurance payments of $96.40.

MBIWD Eligibility and Premium Scenarios

Income (earned & unearned) Eligible?

Premium Amount

$10,000 Yes $0

$20,000 Yes $0

$30,000 Yes $18

$40,000 Yes $102

$50,000 Yes $185

$60,000 Yes $268

$70,000 Yes $352

$80,000 Yes $435

$90,000 + No n/a1313

MBIWD Eligibility and Premium Scenarios

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For an adult, (unmarried) disabled person with less than $10,580 in resources and no monthly health

insurance payments.

MBIWD Eligibility and Premium Scenarios

Income (earned & unearned)

Eligible?Premium Amount

$10,000 Yes $0

$20,000 Yes $31

$30,000 Yes $115

$40,000 Yes $198

$50,000 Yes $281

$60,000 Yes $365

$70,000 Yes $448

$80,000 Yes $531

$90,000 + No n/a 1515

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Once you are eligible – Once you are eligible – what then?what then?

If you lose your job you have 6 months to If you lose your job you have 6 months to find a new onefind a new one

If you get behind (2 months) in paying If you get behind (2 months) in paying premiums, you will lose eligibilitypremiums, you will lose eligibility

If you are determined medically improved If you are determined medically improved you can remain in the program with you can remain in the program with slightly higher work requirements slightly higher work requirements (40 hours (40 hours a month earning state or federal minimum wages a month earning state or federal minimum wages whichever is lower)whichever is lower)

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A Recap of MBIWD A Recap of MBIWD BenefitsBenefits

MBIWD removes a major MBIWD removes a major disincentive to work and disincentive to work and encourages clients to attain encourages clients to attain competitive employment as competitive employment as a realistic goal in recoverya realistic goal in recovery

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A Recap of MBIWD A Recap of MBIWD BenefitsBenefits

MBIWD does not require a MBIWD does not require a specific number of hours worked specific number of hours worked – only requires regular paid – only requires regular paid employment -except for the employment -except for the medically improved categorymedically improved category

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A Recap of MBIWD A Recap of MBIWD BenefitsBenefits

There is no spenddownThere is no spenddown

There may be a small There may be a small monthly premiummonthly premium

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WWhat is the role of hat is the role of Benefits Planning?Benefits Planning?

Work Incentives planningWork Incentives planning Impact of earnings on Impact of earnings on

benefitsbenefits Assistance completing proper Assistance completing proper

formsforms

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WWhat is the role of hat is the role of Benefits Planning?Benefits Planning?

Contact local WIPA project for Contact local WIPA project for servicesservices Legal Aid Society of Greater Legal Aid Society of Greater

Cincinnati – (800) 582-2682Cincinnati – (800) 582-2682 COVA – (877) 521-2682COVA – (877) 521-2682 Ohio Legal Rights Service – Ohio Legal Rights Service –

(800) 282-9181(800) 282-9181

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CMH System SpendsCMH System Spends$6 Million/month on $6 Million/month on

Spenddown!Spenddown!

~ 27,000 individuals on spenddown~ 27,000 individuals on spenddown average monthly spenddown = $240average monthly spenddown = $240

Client’s spenddown is met through:Client’s spenddown is met through: incurred costs of receiving mental incurred costs of receiving mental

health serviceshealth services paid by a Board or provider pursuant paid by a Board or provider pursuant

to Ohio administrative codeto Ohio administrative code

Individuals with a Individuals with a

spenddown, who enroll in spenddown, who enroll in

MBIWD, MBIWD,

go off spenddown.go off spenddown.

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Relationship of MBIWD to Relationship of MBIWD to Medicaid Financing and Medicaid Financing and

SpenddownSpenddown Providers can effectively Providers can effectively

encourage seeking competitive encourage seeking competitive employment opportunities and/or employment opportunities and/or develop part time work or paid job develop part time work or paid job exploration opportunities within exploration opportunities within the mental health system (the mental health system (NOTE: NOTE: Providers will need to address Providers will need to address ethical issues of hiring persons ethical issues of hiring persons treated by their agency) treated by their agency)

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Relationship of MBIWD to Relationship of MBIWD to Medicaid Financing and Medicaid Financing and

SpenddownSpenddown Administrative burden (see next Administrative burden (see next

slide) of spenddown is reduced slide) of spenddown is reduced and state and local funds and state and local funds previously used for spenddown previously used for spenddown are available to be reinvested are available to be reinvested into service deliveryinto service delivery

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Spenddown=Administrative Spenddown=Administrative BurdenBurden

In Cuyahoga County, In Cuyahoga County, administrative costs associated administrative costs associated with spenddown ranged from with spenddown ranged from

approximately $12,000 a year for approximately $12,000 a year for a provider with a relatively small a provider with a relatively small caseload to $60,000 a year for a caseload to $60,000 a year for a provider with a large caseload.provider with a large caseload.

Spenddown Examples

Not Enrolled in MBIWD Hours/MO 70 Hourly Rate $7.00 HI Premium $96.40 SSDI/MO $1,200 Spenddown =

$707.10

Enrolled in MBIWD Hours/MO 70 Hourly Rate $7.00 HI Premium $96.40 SSDI/MO $1,200 Spenddown = None Premium = $0

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Local area experiences

MHAC’s Assessment of Current and MHAC’s Assessment of Current and Potential DemandPotential Demand

Analysis of number of consumers on Analysis of number of consumers on spenddown, average amount, and spenddown, average amount, and time spent on spenddowntime spent on spenddown

Review of current programs providing Review of current programs providing employment servicesemployment services

Consumer surveyConsumer survey

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Consumer Survey Results

Consumers from a number of mental Consumers from a number of mental health provider agencies in Cuyahoga health provider agencies in Cuyahoga County were asked to complete a County were asked to complete a survey about their opinions about survey about their opinions about employment as it relates to the employment as it relates to the possibility of enrolling in a Medicaid possibility of enrolling in a Medicaid Buy-In program. Consumers were Buy-In program. Consumers were asked to complete six questions; this asked to complete six questions; this report includes the results of those report includes the results of those responses*.responses*.

*number of respondents: 75*number of respondents: 75

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When asked whether they would be interested in working if they would

not lose their Medicaid benefits, the majority of consumers indicated that they would be interested in

working.

If You Would Not Lose Your Medicaid Would You Be Interested

In Working?

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There are fewer clients with a spenddown than there are without.

Do You Have A Spenddown?

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The majority of positions held by consumers in the past are in food service, labor (including factory

work, trades, janitorial work, and others), and administrative/clerical

fields.

Although there were numerous and quite varied responses to this

question!

Previous Types of Jobs Held

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The same three areas are the most-reported desired fields of

work, though in a different order. As above, responses to what sort of work is desired are also varied and high in number.

Desired Types of Jobs

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There were a number of factors reported as factors impeding consumers returning to work. Health problems (mental and physical) and fear of losing

benefits were the most commonly reported.

Factors Preventing Return to Work

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4040

The number of hours that consumers The number of hours that consumers reported wanting to work ranged reported wanting to work ranged from zero to 40 per week, with 30 from zero to 40 per week, with 30

hours/week being the average hours/week being the average number of hours desired.number of hours desired.

Partners in the EffortPartners in the Effort

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• Board • Providers• BVR• CCOE• Department of Employment and Family Services

Next StepsNext Steps

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Trainings for providers on Trainings for providers on MBIWDMBIWD

Encourage use of current Encourage use of current employment services and employment services and pursue opportunities to pursue opportunities to expand expand

Tracking of Buy-in EffortsTracking of Buy-in Efforts

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THE BOTTOM LINETHE BOTTOM LINE

Enrollment in MBIWD is a WIN-Enrollment in MBIWD is a WIN-WIN! WIN!

It eliminates It eliminates bothboth monthly spend monthly spend down costs and disincentives to down costs and disincentives to

workwork

Q & AQ & A

Rebecca Steinhauser, Health/Public Benefits Managing Attorney,Legal Aid of Western Ohio Larry Husted, Income Maintenance SupervisorDefiance County Department of Job and Family Services

Rick Tully, TSIG Grant Program AdministratorOhio Department of Mental Health