MEDICAID INFRASTRUCTURE GRANTS

BUILDING SUSTAINABLE EMPLOYMENT SYSTEMS AND SUPPORTS FOR

PEOPLE WITH DISABILITIES

SARA SALLEYNATIONAL CONSORTIUM FOR

HEALTH SYSTEMS DEVELOPMENT

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Created by the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA)◦ First awards made in 2000, funded through FY2011

Primary goal—competitive employment for people with disabilities through:◦ Medicaid Buy-In programs to reduce fear of losing

health benefits due to earnings—a Medicaid category with work incentives built in, premiums

◦ Improved Medicaid services and stronger infrastructure to support working people with disabilities

◦ A comprehensive, coordinated approach to removing employment barriers

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Administered by Centers for Medicare and Medicaid Services—CMS

Grants go to state Medicaid agency, or other entity in cooperation with state Medicaid◦ VR agencies, DD agencies, university policy and

research centers, Governor’s Council on Disability Minimum grant award

◦ States with no Medicaid Buy-In: $500,000 to $750,000 per year

◦ State with Medicaid Buy-In: Up to 10% of MBI expenditures

Forty-eight states have had MIG funding since 2000; about 40 have 2008 MIG award.

Annual awards from $500,000 to more than $5 million per year.◦ 6 states received more than $1 million each in

2006, 2 received more than $5 million each. Two types of grants: “Basic Medicaid

Infrastructure” and “Comprehensive Employment Systems”◦ States without a Medicaid Buy-In get a Basic grant

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Develop and enhance Medicaid Buy-In programs and Medicaid services

Support benefits planning services and infrastructure

Engage with businesses as employers Conduct outreach and education Evaluate state disability and workforce systems Collect and track program and outcomes data Bring state, federal and private partners together Carry out statewide strategic planning

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Convener – convene stakeholders to identify systems needs and promote infrastructure development;

Facilitator – facilitate discussions and relationships necessary to make sustainable changes to state’s infrastructure;

Coordinator – coordinate policy development, pilot projects and initiatives to demonstrate best practices; and

Leader – develop and provide leadership on workforce development for people with disabilities.

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Strengthening supported employment programs—ME, AR, WA

Building capacity for benefits planning—OR, IN, ND, MT

Integrating employment into Medicaid services and policy—WI, AZ

“Marketing” employees with disabilities to businesses—CT, WA, MD

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Brings in federal dollars to build state infrastructure to improve employment outcomes

Plays planning and coordinating role to move the employment agenda forward statewide

Supports Medicaid Buy-In development Creates cross-state partnerships to share

strategies, data and best practices Establishes forum for highlighting Florida’s

accomplishments

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Leading the way in Business Leadership Network development◦ Business-to-business network to increase awareness and

understanding about employment opportunities for people with disabilities

Offering promising practices in benefits planning◦ Florida Benefits Information Resources Network and

Employment Coordinators to build benefits planning capacity Setting the example with Employment First

◦ Encouraging employment as the first option for people with disabilities

Sharing expertise in marketing and outreach◦ Collaborating with other state and federal partners to raise

awareness nationally and locally about disability and employment

MIGs helped develop and implement Medicaid Buy-In programs – roughly 98,000 MBI enrollees nationally in 2006, an increase from 30,000 in 2001.

Combined earnings of all MBI program participants nationally increased from $222 million in 2001 to more than $556 million in 2006 (contribution to tax base).

MIGs helped 20 states expand Personal Assistance Services (PAS) coverage in the workplace up to 40 hours a week.

(Source: Mathematica GPRA Report, December 2007)

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MIG outreach and education efforts provide information about Medicaid Buy-In and other work incentives to millions of people with disabilities.

MIGs contribute hundreds of thousands of dollars towards work incentives planning infrastructure and services.

MIGs provide strategic leadership on disability and employment issues within each state and nationally.

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A Medicaid eligibility category for working people with disabilities whose income or assets would otherwise disqualify them from Medicaid coverage◦Individuals “buy into” coverage by paying premiums.◦States have flexibility to set eligibility criteria (income and asset limits), premium structures and other features.

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Allows people with disabilities to work and earn more without fear of losing health coverage and vital services

Creates incentive for people receiving Social Security benefits to return to work, increase earnings

Offers chance for greater financial independence through earnings and savings

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Employment requirement, verification procedures (proving you’re employed)

Income disregards (retirement funds, Independence Accounts)

Treatment of earned versus unearned income (different limits, spousal income, premium calculations)

Grace periods for temporary loss of work Premium structures

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2006 total enrollment in 32 states = 98,264

(Source: CMS presentation, NCHSD 2007 Fall Conference)

About 70% of MBI enrollees had SSDI just before they enrolled, over half had Medicare.

“Primary disabling condition” (diagnosis data)◦ Mental health disabilities for about 32%◦ Intellectual disabilities for almost 12%◦ Musculoskeletal conditions for almost 10%◦ All other diagnoses – 21%◦ Unknown – 25%

Everything varies by state!

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(Source: Mathematica enrollment report, April 2008)

Gender split is roughly even About three-quarters of enrollees are white Age distribution:

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(Source: Mathematica enrollment report, April 2008)

Most states charge premiums for MBI coverage; $22 million collected in 2006◦ 25 states collected premiums, 7 states did not◦ Two-thirds of states charged $50/month or less,

10% charged $100/month or more

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(Source: CMS presentation, NCHSD 2007 Fall Conference)

Average earnings for MBI enrollees were slightly higher in 2006 than 2005, from $7,876 to $8,237 (roughly 4% increase)

Total combined earnings of MBI enrollees (contribution to the tax base) rose from $222 million in 2001 to $556 million in 2006 (enrollment growth + earnings growth)

Improving employment rates? Nationally, too hard to tell

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(Source: Mathematica GPRA Report, December 2007)

Sustainability Build in the ability to sustain what has been identified as important infrastructure that promotes competitive employment.

Leadership Demonstrate that leadership is engaged at all levels and will sustain itself beyond the life of the grant.

Stakeholder engagement Show that wide range of stakeholders are involved in building infrastructure and creating sustainability plans for new infrastructure.

Measurable outcomes Activities must be measurable; include a thorough evaluation component; collect and analyze data to document program success.

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Lend expertise on workforce development and employment related supports for people with disabilities;

Advise and consult with MIG staff on grant activities & objectives;

Serve as “ambassadors” by providing important connections for MIG staff and stakeholders to key decision makers to move strategic priorities forward; and

Represent MIG goals and objectives in other venues to spread the word about how to get involved.

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A technical assistance center for MIGs developed by states for states to promote the development of sustainable workforce and employment supports infrastructure by:

Promoting state-to-state information sharing and disseminating promising practices through teleconferences, policy briefs and individual state consultation

Offering work incentives training and education Facilitating communication and collaboration with federal

partners agencies (CMS, DOL/ODEP, SSA, etc.) Providing forums for national and regional MIG meetings and

workshops Hosting a comprehensive web-based resource exchange at

www.nchsd.org

A project of Health & Disability Advocates, Chicago, Illinois

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