Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009
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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 Programs San Francisco, California David Mancuso, PhD Senior Research Supervisor Washington State Department of Social and Health Services Planning, Performance and Accountability Administration Research and Data Analysis Division Medicaid Infrastructure Grant Demonstration to Maintain Independence and Employment
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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 Programs San Francisco, California David Mancuso, PhD Senior Research Supervisor - PowerPoint PPT Presentation
Transcript of Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009
Healthcare for Workers with DisabilitiesSupporting 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 todayEvaluation 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 MonthsIndividual 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
DEMOGRAPHICSAverage age 43 43 43 43
Female 49% 51% 49% 49%White 87% 86% 87% 88%
HEALTH AND RISK INDICATORSAverage 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 ELIGIBILITYPrior Categorically Needy Medicaid 5 5 4 4
Prior Dual Medicaid-Medicare 7 7 8 8PRIOR 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 MonthsIndividual 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
DEMOGRAPHICSAverage age 47 48 47 47
Female 52% 53% 49% 49%White 87% 85% 87% 88%
HEALTH AND RISK INDICATORSAverage 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 ELIGIBILITYPrior 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
Individuals with Medicaid Coverage in Prior 12 MonthsAnnual Earnings | HWD participants
versus comparison groupEarnings in constant 2008 dollars, prior to regression adjustment
5 years prior
Healthcare for Workers with Disabilities
Contemporaneous Comparison
$0
$1,000
$2,000
$0
$1,000
$2,000
1 year prior 1 year after
INDEX QUARTER
-5 -4 -3 -2 -1 INDEX QUARTER 1YEARS YEAR
Quarterly Earnings
Individuals with Medicaid Coverage in Prior 12 MonthsAnnual Earnings | HWD participants
versus comparison groupEarnings 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 1YEARS YEAR
Individuals without Medicaid Coverage in Prior 12 MonthsAnnual Earnings | HWD participants
versus comparison groupEarnings in constant 2008 dollars, prior to regression adjustment
$0
$1,000
$2,000
$3,000
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 1YEARS YEAR
Individuals without Medicaid Coverage in Prior 12 MonthsAnnual Earnings | HWD participants
versus comparison groupEarnings in constant 2008 dollars, prior to regression adjustment
$0
$1,000
$2,000
$3,000
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 1YEARS YEAR
Total Annual Dollars EarnedPoint Estimate Standard Error p value
$1,990 208 <.0001
Total Annual Dollars EarnedPoint Estimate Standard Error p value
$5,269 478 <.0001
+39%
Non-ParticipantsAverage earnings in year after enrollment
HWD ParticipantsAverage earnings in year after enrollmentRegression adjusted
$5,136
$7, 126
n = 1,130 n = 1,130
+136%
Non-ParticipantsAverage earnings in year after enrollment
HWD ParticipantsAverage earnings in year after enrollmentRegression 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 WorkedPoint Estimate Standard Error p value
193 17 <.0001
Total Annual Hours WorkedPoint Estimate Standard Error p value
238 17 <.0001
+42%
Non-ParticipantsAverage hoursin year after enrollment
HWD ParticipantsAverage hoursin year after enrollmentRegression adjusted
459
652
n = 1,130 n = 1,130
+135%
Non-ParticipantsAverage hoursin year after enrollment
HWD ParticipantsAverage hoursin year after enrollmentRegression adjusted
306
720
n = 401 n = 401
Individuals with Prior Medicaid Coverage
Individuals without Prior Medicaid Coverage
Working more hoursContemporaneous cohort
Medicaid Coverage (Member Months)Point Estimate Standard Error p value
1.7 0.1 <.0001
Medicaid Coverage (Member Months)Point Estimate Standard Error p value
0.8 0.1 <.0001
+17%
Non-ParticipantsAverage months of Medicaid coveragein year after enrollment
HWD ParticipantsAverage months of Medicaid coveragein year after enrollmentRegression adjusted
9.7
11.4
n = 1,130 n = 1,130
+65%
Non-ParticipantsAverage months of Medicaid coveragein year after enrollment
HWD ParticipantsAverage months of Medicaid coveragein year after enrollmentRegression adjusted
6.7
11.1
n = 401 n = 401
Individuals with Prior Medicaid Coverage
Individuals without Prior Medicaid Coverage
Having medical coverage longerContemporaneous cohort
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-ParticipantsAverage monthsin year after enrollment
HWD ParticipantsAverage monthsin year after enrollmentRegression 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 StampsContemporaneous cohort
Non-ParticipantsAverage monthsin year after enrollment
Average monthsin year afterRegression 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 upHWD participants:
Work more hours ● Earn more money Pay health insurance premiums
Contribute more in taxes ● Rely less on food stamps
