October 2001 Newsletter
Volume 1, Number 2
Behind the Scenes at SRS
SRS staff members have formed an Implementation Team for the Working Healthy
program that has been meeting on a regular basis for several months now. Team
members are working hard on amending contracts with vendors, establishing eligibility
criteria, adjusting all necessary database systems, identifying who will be
eligible for the program and designing conversion techniques, training SRS EES
area office and central office staff on the new program, establishing and drafting
contracts with vendors to provide personal care services, etc. In addition,
they are working with CMS (previously HCFA) to review and approve the amendments
to the state Medicaid plan, a process that will take at least three months.
Despite these efforts, the Working Healthy program staff members regret to
report that because of the complexity of getting this new program up and running,
the January 1, 2002 start up date is not realistic. Another issue adding to
the equation is that Howard Moses has been under the weather for the last couple
of months and is expected to undergo surgery in the near future which will put
him out of commission for several months. Because Howard is the program director
and so critical to this program, work that he would have done to bring the program
up by January 1, 2002 has been put on hold temporarily. Marianne Deagle and
Sharon Johnson will be helping with his work while Howard is gone. Also, a new
program staff person (and maybe two) will be hired in the next month or so.
Although Marianne and Sharon cannot make any promises at this time because so
much has to happen before the program begins, they are hoping to get Working
Healthy up and running sometime between April and July 2002.
Other Activities
Benefits Specialists
The Infrastructure grant will be funding 11 new Benefits Specialist positions.
A Specialist will be on staff at each of the SRS Area offices to work with consumers
who might be eligible for Working Healthy. The Specialists will help consumers
determine how going to work will affect all of their benefits such as Section
8 housing, food stamps, HCBS services, net income, etc. Qualified people with
disabilities will be encouraged to apply for these positions.
Outreach
SRS, Breakthrough Club, Comcare and Connectcare hosted an outreach conference
about the Working Healthy Program on August 23 and 24th at the Wichita Hyatt.
About 200 people attended the first day of the conference, which was designed
to provide information about the program to consumers, especially persons with
HIV or persons with a mental illness diagnosis. The second day’s sessions
were targeted at service providers and how they can assist the people with whom
they work take advantage of Working Healthy. About 80 people attended this part
of the conference. Barb Small from Small and Associates, who has been involved
in the Buy-In program in New York, was a featured speaker. Working Healthy staff
also provided a training and information for consumers at the 7th Kansas Disability
Caucus in Topeka August 8th-10th and at the Region 7 CMS Conference on September
7th.
Future outreach efforts already planned include the Interhab conference in October.
Also, be watching this space for information about a major Working Healthy statewide
outreach conference planned for April, 2002.
What has happened with similar programs in other states?
Vermont initiated a Medicaid buy-in program in January, 2000. The Vermont program
is called the Vermont Work Incentive Initiative, with a Medicaid Buy-In for
Working Disabled component.
Eligibility for the Vermont program is similar to that for Working Healthy.
Participants must be working, satisfy the other SSI-related Medicaid eligibility
criteria, and meet a two-step income test, demonstrating family income under
250 percent of the federal poverty level, and moderate amounts of unearned income.
To encourage a working disabled person to move toward greater independence from
publicly funded programs, only those with income more than 185 percent are charged
a premium on a sliding scale basis.
As of May, 2001, the Vermont program had 390 people enrolled. A breakdown of
the types of disabilities enrollees had is shown in Figure 1. Figure 1 information:
pie chart showing Physical disability, 38%; Brain injury 3%; MR/DD, 10%; Mental
illness, 46%; Other 3%.
CONSUMERS NEEDED!
If you or someone you know is seriously planning to enroll in Working Healthy
when it begins, we would like to talk with you as part of a research study to
help us make the program as effective as possible. Please call or email Jean
Hall for more information (785-864-7083 or jhall@ukans.edu)
Acronym Assistant
SSI : Supplemental Security Income
SSDI : Social Security Disability Insurance
TW-WIIA : Ticket to Work, Work Incentives Improvement Act
HCBS : Home and Community Based Services
EES : Economic and Employment Support
CMS : Centers for Medicare and Medicaid Services
PAS : Personal Assistance Services
MMIS : Medicaid Management Information Systems
Case Studies -- How Working Healthy May Work for People with
Various Disabilities
The Working Healthy program is designed to be beneficial to people with different
disabilities and different circumstances. The following case studies are provided
as general examples of how the program might work for some people.
Case Study 1-- Person with Severe and Persistent Mental Illness
Tom is a 34-year old male who has a severe and persistent mental illness. The
onset of his illness was in his mid 20’s. He was able to work full time
in a general labor job before his illness became so severe that he was unable
to concentrate, became very paranoid and started hearing voices. He was not
able to continue employment. He finally applied for Social Security Disability
and was approved for SSDI benefits and receives $660.00 a month. Having been
on SSDI for more than two years, Tom is Medicare eligible.
After several years of isolated existence, Tom’s psychiatrist referred
him to Breakthrough Club, where he started doing volunteer work in the clubhouse.
After several months, Tom decided he wanted to work. He first tested his job
capabilities doing some temporary employment before taking his current job.
Totaling income from his job and SS cash benefits, Tom had a spend down of $2,500
every six months. He usually did not meet his spend down and had to pay for
his medications out of pocket. Often, he could not meet those costs. Consequently,
Tom had a relapse six weeks ago and immediately needed mental health case management
services. Tom must take a leave of absence from his job, which means his spend
down will be reduced to an amount he can more easily meet. After his spend down
is met, his medical card will pay for the $110 hourly cost for case management
services. Tom will probably need extra services such as medication management,
attendant care or psycho-social activities, paid by the Medicaid card, for another
six months. His goal is to return to work in six to eight weeks.
How Working Healthy could assist Tom
Working Healthy is designed to help people like Tom who have an episodic illness.
These illnesses often require medications or medical care that is costly. Additionally,
their illness may keep people from maintaining employment because they require
periodic time away from work. Because of necessary medical services, most people
in this situation who are Medicaid eligible strive to maintain that eligibility.
They may not be supported in finding employment, or, consciously work just under
allowable levels of income, turning down additional hours or wage increases
out of fear of losing benefits.
By virtue of Medicaid and Social Security eligibility, Tom would be eligible
for Working Healthy. His case manager from the local mental health center refers
him to the benefits specialist for consultation. He meets age and income requirements,
and can verify income. The specialist tells Tom that should he choose to work
full time, he could retain his Medicaid services under the Working Healthy program
through payment of a monthly premium. In addition, participation in the program
means that Tom’s $2500.00 spend down will be eliminated.
Case Study 2 -- Person with a Physical Disability
Carmen is 38 years old. She has a spinal cord injury, and is a high-level (T-3)
paraplegic. Vocational Rehabilitation assistance and student financial aid allowed
her to attend and finish college. After college graduation, VR helped purchase
equipment in order for Carmen to obtain employment. Carmen became employed full
time, in a salaried teaching position, which she maintained for eight years.
During that time, her wheel chair and cushion wore down and Carmen developed
ulcers and other health problems. Her employer’s insurance would cover
only a small portion of the cost of a new power chair. Carmen applied to VR
for assistance but was turned down because she did not meet order of selection
criteria and for various other reasons. Consequently, Carmen lost her teaching
job. High COBRA payments precluded her from continuing her employers health
insurance. Carmen was determined eligible for SSDI, and began receiving a check
for $1100.00 each month. It took Carmen 8 months to spend down her limited assets
and obtain Medicaid coverage during this time of unemployment. Carmen was forced
to relinquish her apartment, and access Section 8 low-income housing assistance.
Carmen obtained 4 hours a week in Personal Assistance Services (PAS) for shopping,
housecleaning, and laundry, and concentrated on improving her health and returning
to work. She was deemed eligible again for VR services, and was able to obtain
a substitute teaching position within a trial work period. She was unable to
obtain employer health insurance coverage.
How Working Healthy could assist Carmen
Carmen would like to increase her work hours and income. Carmen meets with a
Benefits Specialist who determines that she meets the requirements for Working
Healthy and has verified income. Carmen is currently receiving Medicaid and
SSDI benefits. Her income remains below the 300% FPL ($2168/month gross countable
income) level, making her financially eligible. Carmen and the Benefits Specialist
also discuss the following issues:
1) how working would affect her SSDI after reaching substantial gainful activity
(SGA);
2) Home and Community Based Services (HCBS) versus Working Healthy PAS services;
3) Section 8 eligibility; and
4) whether her work will provide her the income necessary to weather the transition
period between SSDI income and employment income.
Under the Buy In, Carmen will receive the full range of basic Medicaid services
and can access employment PAS services as needed. Carmen also learns she can
establish an Individual Development Account (IDA) to begin to save for additional
training required to maintain her teaching license. Any assets accumulated in
the training IDA would be disregarded.
Finally, when she becomes eligible for employer-based health insurance, Carmen
is required to report this information to SRS. If Carmen’s private insurance
offered by her employers is more cost effective, then Medicaid will begin to
pay that premium, as provided for under the Health Insurance Portability and
Accountability Act (HIPAA).
Case Study 3 -- Person with a Developmental Disability
Diane is a 26 year old woman with Down Syndrome. She receives SSDI income of
$800 per month and, since the age of 19, has lived in her own apartment. She
volunteers about 20 hours per week at a local women’s shelter, performing
routine office tasks and helping clean the living areas the shelter maintains.
Recently, the shelter has offered her a full time job at $7.50 per hour, but
without health care benefits.
Diane would very much like to accept the job, but is concerned that she will
not be able to maintain a full-time work schedule without some help with her
personal care. Under the Working Healthy program, Diane would qualify for personal
attendant services to help support her work activities. In addition, she would
qualify for Medicaid coverage to augment the Medicare coverage she receives
under her SSDI benefits.
Case Study 4 -- Person with HIV
Tony is 42 years old and has been HIV positive for 10 years. He ran a successful
business until his illness forced him to quit and go onto SSDI four years ago.
Over the years, Tony accumulated personal assets of about 14,000 in savings
and mutual funds. He also owns a house and car. He currently has too much income
and assets to qualify for Medicaid coverage. Some, but not all, of the cost
of his medications are covered through the AIDS Drug Assistance Program (ADAP).
Tony began using the Internet extensively from home to keep abreast of the newest
AIDS research. Eventually, he developed his own web site and then began designing
web sites for friends and family members. He is now contemplating beginning
a home-based web design company but is worried about how the income from his
business would affect his benefits.
Tony meets with a Benefits Specialist and learns that his assets can be disregarded
for the Buy-In program. Further, under Working Healthy, he would qualify for
Medicaid coverage for prescription drugs, including those not covered by ADAP.
Under the Ticket to Work legislation, he would also be able to maintain Medicare
coverage for eight and a half years after completing his trial work period.
"Working Healthy" is the new name of the Kansas Medicaid Buy-In Program.
All future reference to the Buy-In Program will be under this new title, "Working
Healthy."
Working Healthy is published quarterly by the KU Department of Health Policy
and Management, in cooperation with the KU Division of Adult Studies and the
Kansas Department of Social and Rehabilitation Services.
Additional copies and copies in alternate formats are available upon request
by writing the University of Kansas Department of Health Policy and Management,
c/o Division of Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall
Rm. 517, Lawrence, KS 66045,
by phone (785) 864-7085, by email: pixie@ukans.edu
KU Research Team
Michael Fox, Principal Investigator
Jean Hall, Project Director
Noelle Kurth, Editor
Erin Rink, Research Assistant
SRS, Division of Health Care Policy Staff
Marianne Deagle, Communications Director
Howard Moses, Program Administrator
Sharon Johnson, Program Analyst