July 2003 Newsletter
Volume 3, Number 1
Working Healthy Enrollment At A Glance…
Since Working Healthy began in July 2002, enrollment has steadily increased.
A feature to note in considering enrollment figures is the nature of retroactive
enrollment dates. Upon initial enrollment, consumers are given the choice to
have their enrollment effective for the prior three months. Many consumers
choose this option in order to cover qualifying medical expenses they may have
incurred
before enrolling in Working Healthy. Therefore, enrollment numbers are not
final until three months after a particular month (e.g. the May enrollment
figure will
not be final until August and though early July figures show enrollment to
be 563, this number will also increase and not be final until November).
Over half of Working Healthy enrollees pay a premium for their coverage. As
of December 2002, the average monthly premium paid was $67.00 and as of June
2003,
the average premium was $69.00/month.
Table Information:
Title: Kansas Working Healthy Total Monthly Enrollment
August 2002 = 250 enrollees, 45% paying a premium
November 2002 = 447 enrollees, 57% paying a premium
February 2003 = 545 enrollees, 57% paying a premium
May 2003* = 543 enrollees, 64% paying a premium
*Note. Enrollment figures are based on SRS information that include retroactive
enrollees. Because of the 3-month window for retroactive enrollment, the May
2003 figure will increase in August 2003.
Source: Kansas Automated Eligibility Child Support Enforcement System (KAECSES)
New
Reports on TW-WIIA and Medicaid Buy-In Programs
Highlight Successes and Problems
By Jean Hall, Ph.D.
Two national reports published in the last three months provide timely information
about work incentives programs for people with disabilities. The first of these
reports was released by the national Ticket to Work and Work Incentives Advisory
Panel. The Ticket to Work and Work Incentives Improvement Act (TW-WIIA) was
passed in 1999 with the intent to remove many disincentives to work for people
with
disabilities. The first part of the legislation created a new program called
the “Ticket to Work,” which provides a voucher that consumers can
use to select their own employment services or rehabilitation provider. The
second part of the Act was designed to remove barriers to employment by increasing
access
to health care.
TW-WIIA
The Ticket Advisory Panel is a bipartisan group of twelve citizens who represent
diverse racial and ethnic backgrounds, have diverse experience and knowledge
as recipients, providers, disabled veterans, employers and employees in the fields
of employment services, vocational rehabilitation and other disability related
support services.
The Ticket to Work legislation established the Advisory Panel within the Social
Security Administration to advise the President, the Congress and the Commissioner
of Social Security on issues related to work incentive programs, planning, and
assistance for individuals with disabilities. In its Third Annual Report to Congress
published in April, the Panel:
•
Reaffirmed its recommendation that 16- and 17-year-olds be allowed to participate
in the Ticket Program. As the Panel noted, “ prohibiting youth participation
would send the wrong message and could encourage lifelong dependency on benefits.” Ironically,
the Ticket legislation does mandate that Medicaid Buy-In programs be open to
people with disabilities from ages 16 through 64.
•
Reported that the Social Security Administration (SSA) will implement many of
the Panel’s prior recommendations regarding a feasibility study of a
$1 for $2 cash benefit offset. The offset would allow SSDI cash beneficiaries
to
retain $1 of their cash benefits for every $2 they earn, up to the Substantial
Gainful Activity level of $800 per month. SSA plans to implement a demonstration
program early next year to test the effectiveness of the offset in increasing
the earnings of SSDI beneficiaries.
• Reiterated its 2001 recommendation that Congress consider any employment
successful, even if the individual attaining employment does not earn enough
to completely
leave the cash benefit rolls. Such a provision would likely increase the number
of people utilizing the Ticket and also decrease the overall level of benefits
paid out of the Social Security Trust Fund.
•
Recommended that Congress provide the financial resources necessary for SSA “to
establish a dedicated corps of trained, accessible, and responsive work incentives
specialists, as required by law” and to develop “an immediate, coordinated
national marketing and public education campaign” about the availability
of programs under TW-WIIA.
The Panel’s report is available at: http://www.socialsecurity.gov/work/panel/panel_documents/reports.html
Medicaid Buy-Ins
The second report, published by the General Accounting Office in June, is called “Medicaid
and Ticket to Work: State’s Early Efforts to Cover Individuals with Disabilities.” The
report includes the following summary information:
“
As of December 2002, 12 states had implemented Medicaid Buy-In programs under
the authority of the Ticket to Work legislation, which was effective October
1, 2000, enrolling over 24,000 working individuals with disabilities. These states
used the flexibility allowed by the legislation to raise income eligibility and
asset limits as well as cost-sharing fees. Across the 12 states, income eligibility
levels ranged from 100 percent of the federal poverty level (FPL) in Wyoming
to no income limit in Minnesota, with 11 states setting income eligibility limits
at twice the FPL or higher. In addition to increasing income and asset levels,
these states required participants to buy in to the program by charging premiums,
ranging from $26 to $82 a month, and copayments, generally ranging from $0.50
to $3 for office visits and prescription drugs. In detailed analysis of four
states—Connecticut, Illinois, Minnesota, and New Jersey—GAO found
that most Buy-In participants had prior insurance by Medicaid and Medicare, few
had prior coverage by private health insurance, and many earned low wages—most
making less than $800 per month. “
The report further documented that the percentage of premium payers ranged
from 12% to nearly all participants across the states charging premiums. Additionally,
the GAO found that “crowd out” of private insurance coverage by
Medicaid coverage is not an issue, because less than 10% of participants had
access to
private coverage at enrollment.
The GAO report is available at http://www.gao.gov/ by entering “GAO-03-587” in
the Full Text Search box.
Relationship of these Reports to Working Healthy
How do these findings relate to Working Healthy? First, young people aged 16
to 20 are disproportionately under-represented among enrollees (as of July, only
one person in this age range was enrolled). Second, average earnings of enrollees
are still much lower than the substantial gainful activity level of $800 per
month. Third, the great majority of enrollees work less than forty hours per
week and very few have access to private health insurance through their employers.
Fourth, until Social Security has adequate resources to dedicate to outreach,
the Working Healthy Benefits Specialists will continue to be needed to assist
in that activity to increase enrollment. Finally, Kansas is essentially in line
with other TW-WIIA buy-in programs with regard to enrollment, premium payment,
and earnings of participants.
Did You Know?
If an employer offers health insurance to a Working Healthy participant, SRS
may be able to pay the employee’s share of the premium if doing so
is considered cost-effective. In those instances, Medicaid coverage through
Working Healthy acts as a “wraparound” service to cover medical
services that the private insurance does not. This program is known as the
Health Insurance Premium Payment System (HIPPS). You can learn more about
HIPPS by contacting a Benefits Specialist or by calling the SRS Consumer
Assistance Unit at 1-800-766-9012 or 291-4144 in Topeka. In addition, employers
are allowed to pay consumers’ Working Healthy premiums if they would
like to do so as a benefit for their employees.
Positive Feedback from Enrollees
Continuing their evaluation research, Working Healthy staff at KU sent over
900 surveys to individuals across Kansas, asking them about their life and
work experiences. Of those, 480 individuals who were enrolled in Working Healthy
for at least 4 months were sent a Satisfaction Survey. Below are just a few
of the comments from these surveys. Completing a survey is completely voluntary
and anonymous.
•
“Now with this program I can afford my prescriptions so my health can be
taken care of.”
•
“I am slowly becoming more sure of myself...and gaining confidence.”
•
“I’m setting goals for the future knowing that increased income will
not immediately terminate my health benefits. It’s a weight lifted from
my shoulders.”
•
“I feel better working. This is a very good program to get into.”
•
“We [my family] have more money so we can eat and dress better, we now
get out of the house to church and other activities. I feel better for once.
I can take all my medicines.”
Benefits Specialist Corner
This issue features Working Healthy Benefits Specialist Dan Hallacy from the
Pittsburg Area SRS Office. Before becoming a Benefits Specialist in May 2002,
Dan worked with consumers through the Community Mental Health Center of Crawford
County and the Southeast Kansas Mental Health Center. His knowledge of social
services and supported employment for people with disabilities has proved invaluable
in his work with consumers in his area. Dan can be reached at (620) 431-5096
or CDLH@srskansas.org. The map on page 5 provides information regarding the
counties Dan covers in his area.
“
The task of informing Kansans about the existence of the Working Healthy is
an enormous undertaking. As fast as outreach to agencies and organizations
is accomplished, program changes occur and/or new staff are hired and the need
to educate begins anew. Furthermore, the benefit planning we do is very individualized
and ever changing. The individuals’ marital status, work hours, earned
and unearned income, disability status, property owned, student status, medical
expenses and housing assistance can all change periodically.
We not only provide information to help individuals make informed decisions
about their benefits, but in the event they do find themselves in need of
other assistance we help them transition to their previous services. Individuals
who have disability benefits remember what a troubling procedure it was to
first get assistance and how they had to struggle financially in those initial
months. They oftentimes experienced a loss in income coupled with large medical
debt on top of their normal living expenses; all at a time when they were
emotionally
trying to cope with their new life with a disability. An individual invests
a great amount of trust in a Benefits Specialist.
Many aspects of receiving benefits can be overlooked until individuals are
faced with changes that might or will occur. Some examples include:
• Someone who is reaching their retirement age and the impact that will
have on their SSDI or SSI benefits and medical coverage; or
• Someone who has lost their SSDI or SSI and how he or she might begin
receiving their benefits again, either through reapplying for Social Security
benefits or Expedited Reinstatement of benefits, depending upon which one might
be best in their particular case.
Hopefully we can continue to inform Kansans about Working Healthy in a prompt
and comprehensive way.”
-Dan Hallacy, Benefits Specialist
Working Healthy Outreach Efforts Continue
The Working Healthy Benefits Specialist continue to conduct outreach activities
across the state. These outreach efforts strive to educate consumers, service
providers and the general public of the benefits of Working Healthy and how
it can help people with disabilities maintain their Medicaid coverage while
working. Below is a list of presentations/sessions that Benefits Specialists
will be conducting over the course of the next few months. This information
will be updated on the Working Healthy web site when new sessions are requested
or added
(http://das.kucrl.org/medicaid.html). Please contact the Benefits Specialist
in your area (see box below for contact information) if you or someone in your
area has questions about Working Healthy or is interested in hosting an outreach
presentation. For more information about these outreach activities, please
contact the Benefits Specialist Team Leader, Nancy Scott, by email at nas@srskansas.org
or by phone (785) 291-3461.
July 17-18, Families Together Conference presentation, Topeka, KS
July 26, Display and information available at ADA Celebration, Garden City,
KS
August 6-8, Kansas Disability Caucus presentation, Topeka, KS, Capitol Plaza
Hotel
September 8-13, Display and information available at the KS State Fair, Hutchinson,
KS
October 1-2, Display and information available at InterHab Conference, Wichita,
KS
Changes made in Benefits Specialists Coverage Areas
A few small changes have recently been made in the counties covered by Working
Healthy Benefits Specialists. Due to the saturation of Working Healthy enrollees
in the eastern portion of the state, coverage areas have been changed slightly.
The Northeast Region has been reduced to four counties (Douglas, Wyandotte,
Leavenworth and Johnson), while the Northcentral and Southcentral regions
have gained counties in their coverage areas.
Benefits Specialst Regions
1 - Northwest Region: Gary Youngman, Hays Area Office
Phone - (628) 1066 ext. 268
Email - HAGGY@srskansas.org
2 - Southwest Region: Steve Curtis, Garden City Area Office
Phone - (620) 272-5828
Email - SXXC@srskansas.org
3 - Northcentral Region: Judith Vargas, Manhattan Area Office
Phone - (785) 776-4011 ext. 227
Email - MJXV@srskansas.org
4 - Wichita and surrounding counties: Madeleine Anthony
Phone - (316) 337-6427
5 - Southcentral Region: Carrie Boettcher, Emporia Area Office
Phone - (620) 342-2505 ext. 246
Email - EECAB@srskansas.org
6 – Kansas City and Surrounding counties: Norm While, Lawrence Area Office
Phone - (785) 832-3716
Email - LNBW@srskansas.org
7 - Southeast Region: Dan Hallacy, Pittsburg Area Office
Phone - (620) 231-5300 ext. 330
Email - CDLH@srskansas.org
This newsletter and other Working Healthy program information can be found
online at: http://das.kucrl.org/medicaid.html
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, Co-Principal Investigator
Jean Hall, Co-Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Erin Rink, Research Assistant
Cindy Pressgrove, Research Assistant
SRS, Division of Health Care Policy:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader