October 2002 Policy Brief
University of Kansas Department of Health Policy and Management
Number 1, October 2002
Working Healthy -
A Medicaid Buy-In for Kansas
By Jean P. Hall and Michael H. Fox
Why do we have it?
While official national unemployment estimates hover between 5-7%, reported
unemployment for persons with disabilities are almost ten times that, estimated
at a disturbing 70% (National Organization on Disability, 2000). A significant
majority of unemployed persons with disabilities want to work, but the sharp
increase in persons receiving Social Security Disability Income (SSDI) or Supplemental
Security Income (SSI) benefits in the past five years belies state and federal
efforts to wean people from benefits they need to survive. To return to work
for many would be to jeopardize health insurance coverage, a significantly stronger
disincentive than is the promise of increased earnings. It became clear to many
disability policy analysts and the disability community that even after passage
of the Americans with Disabilities Act (ADA), additional legislation would be
needed to balance the intent of state and federal programs to assure minimal
social security with the goal of increasing independence and social integration
among persons with disabilities seeking work. State Medicaid programs were viewed
as one vehicle for helping achieve this balance.
Legislative History
Since authorized as part of the Balanced Budget Act of 1997, twenty-seven states
have modified eligibility and enrollment requirements for certain groups of
low income residents so that they can receive health insurance benefits under
state Medicaid programs. The reasons states have embraced this approach to expanding
health insurance are as varied as the states themselves, but generally fall
into two broad categories - reducing the uninsured burden and expanding opportunities
for working people with disabilities to increase their earnings. With the passage
of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in 1999,
states were granted increased flexibility to design Buy-in plans that offered
people with disabilities greater income, asset and resource protection.
(side bar) The Kansas Medicaid Buy-In was founded on the philosophy of encouraging
people to earn greater income and accumulate more assets so that they can free
themselves of many forms of public assistance.
(side bar) Want to know more about Working Healthy?
Go on-line at http://das.kucrl.org/medicaid.html
Working Healthy in Kansas
The Kansas Medicaid Buy-in, called Working Healthy, was funded by a grant by
the Centers for Medicare and Medicaid Services (CMS) in October of 2000. With
the strong support of disability rights advocates and many Kansas employers,
it was founded on the philosophy of encouraging people to earn greater income
and accumulate more assets so that they can free themselves of many forms of
public assistance. By eliminating the need to spend down savings in order to
qualify, and allowing savings and checking accounts, retirement funds, and equity
in homes, the program seeks to empower people with disabilities to become self-sufficient
and independent, while receiving necessary health and medical services that
assure their well being. States can require that enrollees pay a premium for
this benefit, which Kansas has chosen to do.
How does it work?
The program is administered through the Kansas Department of Social and Rehabilitation
Services (SRS). Mary Ellen O'Brien Wright is the Program Director, and oversees
a Benefits Specialist Team Leader and five Benefits Specialists. The Benefits
Specialists are currently located in Chanute, Emporia, Hays, Garden City, and
Lawrence, with plans to add two more Specialists in Manhattan and Wichita.
The Working Healthy program contracted with Breakthrough Club in Wichita to
conduct statewide outreach to consumers, service providers and employers about
the program in the period just before and after its implementation. If a person
is interested in the program, he or she is encouraged to speak with the Benefits
Specialist in the area to determine how participating in Working Healthy and
earning more money might affect other benefits such as housing, child care subsidies,
and cash assistance. The Specialist can also help the consumer determine if
he or she will be required to pay a premium to maintain Medicaid coverage.
(side bar) "Finally, there is a program that will allow me to use my talents,
skills, and education in a way that is productive and meaningful without losing
the benefits that I need in order to thrive in my community." - KS resident
Program Monitoring and Evaluation
SRS contracted with the University of Kansas Department of Health Policy and
Management (KU HP&M) to assist with various program activities, including
outreach and educational efforts, program implementation and enhancements, collaboration
with other states, and strategic planning. KU HP&M staff are also charged
with assisting SRS to understand, evaluate, and monitor program performance.
Initial efforts at monitoring the program have included developing and implementing
a baseline survey of all Working Healthy eligibles, conducting a consumer focus
group to discuss barriers to employment, and collecting administrative data
from SRS Health Care Policy and CMS on health care expenditures, and the Kansas
Department of Human Resources on quarterly earnings of eligibles. This first
Policy Brief provides a snapshot of initial enrollment trends and demographics
of the people who have enrolled in the Working Healthy program. The figures
provided are based on administrative data from SRS and baseline survey data
collected by KU HP&M.
Enrollment
This first Policy Brief provides a snapshot of initial enrollment trends and
demographics of the people who have enrolled in the program. The figures provided
are based on administrative data from SRS and baseline survey data collected
by KU HP&M.
Two months into its implementation, the Working Healthy program has 297 enrollees.
In the initial weeks of the program, the majority of enrollees did not have
enough income to be required to pay a premium. However, premium payers have
now increased and outnumber non-payers by more than 10%. Enrollees are required
to pay a premium for their continued Medicaid coverage through Working Healthy
when their income exceeds 100% of the federal poverty level. The premium amount
increases with increased income levels.
Enrollee Demographics
Men and women are represented about equally among program participants. Their
average age is 45 years. More than half worked before going onto cash benefits,
with an average of 15 years' previous work experience. Participants in Working
Healthy have been receiving cash benefits for an average of 10 years. By race,
82% are white, 8% are African American, 8% are Native American or Alaskan Natives,
and 1% are Asian. Two-thirds of enrollees have earned income of less than $400
per month. People with many different disabilities have enrolled in the program,
as illustrated in the pie chart below.
TABLE INFORMATION: Table title: Kansas Working Healthy Total Enrollment
July 2002: Total enrollment = 175, 29% of which are paying a premium
August 2002: Total enrollment = 250, 45% of which are paying a premium
September 2002: Total enrollment = 297, 55% of which are paying a premium
Source: Kansas Medicaid Management Information System (MMIS)
PIE CHART INFORMATION: Title: Enrollees and Disability Type (n=92)
(listed counterclockwise)
Mental illness = 48%
Chronic illness = 16%
Physical disability = 15%
Mental retardation/development disability = 9%
Sensory = 8%
Cognitive = 2%
Traumatic Brain Injury = 1%
HIV = 1%
Source: KU 2002 Baseline Survey of WH Eligibles identified by Kansas SRS
References
National Organization on Disability (2000). 2000 N.O.D./Harris Survey of Americans
with Disabilities. Washington, D.C.: Author
This Policy Brief is published by the KU Department of Healthy Policy and Management
in cooperation with Kansas SRS. The Policy Brief and other information regarding
the Working Healthy program can be found on-line at http://das.kucrl.org/medicaid.html
Additional copies and copies in alternate formats are available upon request
by calling
1-800-449-1439 or e-mailing pixie@ku.edu
KU Research Team
Michael H. Fox, Sc.D.,Principal Investigator
Jean P. Hall, Project Director
Noelle K. Kurth, Graphic Design/Editing
Erin Rink, Research Assistant
SRS, Division of Health Care Policy
Mary Ellen O'Brien Wright, Program Director