March 2004 Policy Brief
University of Kansas Medicaid Infrastructure Change Evaluation Project
Number 5, March 2004
WORKING HEALTHY: THE FIRST STEP IS WORK
By Jean P. Hall, Ph.D., Principal Investigator
Working Healthy, the Kansas Medicaid Buy-In program, allows people with disabilities
to enter or increase employment and keep their Medicaid coverage. One of the
first requirements to qualify for Working Healthy is to have a job. In a Satisfaction
Survey mailed to Working Healthy participants in June 2003, we asked how each
person had found his or her most recent employment (Table 1). By far the most
common way respondents had found their jobs was by themselves, through such
means as newspaper ads and word of mouth.
This finding is interesting in light of two recent pieces of federal legislation.
The Ticket to Work and Work Incentives Improvement Act of 1999 was intended
to provide incentives and supports for people with disabilities to work or
work
more. The first part of the legislation creates a program called the “Ticket
to Work.” The “ticket” is a voucher that consumers can use
to select their own employment or rehabilitation provider and receive services
at no cost. In late 2002 and early 2003, tickets were mailed to 70,610 Kansans
with disabilities receiving Supplemental Security Income (SSI) and/or Social
Security Disability Insurance (SSDI). To date, only 60 of these tickets have
been used, or “assigned” to a participating employment network
(Social Security Administration, March 2004).
Another federal law, the Workforce Investment Act of 1998 (WIA), consolidates
many former federal employment initiatives under the umbrella of “One-Stop” centers.
These One-Stop centers are statutorily required to make their job search and
training services accessible to jobseekers with disabilities, also at no cost.
According to the WIA Strategic Plan for Kansas (Kansas Department of Human
Resources, 2001), core services are available to anyone using a One-Stop Career
Center.
Core services include:
• eligibility determination for specialized services;
• initial assessment of skill levels, aptitudes, abilities, and supportive
service needs; and
• job search and placement assistance and, where appropriate, career counseling.
Other more intensive services are available to people who need them, including:
• adult education and literacy activities;
• job readiness training; and
• on-the-job training.
In a series of recent personal interviews, seven Working Healthy participants recalled having received their “tickets” in the mail, but only one knew what it was for. None of the Satisfaction Survey respondents indicated they had used a Ticket to find their current employment. Similarly, most of the people interviewed did not believe that One-Stop centers would be able to help them find jobs. In fact, other research in Kansas has indicated that people with disabilities often report that One-Stop Centers are not very helpful to them (Hall and Parker, in prep.).
One of the most frequent requests of callers to the Working Healthy information
line is help in finding a job. Based on these calls, as well as findings
from the surveys and interviews, many Kansans with disabilities are simply
not aware
of the variety of no-cost services available to assist them in their job
search and in obtaining training to increase their employability. Others
do not believe
the services can help them or have had negative experiences using them.
These programs cannot fulfill the intent of the legislation that created
them if
eligible persons do not use them or cannot get the services they need.
These findings suggest that service providers and other professionals need
to be aware of the Ticket program and One-Stop centers and share this
information with their clients who have disabilities and want to work.
Equally important,
One-Stop centers must do more to provide effective services to jobseekers
with disabilities.
TABLE INFORMATION:
Table 1. How Working Healthy Enrollees Found Their Jobs* n=146
Method = By myself/newspaper ad/Word of mouth, Frequency = 60, percent
= 41.1;
Method = One-Stop/Employment Center/Job service, Frequency =25, percent
= 17.1;
Method = Case manager/Community Mental health Center/job coach, Frequency
= 23, percent = 15.8; Method = Recruited, Frequency = 12, percent = 8.2;
Method
= Family,
Frequency = 9, percent = 6.2; Method = Vocational Rehabilitation, Frequency
= 5, percent = 3.4; Method = Sheltered Workshop, frequency = 4, percent
= 2.7; Method = Through volunteer work, Frequency = 3, percent = 2.1;
Method = School,
Frequency = 2, percent = 1.4; Method = on-line, frequency = 1, percent
= .7; Method = consumer-run organization, Frequency = 1, percent = .7;
Method = church,
Frequency = 1, percent = .7.
*Taken from the Working Healthy Satisfaction Survey, June 2003
WORKING HEALTHY AND THE NEW MEDICARE LAW
By Jean P. Hall, Ph.D., Principal Investigator
Comments from interviews and surveys of Working Healthy participants who are
dually eligible for Medicare have repeatedly underscored the fact that they
are better able to get their prescription medications because of Working
Healthy. Prior to their enrollment, many Working Healthy participants had
to incur very
large medical expenses to qualify for Medicaid coverage. This process, called
a spenddown, often meant that they had only sporadic coverage for prescription
medications. These individuals, who now have continuous Medicaid eligibility
through Working Healthy, frequently relate that their conditions are more
stable because of consistent access to medications. For these people, especially,
the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(P.L. 108-173) may have serious implications.
If the law is implemented as it is currently written, people with disabilities
who have both Medicare and Medicaid coverage (the so-called “dual-eligibles”)
will no longer be able to access prescription drugs through Medicaid. Rather,
they will be required to participate in the new Part D Medicare prescription
plan. While the actual impacts of this change cannot be assessed with certainty
at this point, the fact remains that Medicare beneficiaries with disabilities
are different from the majority of beneficiaries with regard to their prescription
drug use and costs and may be disproportionately affected by the legislation.
In 2000, the White House National Economic Council/Domestic Policy Council
released a report on “Disability, Medicare, and Prescription Drugs.” One
of the key findings in the report is that, compared to Medicare beneficiaries
in general, those with disabilities require a greater number of prescription
drugs and the drugs are more expensive. Specifically, the average beneficiary
with a disability had 28 prescriptions filled per year compared to the overall
Medicare beneficiary average of 20 prescriptions per year. In addition, people
with disabilities spent 50% more on drugs due not only to having more prescriptions,
but also because the drugs needed were more expensive.
The Kaiser Commission on Medicaid and the Uninsured (2004) recently published
the following information about dual-eligibles and the coming changes to
Medicare:
• As of January 1, 2006, states cannot provide federally-financed prescription
drug coverage to dual-eligibles even if those individuals are not yet enrolled
in a Medicare Part D plan. By the same token, dual-eligibles do not have
the choice to remain with their current Medicaid coverage instead of signing
up
for a Medicare Part D plan.
• Under the new Medicare Part D, people with dual Medicare/Medicaid eligibility
will pay up to $2 per generic drug and $5 per brand name drug in 2006, compared
to a flat $3 co-pay currently for Working Healthy enrollees. After 2006,
the co-pays will increase each year.
• The current Medicaid rule that prohibits providers from denying prescriptions
to individuals who cannot meet a co-payment requirement will not apply to
dual-eligibles enrolled in Part D plans. Thus, if a dual-eligible is unable to
meet a Part
D co-payment, he or she can be denied the prescription until the co-payment
requirement is met.
• In many circumstances, the array of drugs covered by Part D plans may
fall short of those covered under Medicaid. This is likely to be particularly
true
of the Part D plans in which dual-eligibles can afford to enroll given that
they receive a premium subsidy only for the cost of enrolling in plans with
average or below-average premiums. While Medicaid programs generally are
required to cover all medically necessary drugs, Part D plans have far more flexibility
to limit the array of drugs that they will cover.
Given the potential impact on Working Healthy enrollees and other dual-eligibles,
this legislation will need to be watched closely by consumers, service providers
and advocates.
REFERENCES
Kaiser Commission on Medicaid and the Uninsured. (2004). Implications of the
new Medicare law for dual eligibles: 10 key questions and answers. Washington,
DC: Author.
White House National Economic Council. (2000). Disability, Medicare, and prescription
drugs. Available on-line at http://clinton4.nara.gov/WH/EOP/nec/html/ParkMedicareReport000730.html
(retrieved March 10, 2004).
Social Security Administration. (2004). The Work Site. Available on-line at:
http://www.ssa.gov/work/Ticket/ticket_info.html (retrieved March 10, 2004).
Kansas Department of Human Resources. (2001). The State of Kansas Workforce
Investment Act Five Year Strategic Plan. Topeka: KS Department of Human Resources,
Division of Employment and Training.
This Policy Brief is published by the KU-CRL Division of Adult Studies in cooperation with the Kansas Division of Health Policy and Finance. The Policy Brief and other information regarding the Working Healthy program can be found online at http://www.workinghealthy.org
Additional copies and copies in alternate formats are available upon request by calling
1-800-449-1439 or emailing pixie@ku.edu
KU Research Team
Jean P. Hall, Ph.D., Principal Investigator
Noelle K. Kurth, M.S., Project Coordinator
Division of Health Policy and Finance
Mary Ellen O'Brien Wright, Working Healthy Program Director
Nancy Scott, Benefits Specialist Team Leader