August 2005 Policy Brief
University of Kansas Medicaid Infrastructure Change Evaluation Project
Number 7, August 2005
FIRST POINT OF CONTACT: Results from
a recent survey of Kansas frontline staff and the Working Healthy Program
by Noelle K. Kurth, M.S. & Jean P. Hall, Ph.D.
Frontline workers at Kansas Social and Rehabilitation Services (SRS) are often
the first point of contact for people who may be eligible for Kansas’ Medicaid
Buy-In, Working Healthy. These staff members’ perceptions and understanding
of the program and its participants are therefore critical factors in its success
in enrolling eligible persons. Working Healthy allows eligible Kansans with
disabilities who meet Social Security disability criteria to work and maintain
or obtain Medicaid coverage.
In March of 2005, University of Kansas (KU) Evaluation
staff developed and administered an email survey to measure SRS Human Services
Specialists’ (HSS) knowledge and perceptions of the Working Healthy (WH)
program. The survey also served as a tool for evaluating the efficiency and
effectiveness of the program from the perspective of staff who are actively
involved in its day-to-day operation. The survey included demographic questions,
general questions about their experiences with and perceptions of people with
disabilities and their ability and desire to work, and questions specific to
the operation and administration of Working Healthy.
Working Healthy program
management staff from the central office in Topeka emailed the survey to
the Assistant Directors for Service Improvement in each of the six SRS regional
areas, who in turn emailed it to the Human Services Specialists in their
region.
A total of 612 HSS personnel were identified and emailed the survey. They
were given two weeks to complete and return the survey to KU Evaluation staff.
When
received by KU, the surveys were stripped of any personal information so
participants could feel free to answer without inhibition. After two weeks,
164 individuals
completed and returned surveys for a response rate of 26.8%.
Respondent Characteristics
Of the 164 HSS completing surveys, respondents had been employed with SRS for
approximately 9 years on average; with some individuals in their positions
as little as one month and some as long as 34 years. Response rate from across
the six regional areas was balanced, including representation from each region.
Respondents were asked to list all of the types of cases they work on. While
27% (n=44) indicated conducting WH eligibility determinations as part of
their HSS job responsibilities, most respondents indicated other or additional
types of cases covered. ?e top five types of caseloads respondents indicated
were: Food Stamps, 81.0%; Temporary Assistance for Families (TAF), 62.0%;
Medicaid, both disabled and poverty-related cases, 44.3%; Elderly and Disabled,
31.0%; and Child Care, 30.4%. Other categories of caseloads indicated by
respondents include, Home and Community Based Services (HCBS), General Assistance
(GA),Work Assistance Programs Family Medical, Employment Preparation Services
and Low Income Energy Assistance Program (LIEAP).
Respondent Attitudes
The first part of the survey included items related to respondents’ attitudes
toward people with disabilities and work. Using a Likert scale, respondents
were asked to indicate the level to which they agreed or disagreed with three
statements: 1. In general, people with disabilities are able to work;2. In
general, people with disabilities want to work; and3. In general, people with
disabilities should be encouraged to work.
Responses to these questions showed
a distinct trend from less agreement to more agreement, with 24% agreeing or
strongly agreeing to the first statement, 42.2% agreeing or strongly agreeing
to the second statement, and a majority, 56.5%, agreeing or strongly agreeing
to the third statement. A pervasive finding from WH enrollees responding to
previous surveys and interviews has been that service providers often don’t
think they should work, or try to work more. The HSS responses seem to indicate
that, while they believe people with disabilities should be encouraged to work,
they may not truly believe in their ability to do so. Interestingly, the responses
on these items were consistent across several respondent characteristics including
the type of caseload covered, whether they complete WH eligibility determinations
or not, their years of employment with SRS, and their location.
Program Specific Results
All respondents – regardless of whether they conducted WH eligibility
determination as part of their work responsibilities or not – were asked
if they were familiar with the program and knew how to get further information
about the program if they needed it. The response on these items was positive,
indicating HSS know about WH and how to get more information if they have questions.
On average, the 44 respondents who complete WH eligibility determination had
18 months experience in completing the determinations and had completed approximately
14 eligibility determinations each in that time [note: WH began in July 2002,
so the maximum months of experience possible was 32]. When asked if they
had completed enough determinations to become proficient, 50% indicated they
had
while the other 50% indicated they had not. ?ese respondents also indicated
that their understanding of WH and information in any format (e.g. written
materials, training, verbal information and directions) that they received
regarding the program was consistent and complete, generally good, and considered
to be at a level that was about the same as that for other SRS programs.
Further, when asked whether WH is helping the people who need it, 89% (n=39)
of these
respondents indicated that they agree or strongly agree that it is. The only
weakness indicated was in regard to a question about the eligibility paperwork;
respondents felt it is more time consuming and complicated than it needs
to be. When survey participants were asked to share any suggestions they had
for
ways to improve the program, changing the paperwork was the most common response.
Respondents were also asked to provide general comments about Working Healthy
and ways to improve it. The feedback provided through these open-ended
questions generally fell into six categories, listed as follows, with illustrative
quotes.1. Increased outreach about Working Healthy, especially to people
receiving
Social
Security Disability Insurance (SSDI) benefits who may not have contact with
SRS: “More advertisement about the program is necessary. In general,
it is current clients who are [going on to] the WH program;” “When
people do not know that the WH program exists or what it is, it is inaccessible.”2.
Frustration at not being able to set a minimum level of work to qualify for
Working Healthy (the federal Ticket to Work legislation does not give states
this ability): “I have consumers who work 1-3 hours per month. This is
a manipulation of the program.”3. The need for the program to offer “refresher” courses
on Working Healthy to SRS staff: “When we were originally trained on
this program we did not have active cases. Now that we have more understanding
of the program, it might be good to have a short refresher to be sure that
we are benefiting the people that qualify;” “I wouldn’t mind
a refresher course, especially [about] situations with couples (e.g., one is
disabled, both are disabled).”4. Improved coordination with Vocational
Rehabilitation and One-Stop Centers to increase the employment of people with
disabilities, especially in light of the difficulty that many people with disabilities
have in finding and retaining jobs: “It’s very good for those who
are on it but I think job opportunities are limited…maybe a cooperative
with job services would be helpful…maybe VR services could be more involved,
too.”5. Increasing awareness among beneficiaries that they can accumulate
assets while enrolled in Working Healthy: “I do not feel the program
is benefiting people with resources. Our only contact seems to be people who
are Medicaid eligible but are working and not eligible for a medical card [people
who must meet spenddowns to get Medicaid].”6. General positive comments
on the program and its capacity to encourage people with disabilities to work
or work more: “The consumers I have in my caseload who have requested
Working Healthy are pleased with it and realize without the program they would
be faced with most likely either a large spenddown or just completely not having
any medical coverage at all.”
Conclusion
Results of the survey seem to indicate that workers feel they understand the
program and can get information about it when needed. Refresher courses on
Working Healthy and changes in the paperwork process will likely need to wait
until SRS reorganization is completed, but will be on the agenda for the program’s
Implementation Team. Working Healthy has recently implemented a “Disability
Navigator” program at one One-Stop employment center in the state to
begin the process of better coordination with these job service providers [see
red box below]. Improved outreach to non-SRS populations and broader initiatives
to coordinate Working Healthy with employment service providers will be goals
of a Comprehensive Employment Systems grant proposal if Kansas becomes fully
eligible to apply in 2007.
Recognizing that obtaining and retaining employment is the first step
for successful participation in
Working Healthy, program staff began
a pilot “Disability
Navigator” position in a Kansas One-Stop employment center. The Navigator
provides on-site support to One-Stop staff regarding employment issues for
people with disabilities. Evaluation of the Navigator program is being conducted
in two ways. First, One-Stop staff knowledge of various disability employment
services, supports, and legislation was tested at baseline and will be re-measured
after one year. Second, job seekers with disabilities have served as “mystery
customers,” making visits to the center and using a checklist to assess
their experiences. Mystery customers made several visits early this year to
provide a baseline measure of services and will visit again early next year
to document changes.At baseline, staff members show widely varying levels of
knowledge about job accommodations, provision of alternate formats, disability
tax credits, and other disability-specific issues. Mystery customers reported
some accessibility issues at the center, and some difficulty getting information
they needed. The program is also sponsoring staff development sessions for
staff at other One-Stop centers across the state.
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