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Pennsylvania Medicaid Buy-In

2. Pennsylvania. General Population12 million or 12,281,054 ( 2000 Census)Medicaid1.8 million or 1,888,814 (9/30/06)MAWD8,815 (9/30/06). 3. Pennsylvania MAWD. Administered by Department of Public Welfare (DPW)Implemented January 1, 2006Ticket to WorkBasic GroupMedically ImprovedTobacco Mas

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Pennsylvania Medicaid Buy-In

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    1. 1 Pennsylvania Medicaid Buy-In MAWD Medical Assistance for Workers with Disabilities November 2006

    2. 2 Pennsylvania General Population 12 million or 12,281,054 ( 2000 Census) Medicaid 1.8 million or 1,888,814 (9/30/06) MAWD 8,815 (9/30/06)

    3. 3 Pennsylvania MAWD Administered by Department of Public Welfare (DPW) Implemented January 1, 2006 Ticket to Work Basic Group Medically Improved Tobacco Master Settlement established State Funding

    4. 4 Pennsylvania MAWD Tobacco Settlement PA Funding for MAWD is Good MAWD Program Changes Made by Internal Policy/Procedures Waived premiums Good Cause Employment/Work Issues

    5. 5 Pennsylvania MAWD Employed and Disabled 16-64 Years of Age Income is 250% of FPL Resource Limit is $10,000 Premium is 5% of Monthly Income Average premium is $41.00

    6. 6 Pennsylvania MAWD Disability Determination SSA Determination if Title II Medical Review Team (MRT) for Others MRT is DPW Review Contract with Private Entity SSA Guidelines

    7. 7 Pennsylvania MAWD Medically Improved Previously Covered in Basic Group Disability No Longer Meets SSA Employed 40 hours or month in Month Earning at least Minimum Wage Disability Definition Severe Medically Determinable Disability PA Created Definition

    8. 8 Pennsylvania MAWD Medically Improved Medically Improved Disability Definition Loss of Health Care Results in loss of Employment Limits ability to Work/Conduct activities MH/PH Stabilized by Medication Organ Transplants/Medication required Chronic Diseases Documentation required

    9. 9 Pennsylvania MAWD Medically Improved Medically Improved 12/2002 1 12/2003 4 12/2004 7 12/2005 11

    10. 10 Pennsylvania MAWD Medically Improved Where in Pennsylvania ? In 8 Counties/PA has 67 Counties Southeast/ Urban/Suburban 6 Central /Suburban 3 Southwest/Rural 1 Southwest/Urban 1

    11. 11 Pennsylvania MAWD Medically Improved Medically Improved Gender Women 7 Men 4 Disability Mental Illness 50% Heart Disease

    12. 12 Pennsylvania MAWD Medically Improved Age 21 – 29 2 30 – 39 1 40 – 49 5 50 – 59 3

    13. 13 Pennsylvania MAWD Medically Improved Employed Full Time 5 Part Time (100 + Hours) 2 Part Time ( <100 hours ) 3 Self-Employment 1

    14. 14 Pennsylvania MAWD Medically Improved Job Types Cashiers/Tellers Bookkeepers/Accounting Household/Domestic Truck/Cab Drivers Sales Building/Service Related

    15. 15 Pennsylvania MAWD Medically Improved Premiums Average Premium $38.00 Low $16.00 High $75.00 $10-$19 2 $20-$29 2 $30 - $39 2 $40 -$49 3 $60 - $69 1 $70-$79 1

    16. 16 Pennsylvania MAWD Medically Improved Length of Time on Medically Improved 12 Months and Longer 1 10 to 12 Months 4 4 to 6 Months 3 3 Months or Less 3

    17. 17 Pennsylvania MAWD Medically Improved Benefits Ended Requested Benefits Closed Employment Ended Eligible for Other Medicaid Group Health Reasons

    18. 18 Pennsylvania MAWD Medically Improved Most MAWD Remain in Basic Most MAWD Remain SSA Disabled Must be Basic Prior to Medically Improved Basic Group Employment Full Time – 1752 Part Time - < 100 Hours 3966 Part Time- > 100 hours 1416

    19. 19 Pennsylvania MAWD Medically Improved Questions Thank You Carol Tooker ctooker@state.pa.us 717-772-7815

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