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Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009

Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009 MIG and DMIE Employment Summit Services and Strategies that Sustain Employment Innovative Research in MIG Programs San Francisco, California David Mancuso, PhD Senior Research Supervisor

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Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009

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  1. Healthcare for Workers with Disabilities Supporting and Encouraging Employment APRIL 29, 2009 MIG and DMIE Employment Summit Services and Strategies that Sustain Employment Innovative Research in MIG Programs San Francisco, California David Mancuso, PhD Senior Research Supervisor Washington State Department of Social and Health Services Planning, Performance and Accountability Administration Research and Data Analysis Division Medicaid Infrastructure GrantDemonstration to Maintain Independence and Employment

  2. Our focus today • Evaluation of Washington’s Healthcare for Workers with Disabilities Program shows that enrollees are: • Working more hours • Earning more money • Paying health insurance premiums • Contributing more in taxes • Relying less on food stamps

  3. Washington’s Healthcare for Workers with Disabilities Program • The state’s version of Medicaid Buy-In, authorized under the Ticket to Work and Work Incentives Improvement Act of 1999: • Provides health insurance coverage for individuals moving from government support to paid employment • Provides medical coverage to working age individuals 16-65 meeting disability requirements and with incomes/assets disqualifying them from conventional Medicaid • Distinct in that enrollees pay a monthly premium (sliding scale) in exchange for full Medicaid coverage • Monthly net income must be at or below 220 percent of FPL—$1,908 per month, for a single person in 2008 • Eligibility disregards gross earned income, so income threshold is 450 percent FPL for those not on cash assistance—close to $4,000 in gross earned income per month for a single person in 2008

  4. Study Design • Key challenges: • Different eligibility rules for HWD/MBI systematically separate clients into groups on the basis of earned income • Potential for selection bias in quasi-experimental designs • Analytical approach: • Use propensity score based 1:1 matching to select comparison groups • Leverage rich administrative data for matching: • Demographics • Earnings history • Eligibility history • Medical risk level • Behavioral health risk factors

  5. Matched Comparison Groups • Four Matched-Pair Study Groups: • Stratified clients enrolling in HWD/MBI into two groups with strikingly different employment trajectories: • Clients with no prior Medicaid in year before HWD/MBI entry • Clients with prior Medicaid in year before HWD/MBI entry • Separate comparison groups matched from historical and contemporaneous time periods to assess robustness • Index quarter is first quarter on HWD/MBI for treatment group, and is “randomly” assigned for comparison group TIMELINE HWD/MBI group first enrolled 1/2002 to 6/2007 Prior to HWD/MBI “Historical” “Contemporaneous” 7/99 12/00 1/02 6/07

  6. IndividualswithMedicaid Coverage in Prior 12 Months Individual averages following 1:1 match

  7. IndividualswithoutMedicaid Coverage in Prior 12 Months Individual averages following 1:1 match

  8. IndividualswithMedicaid Coverage in Prior 12 Months Annual Earnings |HWD participants versus comparison group Earnings in constant 2008 dollars, prior to regression adjustment INDEX QUARTER Quarterly Earnings Healthcare for Workers with Disabilities Contemporaneous Comparison 1 year prior 1 year after 5 years prior -5 -4 -3 -2 -1INDEX QUARTER1 YEARSYEAR

  9. IndividualswithMedicaid Coverage in Prior 12 Months Annual Earnings |HWD participants versus comparison group Earnings in constant 2008 dollars, prior to regression adjustment INDEX QUARTER Quarterly Earnings Healthcare for Workers with Disabilities Historical Comparison 1 year prior 1 year after 2 years prior -5 -4 -3 -2 -1INDEX QUARTER1 -5 -4 -3 -2 -1INDEX QUARTER1 YEARSYEAR YEARS YEAR

  10. IndividualswithoutMedicaid Coverage in Prior 12 Months Annual Earnings |HWD participants versus comparison group Earnings in constant 2008 dollars, prior to regression adjustment INDEX QUARTER Quarterly Earnings Healthcare for Workers with Disabilities Contemporaneous Comparison 1 year prior 1 year after 5 years prior -5 -4 -3 -2 -1INDEX QUARTER1 YEARS YEAR

  11. IndividualswithoutMedicaid Coverage in Prior 12 Months Annual Earnings |HWD participants versus comparison group Earnings in constant 2008 dollars, prior to regression adjustment INDEX QUARTER Quarterly Earnings Healthcare for Workers with Disabilities Historical Comparison 1 year prior 1 year after 2 years prior -5 -4 -3 -2 -1INDEX QUARTER1 YEARS YEAR

  12. Earning more money Earnings in constant 2008 dollars, CPI adjusted • Contemporaneous cohort Individuals with Prior Medicaid Coverage Individuals without Prior Medicaid Coverage $9, 129 HWD Participants Average earnings in year after enrollment Regression adjusted +136% $7, 126 HWD Participants Average earnings in year after enrollment Regression adjusted +39% $5,136 Non-Participants Average earnings in year after enrollment $3,860 Non-Participants Average earnings in year after enrollment n = 1,130 n = 1,130 n = 401 n = 401

  13. Working more hours Contemporaneous cohort Individuals with Prior Medicaid Coverage Individuals without Prior Medicaid Coverage 720 HWD Participants Average hours in year after enrollment Regression adjusted 652 +135% HWD Participants Average hours in year after enrollment Regression adjusted +42% 459 Non-Participants Average hours in year after enrollment 306 Non-Participants Average hours in year after enrollment n = 1,130 n = 1,130 n = 401 n = 401

  14. Having medical coverage longer Contemporaneous cohort Individuals with Prior Medicaid Coverage Individuals without Prior Medicaid Coverage 11.4 11.1 +17% HWD Participants Average months of Medicaid coverage in year after enrollment Regression adjusted HWD Participants Average months of Medicaid coverage in year after enrollment Regression adjusted 9.7 +65% Non-Participants Average months of Medicaid coverage in year after enrollment 6.7 Non-Participants Average months of Medicaid coverage in year after enrollment n = 1,130 n = 1,130 n = 401 n = 401

  15. Relying less on Food Stamps Contemporaneous cohort Individuals with Prior Medicaid Coverage Individuals without Prior Medicaid Coverage 4.4 4.2 Non-Participants Average months in year after enrollment Non-Participants Average months in year after enrollment —61% —75% 1.7 HWD Participants HWD Participants Average months in year after enrollment Regression adjusted 1.0 Average months in year after Regression adjusted n = 1,130 n = 1,130 n = 401 n = 401

  16. Summing it all up HWD participants: Work more hours ● Earn more money Pay health insurance premiums Contribute more in taxes ● Rely less on food stamps Healthcare for Workers with Disabilities: Supporting and Encouraging Employment FEBRUARY 2009 For full report, visit us at: http://publications.rda.dshs.wa.gov/1374/

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