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This article explores how states can ensure that all recipients who are unable to work are exempted from Medicaid work requirements. It discusses disability determination processes, consequences of Medicaid loss, data matches for disability determinations and applications, and the effectiveness of work requirements.
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Determining Disability Medicaid Work Requirements and the Limits of Digital Health Rachel Gershon October 16, 2018
Medicaid work requirement status Pending Approved Invalidated by a court Based on Kaiser Family Foundation, State Health Facts, Approved Section 1115 Medicaid Waivers and Pending Section 1115 Medicaid Waivers, September 28, 2018
How can states ensure that they are exempting all recipients who are unable to work?
Disability and work Determined Disabled Not Able to Work; Not determined disabled Able to Work
Example 1: Quick determination Determined Disabled Not Able to Work; Not determined disabled Able to Work
Example 2: Slow determination Not Able to Work; Not determined disabled Determined Disabled Able to Work
Example 3: Retains ability to work Not Able to Work; Not determined disabled Determined Disabled Able to Work
Example 4: In and out of ability to work Not Able to Work; Not determined disabled Determined Disabled Able to Work
Example 5: Not able to work Not Able to Work; Not determined disabled Determined Disabled Able to Work
Disabilityand work Not Able to Work; Not determined disabled Determined Disabled Able to Work
Data Matches for disability determinations • Social Security Administration • Veteran’s Affairs • SNAP • Other federal and state agency determinations
Data match for disability determinations Not Able to Work; Not determined disabled Determined Disabled Able to Work
Consequences of Medicaid loss • Access to health care • Financial protection • Access to employment • Access to disability determinations • Access to medical professional • Substantial gainful activity
Example 2: slow determination Not Able to Work; Not determined disabled Determined Disabled Able to Work
Access to medical professional Not Able to Work; Not determined disabled Determined Disabled Able to Work
Substantial gainful activity Not Able to Work; Not determined disabled Determined Disabled Able to Work
Data match for disability applications Not Able to Work; Not determined disabled Determined Disabled Able to Work
Who is not applying for SSA benefits? • Including disability income applicants mitigates the substantial gainful activity issue, but leaves other populations out. • Not yet gathered the information to apply • Does not meet SSA disability standards
Consequences of Medicaid loss Not Able to Work; Not determined disabled Determined Disabled Able to Work
Claims analytics • Diagnoses • Medical expenditures • Social determinants of health
Claim analytics Not Able to Work; Not determined disabled Determined Disabled Able to Work
Consequences of Medicaid loss • Medicaid as a work support • “A large majority of employed Group VIII enrollees (83.5%) reported that Medicaid made it easier to work; most unemployed enrollees (60.0%) reported that Medicaid made it easier to look for work.” • “[Medicaid] allows me to get surgery which has allowed me to return to work.” -Ohio Group VIII evaluation
Consequences of Medicaid loss Determined Disabled Not Able to Work; Not determined disabled Able to Work
Example 5: Not able to work Not Able to Work; Not determined disabled Determined Disabled Able to Work
Going analog • Self-report • Process for analyzing self-report • Who bears the burden of uncertainty?
Are work requirements worth it? • Needle in a haystack • Medicaid as a work support • Potential for disrupting disability determination process
Discussion • Standards for determining disability • Processes for determining disability • Role of technology • Effectiveness of work requirements
