Alexis D. Henry, ScD; Frederick Hooven, MMHS; Lobat Hashemi, MS; Jay Himmelstein, MD, MPH

1. Disability And EmploymentFindings from a survey of Massachusetts Medicaid Buy-In Program enrollees with disabilities

2. Alexis D. Henry, ScD; Frederick Hooven, MMHS; Lobat Hashemi, MS; Jay Himmelstein, MD, MPH Center for Health Policy and Research Commonwealth Medicine University of Massachusetts Medical School

3. INTRODUCTION • Adults with disabilities are at significant risk for unemployment • Many adults with disabilities want to work, but face barriers at both individual and environmental levels • Individual barriers may include type and severity of disability, lack of education and poverty • Environmental barriers may include lack of relevant services, stigma, and real and perceived disincentives in the disability benefit systems

4. Because of high health care costs, many people with disabilities fear losing health insurance (Medicare and Medicaid) if earnings from work are too high • Federal legislation – BBA of 1997 and TWWIIA of 1999 – aimed to reduce this barrier by encouraging states to create Medicaid buy-in programs • Buy-in programs allow people with disabilities who work to “buy into” Medicaid through premiums and deductibles

5. The MassHealth CommonHealth Program • Massachusetts’ Medicaid buy-in program • Created in 1988 under Governor Dukakis • Provides health insurance for adults with disabilities with income too high to qualify for standard Medicaid (over 133% FPL) • Those working 40 hours/month pay income adjusted premium • Those not working or working under 40 hours/month pay one time, income adjusted deductible

6. STUDY GOAL To examine relationship between type of disability and indices of participation in employment among CommonHealth enrollees Specific Research Questions • Does disabling condition predict current employment status among CommonHealth enrollees? • Among currently employed enrollees, does disabling condition predict work effort? • Among currently unemployed enrollees, does disabling condition predict past work and future work intention?

7. 2. Does disabling condition continue to be a significant predictor of employment participation even after demographic variables are controlled for?

8. METHOD • Conducted under the Massachusetts Medicaid Infrastructure Grant (MMIG) • Funded by Centers for Medicare and Medicaid Services • Promotes employment of people with disabilities and access to CommonHealth • The MassHealth Employment and Disability Survey (MHEDS) • Designed to gather data on disability, health, employment status and barriers to employment among MassHealth members with disabilities

9. Administration of the MHEDS • 136 item Survey • Developed with stakeholder input • Fielded by Center for Survey Research at UMass-Boston in summer-fall 2003 • Mailed with telephone follow-up; English and Spanish versions • SAMPLE • 1952 randomly selected CommonHealth members with disabilities across the state • ages 18-64 • Enrolled for at least 6 months • 1166 respondents – 60% response rate

10. RESULTS Table 1: Respondent Characteristics (n=1166)

11. Table 2: Work Participation Among Respondents

12. Table 3. Predicting employment status from disabling conditions* (n=1166)

13. Table 4: Predicting work effort from disabling condition* (n=563)

14. Table 5: Predicting past work and future work intention from disabling condition* (n=603)

15. DISCUSSION • Among people with disabilities in a Medicaid buy-in program, type of disability does predict participation in employment, even after controlling for demographic variables • At the greatest risk for unemployment • People with physical/mobility problems • People with mental/emotional problems • People with long-term illnesses • Most likely to work • People with developmental disabilities

16. Among those currently employed • People with physical disabilities, mental disorders and developmental disorder are more likely to work fewer hours than those with other disabling conditions • Across disabling conditions, work effort appears least favorable for people with mental disorders, who are more likely to work fewer hours, have lower earnings and shorter job tenure than those with other conditions

17. Among those currently unemployed • People with developmental disabilities and sensory disorder are much less likely to have ever worked than those with other conditions • People with physical disabilities are more likely to have a longer period of unemployed and are less likely to intend to work in the future than those with other conditions • People with mental disorders who are not currently working are no less likely to have worked in the past or intend to work in the than those with other conditions

18. CONCLUSION • Disabling condition is an important predictor of participation in employment among people with disabilities, and should be considered in evaluations of the impact of Medicaid Buy-In Programs • People with different types of disabling conditions may need different types of services to support their employment efforts

19. Our study shows people are earning less than 10K, which is under SGA, • Given the part time hours and low earnings reported by many workers, it appears that obstacles to full employment and economic self-sufficiency remain, even for participants in a Medicaid buy-in program, which is designed to removed a major barrier to employment for people with disabilities • Next steps will be to examine include looking at other factors to employment.

20. Acknowledgements • We thank the following colleagues for their contributions to this project: • Center for Health Policy and Research • Abbie Averbach, Steven Banks, Robin Clark, David Jarzobski, Jennifer Katz, Susan Murray, Leslie Olin, Jaiying Zhang • Center for Survey Research, UMass-Boston • Patricia Gallagher, Vickie Stringfellow, Carol Cosenza • Executive Office of Health and Human Services, Office of MassHealth • Ellie Shea-Delaney, Annette Shea