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Iowa s Medicaid Buy-In

Iowa Medicaid Overview. Iowa currently has approximately 357,000 Medicaid Members eligible for full benefits in a given monthChild 200,000Adult 57,000Aged 30,000Disabled 70,000Additional 55,000 in limited benefit programsAnother 15,000 kids in T-XXI Medicaid ExpansionTotal Medicaid Se

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Iowa s Medicaid Buy-In

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    1. Iowa’s Medicaid Buy-In Matthew Haubrich NASMD Fall Conference – Session H November 10, 2009

    2. Iowa Medicaid Overview Iowa currently has approximately 357,000 Medicaid Members eligible for full benefits in a given month Child – 200,000 Adult – 57,000 Aged – 30,000 Disabled – 70,000 Additional 55,000 in limited benefit programs Another 15,000 kids in T-XXI Medicaid Expansion Total Medicaid Services ~$230m per month

    3. Buy-In Program Overview Started in 2000 Current enrollment approximately 13,000

    4. Iowa’s Buy-In Eligible up to 250% of FPL Beyond 150%, monthly premium is charged About 24% pay a premium Must have some earned income each month Earned income tends to be modest Average = $161/month (median = $30/mo) Majority are self-employed Child care, cleaning, chores Most work less than 10 hours per week Data Sources: Eligibility data (IABC) and annual member surveyData Sources: Eligibility data (IABC) and annual member survey

    5. Do MBI members have different costs than other disabled members? Examined claims data Working age adult recipients (age 18 – 64) 36 claims months (July 2007 – June 2009) Average for ALL recipients was $906/month Non-MBI disabled recipients average $1752/month MBI recipients average $526/month Based on this analysis, it appears that MBI members are more similar to non-disabled adult members, at least in terms of cost per recipient.

    6. Do those who earn more have lower healthcare costs? Looked at MBI members paying a premium vs. those not paying a premium Premium kicks in over 150% FPL Premium paying recipients cost the Medicaid program approximately $65/mo less than those MBI recipients not paying a premium

    7. Do those who earn more have lower healthcare costs? Looked at MBI members earning less than $50/month (61% of all members) Within the range of $0 - $50 per month in earnings, each additional dollar earned is correlated with $1.05 less in monthly healthcare costs to Medicaid No evidence for causality

    8. Does working reduce healthcare costs? Examined claims data Recipients both on MBI and a non-MBI disability eligibility category Approximately 5,000 members met the criteria While on MBI, monthly costs per recipient were approximately $250/month less than when the same members were not in the buy-in (and presumably not working) It appears that working and healthcare costs are negatively correlated Can’t necessarily say that there is a causal relationship

    9. Summary Much research over the years has shown the link between work and health Analysis of Iowa’s data suggests evidence for this link, although not proof that work leads to lower healthcare costs Buy-In members costs are more like those of the general working-age adult Medicaid population than other disabled members Buy-In members with greater earnings appear to have lower healthcare costs Members who have been on the Buy-In program have significantly lower costs while on the Buy-In than when not on the Buy-In

    10. Contact: Matthew Haubrich Bureau Chief Bureau of Research and Statistics Division of Results Based Accountability Iowa Department of Human Services mhaubri@dhs.state.ia.us o: (515) 281-5232 f: (515) 281-4243 Thank You! 10

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