How Do Medicaid Buy-In Participants Compare with Other Medicaid Enrollees with Disabilities?
Mathematica^® Brief Notes Participants Had Lower Medicaid Expenditures and
Were More Likely to Receive Treatment for Psychiatric Conditions

Contact: Cheryl Pedersen, (609) 275-2258

WASHINGTON, D.C. (July 16, 2007)—Promoting employment for people with disabilities is an important policy objective for the nation. The fifth policy brief in a Mathematica series examining the Medicaid Buy-In program uses Medicaid eligibility and claims data from eight study states to compare the demographics, health status, and Medicaid expenditures of Buy-In participants with individuals enrolled in Medicaid because they have a disability, but not taking part in the Buy-In program. The brief notes that on average, Buy-In participants cost Medicaid $984 per-member per-month (PMPM) in 2000, almost 40 percent lower than the cost of other Medicaid enrollees with disabilities. Buy-In participants with only a single psychiatric condition cost less PMPM than participants with a single nonpsychiatric condition or participants with multiple conditions.

“We found that Buy-In participants had consistently lower per-member per-month Medicaid expenditures than other Medicaid enrollees with disabilities, regardless of the nature of their health conditions,” said lead author Jody Schimmel, a researcher at Mathematica. “Even though many other factors could contribute to this difference, Buy-In participants do not cost Medicaid more than other enrollees with disabilities, on average. However, program costs could rise if the program attracts many working adults not previously enrolled in Medicaid.”

Medicaid Buy-In, a key component of the federal effort to help people with disabilities return to work without losing health insurance coverage, allows adults with disabilities to earn more than would otherwise be possible and still keep their Medicaid coverage. In return, they “buy into” Medicaid, typically by paying premiums based on income. Without the program, many would have limited health insurance options, despite the fact that they need coverage to enter or remain in the work force. As of December 2006, 33 states had Buy-In programs with total nationwide enrollment of 80,871.

Additional findings include:

Diagnoses: Buy-In participants were more likely to receive treatment for psychiatric conditions than other similar Medicaid enrollees with disabilities. However, they were less likely to be treated for cardiovascular, nervous system, skeletal and connective, pulmonary, and gastrointestinal ailments.

Demographics: Approximately 51 percent of Buy-In participants were male, compared with 45 percent of other Medicaid enrollees with disabilities. Buy-In participants were also more likely to be white (82 percent compared with 71 percent) and of “prime working age,” defined as 25 to 54 years of age (80 percent compared to 69 percent).

For this study, researchers analyzed Medicaid claims data from the year 2000. Only the eight states (Connecticut, Iowa, Maine, Massachusetts, Minnesota, Oregon, Vermont, and Wisconsin) that had enrolled more than 300 people in the Buy-In program by the end of 2000 were included. Combined Buy-In enrollment for these states was 19,086 during 2000. As of December 31, 2006, these same states had Buy-In enrollment of 43,147.

“How Do Buy-In Participants Compare with Other Medicaid Enrollees with Disabilities?” by Jody Schimmel, Carol V. Irvin, and Su Liu is on the web at www.mathematica-mpr.com/publications/redirect_pubsdb.asp?strSite=pdfs/WWDcompare.pdf. Printed copies are available from Publications, (609) 275-2350. Previous briefs from the study, conducted for the Centers for Medicare & Medicaid Services, looked at participant characteristics, overall and increases in earnings, and federal initiatives that help workers with disabilities access health insurance. To access the briefs, go to www.mathematica-mpr.com/disability/medicaidbuy-in.asp.

Mathematica, a nonpartisan firm, conducts policy research and surveys for federal and state governments, foundations, and private-sector clients. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted some of the most important studies of disability, health care, early childhood policies, welfare, education, employment, and nutrition programs in the U.S. Mathematica strives to improve public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on the provision of information collection and analysis to its clients.

#####