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Working with Disability: Who Are the Top Medicaid Buy-In Earners?
More Likely to be Young and Nonwhite Than Participants Overall
Contact: Cheryl Pedersen, (609) 275-2258
WASHINGTON, D.C. (March 19, 2007)—Promoting employment for people with disabilities is an important policy objective for the nation. The third policy brief in a new Mathematica series examining the Medicaid Buy-In program finds that top earners are more likely to be young and nonwhite than program participants overall.
The program, 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” the Medicaid program, typically by paying premiums based on income. Without the program, many would have limited health insurance options, despite the fact that they need adequate coverage to enter or remain in the work force. As of June 2006, 33 states were operating a Medicaid Buy-In program to extend Medicaid coverage to working people with disabilities, with total nationwide enrollment of nearly 76,000.
Findings for top Buy-In program earners in 2004 show that they:
- Earned at least $16,205 annually, or $25,231 on average—equal to 271 percent of the 2004 federal poverty level. In contrast, average earnings for the remaining 90 percent of Buy-In participants were just $5,248.
- Were typically younger than Buy-In participants overall. Sixty percent of top earners were 21 to 44 years old, whereas just 37 percent were 45 to 64 years old. The younger group accounts for only 45 percent of all participants, while the older group accounts for 53 percent.
- Were more likely than participants overall to be nonwhite. Although nonwhites accounted for about 20 percent of total Buy-In participants, they made up almost twice that share among top earners (38 percent).
- Were less likely than participants overall to have received payments from the Supplemental Security Income or Social Security Disability Insurance programs in the year before enrolling in the Buy-In program. Nearly 79 percent of top earners did not receive federal disability benefits in the year before enrollment.
“State policymakers may want to examine features of particular programs that attract certain workers,” said Gilbert Gimm, lead author and a researcher at Mathematica. “Programs that attract younger workers with disabilities may have a greater long-term impact on employment than programs that attract older workers who may be retiring soon. At the same time, policymakers should not lose sight of the program's broader goal: to promote employment opportunities for adults with disabilities who want to enter or increase their involvement in the workforce.”
Mathematica's researchers built data files for this analysis from state enrollment records linked with the Social Security Administration's Master Earnings File, which contains annual earnings information reported on W-2s to the IRS from nearly all workers in the U.S. These data are part of a new longitudinal person-level database on Buy-In participants that also contains information from the Supplemental Security Income and Social Security Disability Insurance programs, and from Medicaid and Medicare programs. The database was made possible through a broad interagency effort to build a comprehensive system for monitoring the employment, health care, and public program participation of people with disabilities.
“Who Are the Top Earners in the Medicaid Buy-In Program?” by Gilbert W. Gimm, Henry T. Ireys, and Caitlin Johnson is on the web at www.mathematica-mpr.com/publications/redirect_pubsdb.asp?strSite=pdfs/WWDtopearners.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 the overall earnings of all Buy-In program participants and federal initiatives that help workers with disabilities access health insurance. Forthcoming briefs will focus on other strategies for monitoring the Buy-In program, including examining how earnings change over time in response to the program and on Medicaid expenditures for selected groups of participants. 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.