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Issue Brief Examines Outcomes for People with Disabilities Who Leave the Medicaid Buy-In Program
Average Employment Rate and Earnings Decline in the Year After Leaving
Contact: Joanne Pfleiderer, (609) 275-2372
PRINCETON, N.J. (September 24, 2009)—Working-age adults with disabilities need adequate health insurance to enter or remain in the work force, but their options are limited. Because of pre-existing conditions, many are not covered by employers’ health insurance. Others who work part-time or have jobs that do not offer health insurance turn to government-sponsored programs such as Medicaid, but some earn more than the allowable amount and are ineligible. The Medicaid Buy-In program helps adults with disabilities earn more than would otherwise be possible and retain Medicaid coverage. In return, participants “buy into” Medicaid, usually by paying premiums based on income. At the end of 2008, 37 states reported covering 92,446 people in the Medicaid Buy-In program.
A new study from Mathematica® explores the paths of participants who leave the Medicaid Buy-In program, finding that their earnings and employment rates decline after disenrollment. The authors also examine the prevalence and characteristics of those who leave the program, as well as their participation in other public programs. They answer two fundamental questions:
- Do individuals leave the Medicaid Buy-In program because higher earnings disqualify them, or do they leave for other reasons, such as loss of employment?
- Are individuals less dependent on public assistance after they leave the Medicaid Buy-In program?
The brief notes that more than 176,000 people from 31 states enrolled in the Medicaid Buy-In program for the first time between 2000 and 2006; 43 percent of this group left the program and did not re-enroll for at least 12 months. On average, disenrollees spent 13.6 months in the program. During the year before enrolling, about one-third of disenrollees were covered by Medicaid, 8 percent were covered by Medicare, and 43 percent were covered by both programs for at least one month. Immediately after leaving the Buy-In program, nearly a quarter (22 percent) had no Medicaid or Medicare coverage; one year after leaving the program, somewhat fewer (17 percent) still lacked Medicaid or Medicare coverage.
The researchers looked at the period beginning in the year before enrollment and continuing to the year after disenrollment, finding both a drop in the employment rate and in the percentage with earnings above the substantial gainful activity level. This pattern suggests that loss of employment may be a common reason for disenrollment.
One year before enrolling in the program, about 72 percent of disenrollees reported positive earnings; in the year after leaving, however, only 52 percent reported positive earnings. Those who reported earnings above the substantial gainful activity level also fell by 27 percent in the year after disenrollment. Even so, nearly 30 percent of those who left the program improved their earnings from one period to the next.
According to Su Liu, a senior researcher at Mathematica, “The Buy-In program was envisioned as a pathway for workers with disabilities to maintain public health coverage while boosting earnings, but many participants had lower earnings after leaving the program. Studying the path of successful participants can suggest ways to improve outreach and design, and to help the program become the bridge to sustained employment it was intended to be.”
What Happens to Medicaid Buy-In Participants After They Leave the Program? by Su Liu and Mathematica researcher Silvie Colman is available at http://www.mathematica-mpr.com/publications/pdfs/disability/WWDDisenrollees.pdf. This issue brief, the ninth in a series on workers with disabilities, was prepared by Mathematica under contract with the Centers for Medicare & Medicaid Services. For other briefs in this series, please visit the Mathematica website at http://www.mathematica-mpr.com/disability/medicaidbuy-in.asp.
Mathematica, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research methods and standards, and program management/data system support, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.