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Medicaid Buy-In Participants with Severe Mental Illness
Mathematica Brief Provides Profile of Recipients and Service Use

Media Advisory: August 30, 2010

Contact: Cheryl Pedersen, (609) 275-2258

Issue: Individuals who experience the onset of severe mental illness may not be able to work full time due to recurring episodes or the need for treatment. Many may seek part-time jobs to better cope with their conditions. While appropriate treatment may facilitate the continuation of work, few part-time jobs offer health insurance.

The Medicaid Buy-In program makes it easier for people with disabilities to maintain their health insurance while working. The program allows states to extend Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid. More than one third of the program’s participants are diagnosed with some form of severe mental illness.

An issue brief from Mathematica Policy Research, the eleventh in a series on workers with disabilities, provides an in-depth profile of Buy-In participants who have severe mental illness and compares their characteristics, employment experiences, and medical expenditures with those of other program participants.

Findings: To evaluate demographics, characteristics, and program service use for participants in the Medicaid Buy-In with severe mental illness, the study linked state-level data on program participation to demographic and diagnosis information in the Social Security Administration’s 2008 Ticket Research File, medical expenditure data from Medicaid and Medicare claims records, and annual earnings information derived from tax records. Using these data, participants with a primary disabling condition of severe mental illness were compared to participants diagnosed with other disabling conditions. Differences by type of mental illness were also considered. Main findings include:

  • Except for a few significant differences, Buy-In participants with severe mental illness were demographically similar to those with other disabling conditions.
  • Participants with severe mental illness used fewer or less expensive services than other participants.
  • Compared with other participants, a greater percentage of those with severe mental illness had at least one year of positive earnings during the time they were enrolled in the Buy-In and were more likely than other participants to increase their earnings from the year before to the year after enrollment.
  • Experiences differed among sub-groups of participants with severe mental illness. For example, participants with schizophrenia were more likely to work than participants with diagnoses of affective disorders or anxiety disorders, but also had the highest medical expenditures. Participants with anxiety disorders earned more than the other two sub-groups.

Quote: “This study suggests that Medicaid Buy-In participants with severe mental illness have better employment outcomes than participants with other disabling conditions, at least in the short to medium term,” says Sarah Croake, co-author and analyst at Mathematica. “This information can help policymakers as they design programs and target services for participants."

Issue Brief: "How Are the Experiences of Individuals with Severe Mental Illness Different from Those of Other Medicaid Buy-In Participants?" Working with Disability Work and Insurance In Brief #11, Su Liu and Sarah Croake, August, 2010.

About Mathematica: Mathematica Policy Research, 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 assessment and interpretation, and program performance/data management, 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, international, disability, education, family support, employment, nutrition, and early childhood policies and programs.