MassHealth, Disability and Employment: Annual Update

1
MassHealth, Disability and Employment Annual
Update
Massachusetts Medicaid Infrastructure and
Comprehensive Employment Opportunities (MICEO)
Grant
The Massachusetts Medicaid Infrastructure and
Comprehensive Employment Opportunities Grant
(MICEO) is a collaborative project of the
Massachusetts Executive Office of Health and
Human Services, the Institute for Community
Inclusion at UMass Boston, and the Center for
Health Policy and Research at UMass Medical
School. This grant is funded by the Centers for
Medicaid and Medicare Services (CFDA 93-768).
2
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

3
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

4
Trend in the Employment Rate of Working-Age
Persons, by Reporting of Work Limitation (CPS)

• In the year 2000, the employment rate for people
  with disabilities was 32.8 compared to 88.1 for
  people without disabilities.
• In the 1980s, employment trends of people with
  disabilities, while lower, kept pace with
  employment trends among people without
  disabilities.
• In the 1990s, however, the employment gap widened.

Percent
Source The Decline in Employment of People with
Disabilities, A Policy Puzzle, David C. Stapleton
and Richard V. Burkhauser, Editors 2003
5
Employment Rates of Individuals with Disabilities
Compared to Non-Disabled in MA, CPS(Adults 18
64)
From 1996 2002, the gap in employment between
people with disabilities and without in
Massachusetts has widened.
Source Houtenville, Andrew J. 2005. Disability
Statistics in the United States. Ithaca, NY
Cornell University Rehabilitation Research and
Training Center, www.disabilitystatistics.org .
Posted May 15, 2003. Accessed March 07, 2005.
6
Employment Rates of Individuals with
Disabilities, The Nation Compared to MA, CPS
(Adults 18 64)
The employment rate of people with disabilities
in MA is almost 10 lower than in the Nation.
Source Houtenville, Andrew J. 2005. Disability
Statistics in the United States. Ithica, NY
Cornell University Rehabilitation Research and
Training Center, www.disabilitystatistics.org .
Posted May 15, 2003. Accessed March 07, 2005.
7
Employment Characteristics of Individuals with
Disabilities Compared to Non-Disabled in MA,
Census 2000 (Adults 18 64)

• People who reported a disability in Census 2000
  were less likely to have worked in the last 6
  years than people without a disability.

Source Employment of People with Disabilities
2000 Census Data from Three States, Allard E.
Dembe, Sc.D., Fred Hooven, M.M.H.S., Rachel
Delbos, M.S., Leslie Olin, B.A., Jay
Himmelstein, M.D., M.P.H.
8
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

9
Why is there an employment gap?

• Barriers to employment
• Fear of loss of benefits
• Health care benefits and cash
• Housing benefits
• Lack of access to support services
• Transportation, personal care, education and
  training
• Historical emphasis on sheltered versus
  competitive employment.
• Environmental barriers
• Health and functional status

10
Why is there an employment gap?

• The widening gap in the 1990s
• Increasing severity of disabilities.
• Passage and implementation of the ADA in 1990.
• Greater social acceptability of disability
  status
• Heightened employer awareness.
• Easing of eligibility standards and increases in
  the relative benefits of Social Security
  disability programs.

Source The Decline in Employment of People with
Disabilities, A Policy Puzzle David C.
Stapleton and Richard V. Burkhauser, Editors 2003
11
Response Changes in Public Policy

• National legislation was designed to address some
  of these contributing factors
• Ticket to Work and Work Incentives Improvement
  Act, 1999
• New Freedom Initiative, 2001
• Medicaid Buy-in Programs (CommonHealth Working in
  MA)
• Addresses the health insurance barrier.

Source Real Trends Or Measurement Problems?
Disability And Employment Trends From The Survey
Of Income And Program Participation, Elaine M.
Maag, David C. Wittenburg May 2003
12
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

13

• The prospect of losing publicly funded health
  insurance is a significant barrier to entering
  the workforce or returning to work for
  individuals with disabilities.
• Medicaid buy-in programs are designed to remove
  this barrier, and promote employment for people
  with disabilities, by providing health insurance
  and allowing the continuation of health insurance
  coverage after the return to work.

Source The Massachusetts CommonHealth Plan for
Working Adults with Disabilities Volume 1
Administrative Data 1996-2003
14
What Programs does MassHealth Offer for Working
Age Adults with Disabilities?
MassHealth Offers Three Insurance Programs for
Working Age Adults with Disabilities
15
CommonHealth Working PlanMember Benefits

• CommonHealth Working covers services not
  typically covered, or only partially covered by
  commercial health insurance plans or Medicare.
• Benefits for medically necessary care
• Physician Care
• Acute and Chronic Care Services
• Personal Care Attendant Services
• Pharmacy Benefits
• Medical Transportation
• Durable Medical Equipment

16
Percent of enrollment in CommonHealth Working
(CHW) among all MassHealth programs for people
with disabilities, FY 2003 Ages 18 - 64
The vast majority of people with disabilities in
MassHealth are enrolled in the MassHealth
Standard program.
Source UBER Eligibility Snapshot Data FY03,
Adults Only
17
CommonHealth Working Enrollment Patterns, Data
Snapshot June 30, FY 1996 - 2005 (Ages 18 64)
Number of Members
1115 DemonstrationWaiver Implemented
Enrollment in the CommonHealth Working program in
2005 is 5.5 times what it was in 1996.
Source MMIS Eligibility Data-Snapshot as end of
each FY. FY 96-99, Data as of June 00 FY
00-01-Data as of May 05 FY 02-05 Data as of Dec
06
18
Percentage of All Disabled Members Enrolled in
CommonHealth Working FY 1996 - 2005 (Ages 18
64)
The percentage of all working age Disabled
Members enrolled in CommonHealth Working
increased nearly five times from FY 1996 to FY
2005
Source MMIS Eligibility Data-Snapshot as end of
each FY. FY 96-99, Data as of June 00 FY
00-01-Data as of May 05 FY 02-05 Data as of Dec
06
19
Some Characteristics of CommonHealth Working
Members with Disabilities (Ages 18 64)

• People with disabilities have a variety of
  potentially disabling conditions
• Mental or emotional problems 53
• Physical conditions 38
• Long term illnesses 28
• Developmental disabilities 12
• Head injuries 8
• Sensory disorders 5
• Total percentage exceeds 100 as respondents
  could indicate more than one condition

Source MassHealth Employment and Disability
Survey, 2003
20
Percentage of CommonHealth Working Members by
Federal Poverty Level, FY 2005(Ages 18 64)
There is no income limit for CommonHealth Working
eligibility. Still, approximately 80 of
CommonHealth Working members have incomes below
250 of the 2005 FPL (1993 per month for an
individual, or 4031 for a family of four).
Data Source Eligibility MMIS FY 2005 as of Dec
05
21
Distribution of CHW Member Expenditures by
Service Type FY 2005
The majority of spending for CHW members is for
prescription drugs community services
(including PCA services).
Note Dental Coverage is No Longer Offered by
MassHealth
Source MMIS Claims Data Expenditures MBHP
HMO data is NOT included. (Disburse Zero) Date
as of July 05
22
Percent of Total Cost of CommonHealth Working and
Standard Disabled Members By Invoice Types FY
2005, (Ages 18 64)
CommonHealth Working members use more pharmacy
services as a proportion of all services than
Standard Disabled members.
Invoice Type
Source MMIS Claims Data Expenditures (Disburse
Zero) Date as of July 05
23
PMPM Cost Expenditures for CommonHealth Working
and Standard Disabled MembersFY 1999
2003,(Ages 18 64)
(Expenditures NOT Adjusted for Inflation)
PMPM Medicaid expenditures have been consistently
lower for CommonHealth Working members than for
Standard Disabled members since 1999.
Source MMIS Claims Data Expenditures (Disburse
s Zero) Date as of June 05
24
Comparison of Commercial and Medicare Coverage
for CommonHealth Working and Standard Disabled
Members FY 2005 (Ages 18 64)
A higher percentage of CommonHealth Working
(13.2) than Standard Disabled members (4.6)
have other health insurance coverage.
71.4
6.8
7.1
48.6
57.5
1.9
2.6
44.1
Data Source Eligibility MMIS FY 2005- Data as
of Dec 05
25
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

26
Employment Rate for MassHealth Members with
Disabilities by Type of Disabling Condition
(Adults 18 64)
Estimated rate of employment of all adults with
disabilities in MassHealth is 17
Source MassHealth Employment and Disability
Survey, 2003
27
Number of Hours Worked per Week by Workers with
Disabilities in MassHealth (Adults 18 64)

• 70 of workers report working 20 hours per week
  or less.
• Those working more hours per week tend to be more
  highly educated and to be white.

Source MassHealth Employment and Disability
Survey, 2003
28
Annual Earnings Among Workers with Disabilities
in MassHealth (Adults 18 64)

• Over 70 of workers report annual earnings of
  10,000 or less. It appears that many workers
  have earnings that would keep them under SGA
  (800/month in 2003).
• Higher earners are more likely to be male, older
  and white.

SSDI recipients can earn up to the Substantial
Gainful Activity (SGA) limit without losing their
cash benefits.
Source MassHealth Employment and Disability
Survey, 2003
29
Job Tenure Among Workers with Disabilities in
MassHealth (Adults 18 64)

• A majority of workers report holding their
  current jobs for more than one year.
• Workers with longer job tenure are more likely to
  be older, male and English-speaking.

Source MassHealth Employment and Disability
Survey, 2003
30
Employer-Based Health Insurance Among Workers
with Disabilities in MassHealth (Adults 18 64)

• Only 10 of all workers have employer-based
  health insurance.
• 23 of full-time workers and 7 of part-time
  workers receive employer based insurance.

Source MassHealth Employment and Disability
Survey, 2003
31
Summary Job Characteristics

• Most working MassHealth members with disabilities
  work part-time and have low earnings.
• But job tenure is relatively long and job
  satisfaction is relatively high among these
  workers.

32
Unemployed Members with Disabilities

• 82 of unemployed members have worked for pay in
  the past
• Of these members, almost 30 have worked within
  the past 2 years.
• Many unemployed members want to work
• Survey findings suggest that over 40 of members
  are either looking for work or hope to work
  within the next few years.

33
Survey findings suggest that, from an employment
perspective, there are 3 groups of MassHealth
members with disabilities

• Workers currently working at a job for pay
• Potential workers not currently working, but
  either looking for a job or planning to work in
  the next few years
• Non-workers not currently working and not
  planning to work in the next few years

How do these three groups differ?
Source MassHealth Employment and Disability
Survey, 2003
34
Workers, Potential Workers and Non-Workers in
MassHealth Member Characteristics(Ages 19-64)

• Workers and potential workers are significantly
  more likely to be younger and more highly
  educated than non-workers.

Values with different superscripts are
significantly different from each other at plt.05
Source MassHealth Employment and Disability
Survey, 2003
35
Workers, Potential Workers and Non-Workers in
MassHealth Number of Disabling Conditions(Ages
19-64)

• Workers report significantly fewer disabling
  conditions than potential workers and
  non-workers.
• Potential workers report significantly fewer
  disabling conditions than non-workers.

All pairwise comparisons significantly different
at plt.05.
Source MassHealth Employment and Disability
Survey, 2003
36
Workers, Potential Workers and Non-Workers in
MassHealth Overall Health Status (Ages 1964)

• Workers report significantly better overall
  health than potential workers and non-workers.
• Potential workers report significantly better
  overall health than non-workers.

All pairwise comparisons significantly different
at plt.05.
Source MassHealth Employment and Disability
Survey, 2003
37
Workers, Potential Workers and Non-Workers in
MassHealth Secondary Health Problems(Ages 1964)

• Workers report significantly less fatigue,
  anxiety/ depression, and pain than non-workers,
  and less anxiety/depression and pain than
  potential workers.
• Potential workers report significantly less pain
  than non-workers.

Fatigue Workers significantly different than
non-workers at plt.05 Anxiety/Depression Workers
significantly different than potential workers
and non-workers at plt.05 Pain All pairwise
comparisons significantly different at plt.05
Source MassHealth Employment and Disability
Survey, 2003
38
Workers, Potential Workers, and Non-Workers in
MassHealth Daily Activity Limitations(Ages
1964)

• Workers are significantly less likely to report
  any limitation than non-workers.
• Potential workers are significantly less likely
  to report limitations in chores, self-care and
  moving around inside than non-workers.

Concentrating and Getting Out Workers
significantly different than potential workers
and non-workers at plt.05. Self-care Workers and
potential workers significantly different than
non-workers at plt.05. Chores and Moving Around
Inside all pairwise comparisons significantly
different at plt.05.
Source MassHealth Employment and Disability
Survey, 2003
39
Health of Workers, Potential Workers and
Non-Workers

• Across multiple indicators of health, workers
  have better health than potential workers and
  non-workers.
• Potential workers do report more health
  challenges than workers, however, they have
  better overall health than non-workers.

40
What barriers to employment may keep people with
disabilities from working or from earning more?

• Health challenges 62 of MassHealth members with
  disabilities report fair or poor health
• 86 of unemployed members report not working
  because of health or disability
• Limited education 71 of members have a high
  school education or less
• Problems with transportation 35 of members
  report difficulty with transportation
• Discouraged from work by health care providers
  35 of members report having a health care
  provider tell them not to work.
• Discouraged from work by their family members
  20 of members report having family members tell
  them not to work.
• Concerns about losing SSDI/SSI cash benefits 7
  of unemployed members report not working because
  of fear of loss of cash benefits
• Concerns about losing MassHealth or Medicare 6
  of unemployed members are concerned they will
  lose MassHealth or Medicare if they return to
  work.

Source MassHealth Employment and Disability
Survey, 2003
41
Outline

• The low employment rate of people with
  disabilities is a persistent problem in
  Massachusetts and the Nation.
• Why is there such a substantial employment gap
  and why did it increase?
• Medicaid programs address a significant barrier
  to employment access to health insurance.
• Disabled workers are still earning less than
  hoped, and many who want to work are not working.
• The role of the MICEO in improving employment
  outcomes.

42
Medicaid Infrastructure and Comprehensive
Employment Opportunities Grant (MICEO)

• MICEO is funded by the Centers for Medicare and
  Medicaid Services (CMS) under the New Freedom
  Initiative designed to remove barriers to
  community living for people with disabilities
• Began in 2004, funded for 4 years at 1.5 million
  per year
• A collaborative effort of Executive Office of
  Health and Human Services (EOHHS), the Institute
  for Community Inclusion (ICI) at UMass Boston,
  and the Center for Health Policy and Research
  (CHPR) at UMass Medical School (UMMS).

43
MICEO Grant Leadership

• EOHHS Sponsors Beth Waldman Gerry Morrissey
• Project Direction
• Eleanor Shea-Delaney and Annette Shea, EOHHS
• Jay Himmelstein and Abbie Averbach, CHPR/UMMS
• William Kiernan and Cindy Thomas, ICI/UMASS
  Boston
• Grant Leadership Team
• 6 Agency members, 6 consumer representatives
• Mass. Rehabilitation Commission
• Department of Mental Retardation
• Department of Transitional Assistance
• Mass. Commission for the Blind
• Division of Workforce Development
• Department of Mental Health

44
MICEO Grant Organizational Chart
Authorizes
Executive Office of Health and Human Services
(EOHHS) Office of MassHealth, Beth Waldman Office
of Disability and Community Services, Gerry
Morrissey

• EOHHS Strategic Task Force on Employment
• MA Rehabilitation Commission
• Department of Transitional Assistance
• Department of Social Services
• Department of Mental Retardation
• Department of Mental Health
• Department of Veterans Services
• Massachusetts Office of Refugees and Immigrants
• Massachusetts Commission for the Deaf and Hard of
  Hearing
• Department of Youth Services
• Department of Workforce Development
• Department of Education
• Institute for Community Inclusion, UMass Boston
• Center for Health Policy and Research, UMass
  Medical School

• MICEO Grant Leadership Team
• MA Rehabilitation Commission
• Division of Transitional Assistance
• Department of Work Force Development
• Department of Mental Health
• Department of Mental Retardation
• 6 Consumers

Provides recommendations
Supports provides information
MICEO Grant Management Team Project Co-Director
Eleanor Shea-Delaney (EOHHS) Jay Himmelstein
(CHPR) William Kiernan (ICI)
Informs grant activities
Supports provides information
Staff, Sub-Contractors and Consultants Abbie
Averbach, Senior Project Director (CHPR) Cindy
Thomas, Project Coordinator (ICI) Abt
Associates Cornell University Department of
Workforce Development New England Independent
Living Center Massachusetts Rehabilitation
Commission Benefits Planning and Outreach
Grantees Disability Law Center
Benefits Planning Peer-to-Peer Mentorship Model
CommonHealth Dissemination Task Force
Informs grant activities
The single state Medicaid Agency in Massachusetts
45
The goal of the MICEO is to maximize employment
opportunities for people with disabilities who
want to work by improving the Medicaid and
employment services infrastructure in the state

• Outcome Measures
• Increase in number of people working in
  MassHealth Standard and CommonHealth Increase in
  the proportion of people working in CommonHealth
  relative to all MassHealth programs
• Increase in wages, job tenure, and availability
  of benefits (as measured by unemployment
  insurance data and survey of MassHealth members)

46
Examples of MICEO Activities

• Policy Development Support
• MA Employment and Disability Snapshot Report
• State Budget Analysis of Employment and
  Disability Spending
• Strategic Planning Task Force on Employment
• Employment Services and Supports
• Improve access to information for consumers and
  families
• Improve capacity of the service system at the
  direct delivery level to support employment
• Promote CommonHealth and other work-incentive
  programs
• Research to Inform Policy
• Premium Study (Phase 1 and 2)
• Semi-annual survey of MassHealth members
• Depression treatment and work outcomes

47
For More Information

• Grant Contacts
• Abbie Averbach, abigail.averbach_at_umassmed.edu
• Cindy Thomas, cindy.thomas_at_umb.edu
• Websites
• MICEO website http//www.massmig.org
• MICEO Consumer website www.MassCHEC.org
• Provider website www.MassWorks.org
• Employer website www.ForEmployers.Com
• Center for Health Policy and Research
  http//www.umassmed.edu/healthpolicy
• Institute for Community Inclusion
  http//www.communityinclusion.org/index.html
• Northeast Partnership http//www.nepartnership.or
  g

48
Data Sources

• MMPI Report Presentation on Understanding
  MassHealth Members with Disabilities, June 2004,
  page 20, Source U. S. Census 2000, Summary File
  3
• MMIS Eligibility Data FY 96 98
• FY 99 03 MMIS claims data.
• MassHealth Employment and Disability Survey
  (MHEDS), 2003 Massachusetts Medicaid
  Infrastructure Grant, Monitoring and Evaluation

Refer to each slide for detail on each data source
49
Bibliography

• Employment Declines Among People with
  DisabilitiesPopulation Movements, Isolated
  Experience, or Broad Policy Concern?
  Rehabilitation Research and Training Center for
  Economic Research on Employment Policy for
  Persons with Disabilities Program on Employment
  and Disability Cornell University, Andrew J.
  Houtenville, Ph.D.
• The Decline in Employment of People with
  Disabilities, A Policy Puzzle, David C. Stapleton
  and Richard V. Burkhauser, Editors 2003
• Employment of People with Disabilities 2000
  Census Data from Three States, Allard E. Dembe,
  Sc.D., Fred Hooven, M.M.H.S., Rachel Delbos,
  M.S., Leslie Olin, B.A., Jay Himmelstein, M.D.,
  M.P.H, June 2004
• The Massachusetts CommonHealth Plan for Working
  Adults with Disabilities Volume 1
  Administrative Data 1996-2003, Massachusetts
  Medicaid Infrastructure Grant, Monitoring and
  Evaluation