Pennsylvania Medicaid BuyIn

1
PennsylvaniaMedicaid Buy-In

• MAWD
• Medical Assistance for Workers with Disabilities
• November 2006

2
Pennsylvania

• General Population
• 12 million or 12,281,054 ( 2000 Census)
• Medicaid
• 1.8 million or 1,888,814 (9/30/06)
• MAWD
• 8,815 (9/30/06)

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Pennsylvania MAWD

• Administered by Department of Public Welfare
  (DPW)
• Implemented January 1, 2006
• Ticket to Work
• Basic Group
• Medically Improved
• Tobacco Master Settlement established State
  Funding

4
Pennsylvania MAWD

• Tobacco Settlement
• PA Funding for MAWD is Good
• MAWD Program Changes
• Made by Internal Policy/Procedures
• Waived premiums
• Good Cause
• Employment/Work Issues

5
Pennsylvania MAWD

• Employed and Disabled
• 16-64 Years of Age
• Income is 250 of FPL
• Resource Limit is 10,000
• Premium is 5 of Monthly Income
• Average premium is 41.00

6
Pennsylvania MAWD

• Disability Determination
• SSA Determination if Title II
• Medical Review Team (MRT) for Others
• MRT is DPW Review
• Contract with Private Entity
• SSA Guidelines

7
Pennsylvania MAWDMedically Improved

• Previously Covered in Basic Group
• Disability No Longer Meets SSA
• Employed 40 hours or month in Month
• Earning at least Minimum Wage
• Disability Definition
• Severe Medically Determinable Disability
• PA Created Definition

8
Pennsylvania MAWDMedically Improved

• Medically Improved Disability Definition
• Loss of Health Care Results in loss of Employment
• Limits ability to Work/Conduct activities
• MH/PH Stabilized by Medication
• Organ Transplants/Medication required
• Chronic Diseases
• Documentation required

9
Pennsylvania MAWDMedically Improved

• Medically Improved
• 12/2002 1
• 12/2003 4
• 12/2004 7
• 12/2005 11

10
Pennsylvania MAWDMedically Improved

• Where in Pennsylvania ?
• In 8 Counties/PA has 67 Counties
• Southeast/ Urban/Suburban 6
• Central /Suburban 3
• Southwest/Rural 1
• Southwest/Urban 1

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Pennsylvania MAWDMedically Improved

• Medically Improved
• Gender
• Women 7
• Men 4
• Disability
• Mental Illness 50
• Heart Disease

12
Pennsylvania MAWDMedically Improved

• Age
• 21 29 2
• 30 39 1
• 40 49 5
• 50 59 3

13
Pennsylvania MAWDMedically Improved

• Employed
• Full Time 5
• Part Time (100 Hours) 2
• Part Time (
• Self-Employment 1

14
Pennsylvania MAWDMedically Improved

• Job Types
• Cashiers/Tellers
• Bookkeepers/Accounting
• Household/Domestic
• Truck/Cab Drivers
• Sales
• Building/Service Related

15
Pennsylvania MAWDMedically Improved

• Premiums
• Average Premium 38.00
• Low 16.00
• High 75.00
• 10-19 2 20-29 2
• 30 - 39 2 40 -49 3
• 60 - 69 1 70-79 1

16
Pennsylvania MAWDMedically Improved

• Length of Time on Medically Improved
• 12 Months and Longer 1
• 10 to 12 Months 4
• 4 to 6 Months 3
• 3 Months or Less 3

17
Pennsylvania MAWDMedically Improved

• Benefits Ended
• Requested Benefits Closed
• Employment Ended
• Eligible for Other Medicaid Group
• Health Reasons

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Pennsylvania MAWDMedically Improved

• Most MAWD Remain in Basic
• Most MAWD Remain SSA Disabled
• Must be Basic Prior to Medically Improved
• Basic Group Employment
• Full Time 1752
• Part Time -
• Part Time- 100 hours 1416

19
Pennsylvania MAWDMedically Improved

• Questions
• Thank You
• Carol Tooker
• ctooker_at_state.pa.us
• 717-772-7815