Disabling Conditions, Activity Limitations and Work Outcomes among Adults with Disabilities in the Massachusetts Medicaid Buy-in Program Findings from the MassHealth Employment and Disability Survey, 2003

1
Disabling Conditions, Activity Limitations and
Work Outcomes among Adults with Disabilities in
the Massachusetts Medicaid Buy-in
ProgramFindings from the MassHealth Employment
and Disability Survey, 2003

• Alexis Henry, Steven Banks, Lobat Hashemi,
• Robin Clark and Jay Himmelstein
• Center for Health Policy and Research
• University of Massachusetts Medical School
• NCHSD Medicaid Infrastructure Grantees Technical
  Assistance Conference
• November 9, 2006 Chicago, IL

2
Background

• Unemployment and underemployment are significant
  problems among adults with disabilities
• Many adults with disabilities want to work
• Person level barriers to employment
• Severity of disabling condition and/or functional
  limitations
• Disrupted education or limited work history
• Environment level barriers to employment
• Stigma
• Inaccessible workplaces or transportation
• Complexity of public disability benefit programs
• Fear of loss of health insurance with work
• Person and environment effects are difficult to
  disentangle

3
Study Goals

• To examine relationship of health characteristics
  to work outcomes among adults with disabilities
  enrolled in the Massachusetts Medicaid Buy-in
  program
• Designed to promote work and higher earnings
• Provide health insurance and access to services
• Should eliminate fear of loss of health insurance
  
• Health characteristics
• types of disabling conditions members reported
• types of current functional or activity
  limitations members reported
• Work outcomes
• Work status (working vs. not) of all members
• Annual earnings over 10,000 (over SGA) among
  working members
• Future work intentions among non-working members

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The Massachusetts Medicaid Buy-in Program
MassHealth CommonHealth

• First buy-in in the US, created in 1988
• Funded under a Medicaid 1115 Waiver since 1997
• Provides health insurance for those who meet SSA
  criteria for disability, but who have family
  income too high to qualify for standard Medicaid
• Those working 40 hours/month pay income adjusted
  premium
• Those not working or working under 40 hours/month
  meet a one-time deductible and pay income
  adjusted premium
• CommonHealth has no income or asset limit

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Method The MassHealth Employment and Disability
Survey, 2003

• Examined disability, health, employment status
  among MassHealth members with disabilities
• 136 item survey developed with stakeholder input
• Fielded in summer-fall 2003
• Mailed with telephone follow-up English and
  Spanish versions
• Survey Sample
• 1933 randomly selected CommonHealth members with
  disabilities across the state
• ages 19-64
• Enrolled for at least 6 months
• 1093 respondents 57 response rate

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Member Characteristics (n1093) Members reported
a variety of disabling conditions and current
activity limitations
Source MassHealth Employment and Disability
Survey, 2003
7
Disabling conditions (n1093)Rates of working
varied among members reporting different types of
disabling conditions
Source MassHealth Employment and Disability
Survey, 2003
8
Odds (OR) of working, earning over 10K, and
intending to work in the future for members with
differing disabling conditions
Source MassHealth Employment and Disability
Survey, 2003
9
Activity limitations (n1093) Rates of working
varied among members reporting different types of
activity limitations
Self-reported current activity limitation N Working
No limitations 342 68
One limitation
Concentrating, chores or self-care (non-mobility limitations) 165 62
Moving inside home or going outside home (mobility limitations) 39 28
Multiple limitations
Combinations of non-mobility limitations 77 55
Combinations with at least one mobility limitations 344 28
All five limitations 126 19
Source MassHealth Employment and Disability
Survey, 2003
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Across three disability groups, members with
mobility limitations were significantly less
likely to work than those with non-mobility
limitations (n955)
working
(common OR .28 95CI .21-.38 plt.0001)
Source MassHealth Employment and Disability
Survey, 2003
11
Across three disability groups, non-workers with
mobility limitations were significantly less
likely to intend to work than those with
non-mobility limitations (n547)
intending future work
(common OR .58 95CI .39-.86 plt.005)
Source MassHealth Employment and Disability
Survey, 2003
12
Across three disability groups, only workers with
co-occurring psychiatric and physical
disabilities and mobility limitations were less
likely to earn over 10K (n501)
earning over 10K
OR1.43
OR0.30
OR1.07
(OR for co-occurring group sig. lower than
pooled OR of other two groups plt.005)
Source MassHealth Employment and Disability
Survey, 2003
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Summary of Findings

• Health characteristics are significantly
  associated with work outcomes among CommonHealth
  members
• Type of disabling conditions and type of current
  activity limitations
• Working and earning are not equivalent outcomes
• Some health characteristics may make it difficult
  to enter the workforce others may make it
  difficult to have higher earnings
• People with co-occurring psychiatric and physical
  disabilities appear at risk for the poorest work
  outcomes
• Activity limitations moderate the impact of
  disabling conditions on work outcomes
• Mobility limitations (vs. non-mobility
  limitations) are generally associated with poorer
  work outcomes across disabling conditions
• An exception to this patterns was seen for
  earnings over 10K

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Implications for Medicaid Infrastructure Grantees

• Evaluations of buy-in programs
• Should consider enrollees health characteristics
  
• Efforts to enhance services and supports that
  promote employment
• What specialized services might be needed for
  people with co-occurring conditions?
• What specialized serviced might be needed to
  address mobility limitations for people with
  varying conditions?

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Acknowledgements

• This work is funded by a grant from the Centers
  for Medicare and Medicaid Services (CFDA 93-768)
  and administered by UMASS Medical School, Center
  for Health Policy and Research UMASS Boston,
  Institute for Community Inclusion and the
  Massachusetts Executive Office of Health and
  Human Services. For more information visit
  www.MI-CEO.org.
• We thank Fred Hooven, Leslie Olin, David
  Jarzobski, Allard Dembe, Ann Lawthers, Raymond
  Glazier, John Butterworth, Tina Edlund, Pamela
  Hanes, David Stapleton Gina Livermore, Patricia
  Gallagher, Vickie Stringfellow, Ellie
  Shea-Delaney and Annette Shea for their
  contributions to the development of the
  MassHealth Employment and Disability Survey,
  2003.
• For more information on MHEDS alexis.henry_at_umassm
  ed.edu