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Non-State MIG Reports

Allen Jensen's Website       http://disability.law.uiowa.edu/lhpdc/rrtc/mig/

Allen Jensen is a senior research scientist and the Director of the Work Incentives Project at George Washington University (Washington, DC).  He has advised states on implementing Medicaid Buy-In programs for people with disabilities.  In addition, he is a policy expert on the SSI and SSDI programs and served as a staff member for the U.S. House of Representatives' Ways and Means Committee.  This link provides lots of useful research information such as an updated table of states with Medicaid Buy-In programs and guides to estimating program enrollment and costs.

Key Topic(s) - Medicaid Buy-In

Center for Workers with Disabilities       http://cwd.aphsa.org

This T/A center works to enhance public policy for persons with disabilities and sponsors a number of conferences that address MIG-related state issues. CWD is an affiliate of the American Public Human Services Association (APHSA).

Key Topic(s) - Medicaid Buy-In

Clearinghouse for the Community Living Exchange Collaborative       http://www.hcbs.org/theme.php/5/Medicaid%20Infrastructure%20Grants

This HCBS clearinghouse website, supported by CMS, provides a link to state MIG research reports and other documents.  Please note that some state documents and reports may not be the most current or updated version.

Key Topic(s) - Medicaid Buy-In

CMS Ticket to Work Reports       http://www.cms.hhs.gov/TWWIIA

This CMS website includes an overview of the MIG, Medicaid Buy-In program, and DMIE , which are part of the Ticket Act. The GRPA report includes a summary of Buy-In enrollment and policy changes.

Key Topic(s) - Medicaid Buy-In, Benefits Counseling, Demonstration to Maintain Independence and Employment (DMIE)

Design Features for Employment-Supportive Personal Assistance Services in Medicaid Programs.       http://dps.sagepub.com/content/early/2010/04/08/1044207310370682.abstract?rss=1

This article explores Medicaid-funded Employment-Supportive Personal Assistance Services (EPAS) through examination of programs in seven states and analysis of results from PAS user focus groups and employer interviews. Medicaid policy recommendations include: link EPAS with existing PAS programs in Medicaid state plans or waivers, distinguish EPAS from job- or task-related assistance that is the responsibility of the employer, and specify explicit coverage for personal care services at home, at the work site, and for work-related transportation.

Key Topic(s) - Personal Assistive Services (PAS)

Florida Medicaid Buy-In: An Overview of National and State Experience       http://www.nchsd.org/libraryfiles/MBI/FL_MBI_Report_NDI_2006.pdf

This is the first of three reports that focus on identifying the state of the Medicaid Buy-In program across the country and in Florida. The Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 provides a mechanism for state’s to allow individuals, ages 16-64 with disabilities who are working to "buy-in" to Medicaid services by creating two new optional eligibility groups. This report seeks to identify the framework for decision-making in Florida as the state, through its Medicaid Infrastructure Grant, attempts to provide Floridians with disabilities who are working - options for retaining essential health care services through the state’s Medicaid program.

Key Topic(s) - Medicaid Buy-In State(s) - Florida

Getting to Work: A Case Study Report on Accessible Transportation Projects       http://cwd.aphsa.org/home/docs/CWDTransportationBrief.pdf

This report describes MIG transportation projects pursued by Illinois, Massachusetts, Minnesota, and New Jersey.

Key Topic(s) - Working with Disability State(s) - Illinois, Massachusetts, Minnesota, New Jersey

How Are the Experiences of Individuals with Severe Mental Illness Different from Those of Other Medicaid Buy-In Participants?       http://www.mathematica-mpr.com/publications/PDFs/Disability/WWD_mental_illness.pdf

This issue brief, 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 participants in the program.

Key Topic(s) - Medicaid Buy-In, Disability Research

How Will Health System Reform Address the Needs of Working-Age People with Disabilities?       http://www.disabilitypolicyresearch.org/Forums/index.asp

This was the fourth bimonthly lunchtime seminar series on disability policy research findings hosted by the Center for Studying Disability Policy at Mathematica Policy Research.   The forum explored how health system reform will address the needs of working-age individuals with disabilities.  Center researchers David Stapleton and Su Liu presented policy issues concerning health care coverage for this population based on the findings from two recent studies.  Dr. Stapleton presented findings on the experiences of workers with disabilities before, during, and after their entry into the Social Security Disability Insurance program. Dr. Liu discussed findings from analyses of the Medicaid Buy-In program, an optional program designed to address coverage issues for workers with disabilities. Additionally, Peter Thomas, a lawyer specializing in the areas of health care, rehabilitation, disability, and employment, discussed the extent to which major health reform proposals would address coverage issues.

Key Topic(s) - Medicaid Buy-In

Impact of Health Benefits on Retention of Homecare Workers       http://pacecare.com/publications/benefits_prelim_la2003.pdf

This paper is a preliminary study of the impacts of health benefits on homecare worker retention and recruitment. The authors found that homecare workers who enrolled in health benefits were more likely to remain in homecare at the end of 12 months and were more likely to return within the same 12-month period if they left at some point.

Key Topic(s) - Personal Assistive Services (PAS) State(s) - California

Improving The Quality Of Medicaid Personal Assistance Through Consumer Direction       http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.162v1

As states seek to improve home and community-based services for people with disabilities, many are incorporating consumer-directed supportive services into their Medicaid programs. The national Cash and Counseling Demonstration uses a randomized design to compare an innovative model of consumer direction with the traditional agencydirected approach. This paper presents findings from the first demonstration program to be implemented, in Arkansas. A survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participants’ health and safety.

Key Topic(s) - Personal Assistive Services (PAS) State(s) - Arkansas

Mathematica Policy Research (MPR)       http://www.mathematica-mpr.com/disability/medicaidbuy-in.asp

This website provides a complete set of links to Medicaid Buy-In reports and the Working with Disabilities issue briefs.

Key Topic(s) - Medicaid Buy-In, Demonstration to Maintain Independence and Employment (DMIE), Disability Research

National Consortium for Health System Development       http://www.nchsd.org

This T/A center has an active membership of about 30 states and sponsors a number of conferences and other activities that address MIG-related state issues. NCHSD's website contains resources on Medicaid Buy-In, benefits planning, employer partnerships, strategic planning and other topics.

Key Topic(s) - Medicaid Buy-In, Benefits Counseling, Personal Assistive Services (PAS), Outreach/Marketing

Northeast Partnership for Health System Development       http://www.nepartnership.org

This consortium of New England states work together to share research ideas and findings on MIG-related issues.

Key Topic(s) - Outreach/Marketing, Disability Research

Predictors of Employment for Young Adults with Developmental Motor Disabilities.       http://iospress.metapress.com/content/e7lx5nt35k7240h7/?p=77df8a73c4f048db99bfe52b4dbda68f&pi=8

The objective of this study was to identify the personal, family, and community factors that facilitate or hinder employment for young adults with developmental motor disabilities. Quantitative methods with an embedded qualitative component were used. Seventy-six persons between the ages of 20 and 30 years of age (Mean = 25, SD = 3.1) with a diagnosis of either cerebral palsy or spina bifida completed questionnaires addressing factors such as depression, and participated in a semi-structured interview that allowed participants to describe their experiences with education, employment, transportation, and other services.  Almost half of the participants (n = 35) were not currently employed. Hierarchical regression analyses indicated that gender (females were less likely to be employed), IQ (lower IQ associated with unemployment), and transportation dependence accounted for 42% of the variance in employment. Themes emerging from content analysis of the interviews supported the findings related to transportation barriers. Social reactions to disability limited employment opportunities, and participants often felt stuck in terms of employment options with limited opportunities for advancement. Transportation is a significant barrier to employment and innovative solutions are needed. Issues related to gender need to be considered when addressing employment inequities for persons with primarily motor disabilities.     Magill-Evans, J., Galambos, N. L., Darrah, J., &. Nickerson, C. "Predictors of Employment for Young Adults with Developmental Motor Disabilities." Work: A Journal of Prevention, Assessment, and Rehabilitation, 31(1). (2008)

Key Topic(s) - Disability Research

The effectiveness of Medicaid Buy-In programs in promoting the employment of people with disabilities       http://www.pascenter.org/publications/publication_home.php?id=125

This report is meant to provide the Advisory Panel with information about the features of states' Medicaid Buy-In programs and their potential to promote the employment of people with disabilities. At the time of the report, 29 states had implemented Buy-In programs; 15 of these had done so under the Ticket to Work and Work Improvement Incentives Act. There was considerable variation across states in Buy-In eligibility criteria, premiums charged to participants, and enrollment rates. Most participants were covered by Medicaid prior to Buy-In enrollment, and tended to have low earnings. State policies tended to restrict access to their Buy-In programs to those with low SSDI benefits or low earnings. Buy-In programs appeared to provide significant supports for people with disabilities, notably through Medicaid coverage of prescription drugs and personal assistance services to SSDI beneficiaries who would not ordinarily qualify for Medicaid. However, many enrollees lacked clarity or knowledge about the benefits of the program. The report concludes that while Buy-In programs appear to provide needed supports, they may not reduce work disincentives in the context of a complex system that defines disability in terms to inability to work.

Key Topic(s) - Medicaid Buy-In

The Effects of State Policy Decisions on the Employment and Earnings of Medicaid Buy-In Participants in 2006       http://dps.sagepub.com/cgi/content/abstract/20/3/142?rss=1

This article examines the Medicaid Buy-In program, so named because workers with disabilities "buy into" Medicaid coverage with monthly premiums. In 2006, 97,491 individuals were enrolled in 32 state Buy-In programs. States have taken different pathways toward the program’s dual objectives: expanding Medicaid coverage to vulnerable populations and promoting employment of working-age adults with disabilities. Analyses indicate that (a) some states appear to have accomplished both objectives, whereas other states have emphasized one over the other, and that (b) certain program features (e.g., higher earned income limits) contribute to both larger percentages of Buy-In participants who are employed and higher earnings of employed participants. The authors’ findings have implications for Buy-In design and the study of federalism in health care.

Key Topic(s) - Medicaid Buy-In

The United States Disability System and Programs to Promote Employment for People with Disabilities       http://www.mathematica-mpr.com/publications/pdfs/labor/usdisabilitysystem08.pdf

An article in la Revue française des Affaires socials includes a discussion of the role of employment-focused policies and summarizes findings from several evaluations of return-to-work supports targeted to people with disabilities. Despite effective alternatives to traditional approaches, the authors conclude that more work needs to be done given that many interventions are still untested and many programs contain work disincentives. The paper provides an overview of disability programs, a comparison to Western European programs, the development of disability programs, and a discussion of innovative programs including the Accelerated Benefits Demonstration, the Youth Transition Demonstration, the Medicaid Buy-In, and the Demonstration to Maintain Independence and Employment.

Key Topic(s) - Medicaid Buy-In, Youth in Transition, Demonstration to Maintain Independence and Employment (DMIE)

University of Iowa: State Work Incentives Center       http://www.uiowa.edu/~lhpdc/work/

The University of Iowa’s state work incentives center includes research on State Medicaid Buy-In programs. Some of the information is not current (e.g., 2002), but still useful.

Key Topic(s) - Medicaid Buy-In

What Happens to Medicaid Buy-In Participants After They Leave the Program?       http://www.mathematica-mpr.com/publications/pdfs/disability/WWDDisenrollees.pdf

This issue brief, the ninth in a series on workers with disabilities, examines the prevalence and characteristics of Medicaid Buy-In participants who leave the program as well as their participation status in other public programs and their employment outcomes after disenrollment.

Key Topic(s) - Medicaid Buy-In

Workforce issues and consumer satisfaction in Medicaid personal assistance services.       http://goliath.ecnext.com/coms2/gi_0199-6094531/Workforce-issues-and-consumer-satisfaction.html

The goal of this study is to assess the impact of workforce issues on two measures of consumer satisfaction with Medicaid personal assistance services among older people and younger persons with disabilities using primary data analysis. First, we examine the independent effects of problems with recruitment and retention on a consumer satisfaction scale. Second, we analyze the independent effects of worker training, treatment, and respect on a single consumer satisfaction measure.

Key Topic(s) - Personal Assistive Services (PAS)