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Review of Medicaid Buy-In studies.

With support from the National Institute on Disability and Rehabilitation Research, the Center for Psychiatric Rehabilitation at Boston University undertook a review of national and state studies on Medicaid Buy-In (MBI) programs. The authors identified and reviewed 30 studies that discussed the impact of the MBI program on earnings and/or employment for people with disabilities. Through this review, the authors identified quantitative and qualitative findings for MBI programs that include the following.

* Overall, enrollment in the MBI program appears to result in increased earnings for participants. Analysis of Social Security Administration earnings data by Mathematica Policy Research shows that, nationwide, an average of 40 percent of participants increased their wages upon enrollment in the MBI program. The median, inflation-adjusted increase from earnings in the year pre-enrollment, to earnings in the year post-enrollment was $2,582. Additionally, these increased earnings are significant given participants' historically low earning levels. The authors also found that MBI participants work, and work more than before enrollment or as compared to control groups.

* Program structure influences earnings (and employment) profiles of state programs. MBI programs can affect participant employment and earnings averages by setting eligibility parameters that attract participants likely to work and earn more, or by helping participants--once enrolled--to increase their earnings.

* Individual participant characteristics also influence earnings outcomes. States can also try to attract participants with certain demographic characteristics and experiences to their MBI programs. Specifically, younger participants, nonwhite participants, and those who have not previously received Medicaid benefits are likely to earn more than the average MBI enrollee. The type of primary disability also appears to factor into earnings outcomes.

* Increased earnings have positive implications for state budgets, which some states have demonstrated. For example, some states have tracked state income taxes paid by enrollees, or found reductions in medical expenditures for MBI participants. Also, increased earnings and disposable income may mean a reduced demand for social service programs. For example, Washington state participants with prior Medicaid coverage reduced dependency on SNAP by $217 per month; those without prior Medicaid coverage reduced SNAP dependency by $300 per month.

The authors also found lessons for MBI design, administration and outreach through their study review. These include understanding the trade-off between continuous enrollment in the MBI program and higher employment and earnings averages of the participant population. For example, shorter grace periods are the design feature most strongly associated with improved employment/earnings outcomes, while longer grace periods are associated with continuous enrollment. Along with this and other lessons, the authors strongly suggest that programs should improve state-level capacity for program communication and support strategies. The full report is available at For additional information on MBI, see "Rewarding Work: Medicaid Buy-In Programs for Workers with Disabilities," by Michael Dalto, Policy & Practice, April 2011, pp. 24-26.
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Title Annotation:noted studies
Publication:Policy & Practice
Geographic Code:1USA
Date:Jun 1, 2011
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