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									 MEDICAID INFRASTRUCTURE
                  GRANTS
BUILDING SUSTAINABLE EMPLOYMENT
       SYSTEMS AND SUPPORTS FOR
          PEOPLE WITH DISABILITIES


                            SARA SALLEY
                NATIONAL CONSORTIUM FOR
            HEALTH SYSTEMS DEVELOPMENT
   Created by the Ticket to Work and Work
    Incentives Improvement Act of 1999 (TWWIIA)
    ◦ First awards made in 2000, funded through FY2011
   Primary goal—competitive employment for
    people with disabilities through:
    ◦ Medicaid Buy-In programs to reduce fear of losing
      health benefits due to earnings—a Medicaid category
      with work incentives built in, premiums
    ◦ Improved Medicaid services and stronger infrastructure
      to support working people with disabilities
    ◦ A comprehensive, coordinated approach to removing
      employment barriers

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   Administered by Centers for Medicare and
    Medicaid Services—CMS
   Grants go to state Medicaid agency, or other
    entity in cooperation with state Medicaid
    ◦ VR agencies, DD agencies, university policy and
      research centers, Governor’s Council on Disability
   Minimum grant award
    ◦ States with no Medicaid Buy-In: $500,000 to
      $750,000 per year
    ◦ State with Medicaid Buy-In: Up to 10% of MBI
        expenditures

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   Forty-eight states have had MIG funding
    since 2000; about 40 have 2008 MIG award.
   Annual awards from $500,000 to more than
    $5 million per year.
    ◦ 6 states received more than $1 million each in
      2006, 2 received more than $5 million each.
   Two types of grants: “Basic Medicaid
    Infrastructure” and “Comprehensive
    Employment Systems”
    ◦ States without a Medicaid Buy-In get a Basic grant


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   Develop and enhance Medicaid Buy-In programs
    and Medicaid services
   Support benefits planning services and
    infrastructure
   Engage with businesses as employers
   Conduct outreach and education
   Evaluate state disability and workforce systems
   Collect and track program and outcomes data
   Bring state, federal and private partners together
   Carry out statewide strategic planning


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   Convener – convene stakeholders to identify
    systems needs and promote infrastructure
    development;
   Facilitator – facilitate discussions and relationships
    necessary to make sustainable changes to state’s
    infrastructure;
   Coordinator – coordinate policy development, pilot
    projects and initiatives to demonstrate best
    practices; and
   Leader – develop and provide leadership on
    workforce development for people with disabilities.

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Strengthening supported employment
  programs—ME, AR, WA
Building capacity for benefits
  planning—OR, IN, ND, MT
Integrating employment into Medicaid
  services and policy—WI, AZ
“Marketing” employees with disabilities
  to businesses—CT, WA, MD

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   Brings in federal dollars to build state
    infrastructure to improve employment
    outcomes
   Plays planning and coordinating role to move
    the employment agenda forward statewide
   Supports Medicaid Buy-In development
   Creates cross-state partnerships to share
    strategies, data and best practices
   Establishes forum for highlighting Florida’s
    accomplishments

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   Leading the way in Business Leadership Network
    development
    ◦ Business-to-business network to increase awareness and
      understanding about employment opportunities for people with
      disabilities
   Offering promising practices in benefits planning
    ◦ Florida Benefits Information Resources Network and Employment
      Coordinators to build benefits planning capacity
   Setting the example with Employment First
    ◦ Encouraging employment as the first option for people with
      disabilities
   Sharing expertise in marketing and outreach
    ◦ Collaborating with other state and federal partners to raise
      awareness nationally and locally about disability and employment

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   MIGs helped develop and implement Medicaid Buy-
    In programs – roughly 98,000 MBI enrollees
    nationally in 2006, an increase from 30,000 in
    2001.
   Combined earnings of all MBI program participants
    nationally increased from $222 million in 2001 to
    more than $556 million in 2006 (contribution to
    tax base).
   MIGs helped 20 states expand Personal Assistance
    Services (PAS) coverage in the workplace up to 40
    hours a week.
                    (Source: Mathematica GPRA Report, December 2007)
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   MIG outreach and education efforts provide
    information about Medicaid Buy-In and other work
    incentives to millions of people with disabilities.
   MIGs contribute hundreds of thousands of dollars
    towards work incentives planning infrastructure
    and services.
   MIGs provide strategic leadership on disability and
    employment issues within each state and
    nationally.



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A Medicaid eligibility category for
working people with disabilities whose
income or assets would otherwise
disqualify them from Medicaid coverage
 ◦ Individuals “buy into” coverage by paying
   premiums.
 ◦ States have flexibility to set eligibility
   criteria (income and asset limits), premium
   structures and other features.

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 Allows people with disabilities to work
  and earn more without fear of losing
  health coverage and vital services
 Creates incentive for people receiving
  Social Security benefits to return to
  work, increase earnings
 Offers chance for greater financial
  independence through earnings and
  savings
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   Employment requirement, verification
    procedures (proving you’re employed)
   Income disregards (retirement funds,
    Independence Accounts)
   Treatment of earned versus unearned
    income (different limits, spousal income,
    premium calculations)
   Grace periods for temporary loss of work
   Premium structures

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   2006 total enrollment in 32 states = 98,264




                (Source: CMS presentation, NCHSD 2007 Fall Conference)
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   About 70% of MBI enrollees had SSDI just
    before they enrolled, over half had Medicare.
   “Primary disabling condition” (diagnosis
    data)
    ◦   Mental health disabilities for about 32%
    ◦   Intellectual disabilities for almost 12%
    ◦   Musculoskeletal conditions for almost 10%
    ◦   All other diagnoses – 21%
    ◦   Unknown – 25%
                  Everything varies by state!
                      (Source: Mathematica enrollment report, April 2008)
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   Gender split is roughly even
   About three-quarters of enrollees are white
   Age distribution:




                 (Source: Mathematica enrollment report, April 2008)

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   Most states charge premiums for MBI
    coverage; $22 million collected in 2006
    ◦ 25 states collected premiums, 7 states did not
    ◦ Two-thirds of states charged $50/month or less,
      10% charged $100/month or more




                       (Source: CMS presentation, NCHSD 2007 Fall Conference)
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   Average earnings for MBI enrollees were
    slightly higher in 2006 than 2005, from
    $7,876 to $8,237 (roughly 4% increase)
   Total combined earnings of MBI enrollees
    (contribution to the tax base) rose from
    $222 million in 2001 to $556 million in
    2006 (enrollment growth + earnings
    growth)
   Improving employment rates? Nationally, too
    hard to tell
                      (Source: Mathematica GPRA Report, December 2007)

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   Sustainability Build in the ability to sustain what
    has been identified as important infrastructure that
    promotes competitive employment.
   Leadership Demonstrate that leadership is engaged
    at all levels and will sustain itself beyond the life of
    the grant.
   Stakeholder engagement Show that wide range of
    stakeholders are involved in building infrastructure
    and creating sustainability plans for new
    infrastructure.
   Measurable outcomes Activities must be
    measurable; include a thorough evaluation
    component; collect and analyze data to document
    program success.
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   Lend expertise on workforce development and
    employment related supports for people with
    disabilities;
   Advise and consult with MIG staff on grant
    activities & objectives;
   Serve as “ambassadors” by providing important
    connections for MIG staff and stakeholders to key
    decision makers to move strategic priorities
    forward; and
   Represent MIG goals and objectives in other
    venues to spread the word about how to get
    involved.
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A technical assistance center for MIGs developed by states
for states to promote the development of sustainable
workforce and employment supports infrastructure by:
   Promoting state-to-state information sharing and
    disseminating promising practices through teleconferences,
    policy briefs and individual state consultation
   Offering work incentives training and education
   Facilitating communication and collaboration with federal
    partners agencies (CMS, DOL/ODEP, SSA, etc.)
   Providing forums for national and regional MIG meetings and
    workshops
   Hosting a comprehensive web-based resource exchange at
    www.nchsd.org

      A project of Health & Disability Advocates, Chicago, Illinois
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