Medicaid Infrastructure Grant(1)

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					                 Medicaid Infrastructure Grant
                         Final Report

                         December 2005




Prepared by Carol Baker and John Miller, AHEDD Grant
Administrators. For further Information, contact John Miller at (717)
763-0968 x118.
Table of Contents
Executive Summary
Background
Advisory Committee on Employment
Community Education and Outreach
Evaluation – Medical Assistance for Workers with Disabilities
One Stop Pilot Project
Personal Attendant – Back-up Service for Employment




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Medicaid Infrastructure Grant
Executive Summary

The PA Department of Public Welfare received a Medicaid
Infrastructure Grant (MIG) from the Center for Medicaid & Medicare
Services (CMS) in 2001. MIG Grants have been made available to
states to encourage the development of Medicaid Buy-In (i.e. health
care for individuals with disabilities who work) and other initiatives of
the Ticket to Work and Work Incentives Improvement Act.

AHEDD was recruited to serve as a grant administrator to assist the
PA Department of Welfare (DPW) in the coordination of key project
activities. In order to maximize community input, AHEDD facilitated
the development of a state Advisory Committee on Employment
(ACE). In addition local advisory committees were developed in order
to implement specific pilot projects. Key initiatives included:
      Development of professional marketing materials including print
       (e.g. brochures, kits, newsletters), videos and alternate formats;
      Expansive distribution to targeted groups including community
       agencies, schools, SSA beneficiaries, business and media,
       including active collaboration of community organizations
       through mini-grants for education and outreach;
      Independent evaluation of the PA Medicaid Buy-in: Medical
       Assistance for Workers with Disabilities (MAWD). This study
       revealed a high level of satisfaction among consumers, and
       indication that a significant number were encouraged to become
       employed due to the availability of MAWD;
      Exploration of a navigator “one stop” model to facilitate the
       employment of persons with disabilities. These pilots were
       conducted in PA Career Link programs in a rural (Schuylkill
       County) and an urban (Pittsburgh) community;
      Pilot project to explore the need for a back-up system to support
       employment of consumers who use personal attendant services.

Through the leadership of the PA Department of Public Welfare, MIG
resources, and the Advisory Committee on Employment,
Pennsylvanians with disabilities have access to high quality
information, health care, and essential supports to facilitate
employment and enhanced levels of financial independence.


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Background

In 2001, the PA Department of Public Welfare received a Medicaid
Infrastructure Grant (MIG) from the Center for Medicaid & Medicare
Services (CMS). MIG Grants have been made available to states to
encourage the development and implementation of Medicaid Buy-In
(i.e. health care for individuals with disabilities who work) as well as
other initiatives related to the Ticket to Work and Work Incentives
Improvement Act.

AHEDD was recruited to serve as a grant administrator for the PA
Department of Welfare (DPW) – Medicaid Infrastructure Grant (MIG) in
July 2002.

AHEDD is a private, non-profit organization with a mission to serve the
community as a catalyst in the employment and development of
persons with disabilities. AHEDD serves within the SSA Benefits
Planning Assistance and Outreach (BPAO), coordinator of the PA
Business Leadership Network, and also provides job placement and
employment support services to over 1,000 individuals each year.
Because of its expertise and specialization in the administration and
delivery of employment services for persons with disabilities, AHEDD
was selected by DPW to facilitate key grant activities.


Advisory Committee on Employment

Establish a Statewide Advisory Committee on Employment (ACE) to
oversee the implementation of this grant and provide
recommendations on programmatic and policy decisions related to
reducing and eliminating employment barriers for persons with
disabilities

The PA Advisory Committee on Employment (ACE) consists of a
cross-section of representatives from public and private sector
agencies serving persons with disabilities, advocacy groups, and
individuals with disabilities who are using the Medicaid Buy-in.
AHEDD served as the administrative liaison, with the addition of co-
chairs who were members of the ACE. A planning subcommittee,

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consisting of AHEDD, DPW, and the co-chairs met regularly in order to
facilitate project related activities.

The ACE met quarterly over the course of the grant contributing to the
development of the policies and procedures for Pennsylvania’s
Medicaid Buy-in, referred to as Medical Assistance for Persons with
Disabilities (MAWD). Examples of activities include:
            Streamline the application process;
            Implement changes to the disability review process;
            Analyze demographics of individuals who have been using
             MAWD in their return to work;
            Development of a self-employment form to ensure
             statewide consistency for reporting self-employment;
            Members of the ACE actively participated in partnership
             with the grant’s initiatives to enhance accessibility to jobs
             for persons with disabilities, including the PA Department
             of Transportation and promotion of the rural transportation
             project for the employment of persons with disabilities.


Community Education and Outreach

Grant funds will be used to provide consumer input into the
implementation of Medical Assistance for Workers with Disabilities as
well as to develop education and outreach efforts.

A marketing campaign consisting of posters, educational kits,
brochures, and videos was launched early in 2003 and continued
throughout the grant. Professional media contractors including Bravo
and Commonwealth Media were used with extensive input
From the ACE in the development of each product. Distribution
occurred through direct mailings across the state. Through this
process:

           Approximately 14,000 video CDs were distributed
           Over 300,000 direct mailings of materials, including
            educational kits, posters, brochures, and newsletters.




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With active involvement from DPW and the ACE, AHEDD developed a
series of requests for proposals (RFPs) specifically to award mini-
grants, i.e. capped at $7,500, to grass-roots organizations throughout
the state. Targeted audiences included SSA beneficiaries, transitioning
youth, their parents or caregivers and business. Organizations
receiving mini-grants included: centers for independent living, Benefits
Counseling Programs, schools, social service and advocacy agencies.
Activities of mini-grants included:
      Presentations, local mailings, local media initiatives such as
       radio and TV talkshows, advertising, public service
       announcements, and outreach to other local transition entities
       were the bulk of their initiatives.
      Businesses likely to hire transitioning youth were also a center of
       focus for these initiatives.

In summary, through 46 Mini-grantees, the project estimated that over
35,000 individuals were contacted through presentations and targeted
mailings.

Evaluation of Medical Assistance for Workers with Disabilities
(MAWD)

In 2004, DPW conducted an independent evaluation of
Pennsylvania’s Medicaid Buy-In, Medical Assistance for Workers with
Disabilities (MAWD). AHEDD coordinated the request for proposal
and contract administration with the selected organization, Morrison
Informatics, Inc. Morrison Informatics, Inc. provides strategic
healthcare information technology, operations, regulatory compliance,
and financial analysis consulting for health care organizations and
health insurers.

The evaluation included surveys of distinct groups, including:
          MAWD consumers,
          Social Security Beneficiaries,
          Community agency personnel, and
          Business.

The major component of the study was a survey of MAWD consumers.



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          Out of 1,459 telephone calls made to MAWD consumers,
           335 (23%) respondents provided data.
          The rating of the quality of MAWD by the Consumer
           Survey respondents was overwhelmingly positive;
          78% of the respondents rated their experience as excellent
           or very good.
          Among MAWD consumers, 42% were already receiving
           Medicaid
          75% felt the MAWD premium was affordable
          Among prior Medicaid consumers, 64% were not
           previously working prior to enrollment in MAWD.
          Among MAWD Consumers who were not prior Medicaid
           consumers, 55% were not employed prior to MAWD
           enrollment.
          This data suggests that DPW has created an excellent
           incentive for employment.

A key issue relevant to the effectiveness of the Medicaid Buy-in is
whether they encourage and/or attract consumers to achieve
significant earned income. A benchmark readily available is whether
consumers earn “substantial gainful activity” (SGA), which was
established by the Social Security Administration as gross monthly
earnings of $810 for calendar year 2004. Only 3% of MAWD
Consumers reported earnings above this benchmark. In addition, 60%
of MAWD consumers reported that they also receive Social Security
Disability Insurance (SSDI), indicating that they will continue to be
highly dependent on this source of income.
As a means of surveying potential MAWD Consumers, the telephone
calls were made to 2,300 adult SSA beneficiaries in PA. A total of 435
(19%) respondents provided data for this component of the study.
    Among persons receiving SSI and/or SSDI, the majority of
     persons (87%) were not employed;
    However, 50% of these individuals indicated that they would like
     to be working.




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     It was suggested that this represents an opportunity for DPW to
      continue to collaborate with SSA, the state Vocational
      Rehabilitation, Benefits Planning Assistance and Outreach
      (BPAO), and other organizations to identify and respond to the
      employment needs of these individuals.
The study included a series of focus groups among selected
community agency personnel. In all, agency personnel indicated a
positive experience with MAWD, including its impact on employment.
Finally, the evaluation included a telephone survey of 296 businesses.
     The majority of respondents (81%) were not aware of MAWD,
      and of these,
     89% felt it would be beneficial for business to learn of this health
      care option.


One Stop Pilot Projects

Conduct pilot projects to determine if one-stop models could effectively
facilitate the employment of persons with disabilities. Utilization of the
PA CareerLinks as a primary resource to conduct this project

BACKGROUND

A task force, which included DPW, other public and private
organizations, advocates and consumers assisted in the development
Of the PA MIG. A key initiative was the implementation of a One-Stop
Pilot Project which was recommended by the ACE to establish and
demonstrate whether a “one stop model” could be a viable resource
for employment of persons with disabilities. The design included sites
located in a rural and urban area, of which the task force selected
Pittsburgh (urban) and Pottsville, Schuylkill County (rural). Each site
included a Project Coordinator based at a local CareerLink, (i.e.
Pennsylvania’s one-stop system through the Workforce Investment
Act).

The One Stop Pilot Project began in October 2002 and concluded in
March 2005. The goals of the one stop pilot included:




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     To establish a one-stop service model for persons with
      disabilities to learn about and obtain information on services
      related to finding employment and maintaining a job;
     To develop best practices and a one-stop model for assisting
      people with disabilities to learn about employment opportunities,
      health care coverage, and other ancillary services necessary for
      employment, and to serve as a navigator through this system of
      interrelated programs
     To oversee the project activities aimed at identifying, assessing,
      and improving policies and practices affecting employment of
      people with disabilities.

LOCAL ADVISORY COMMITTEE ON EMPLOYMENT

Community leaders were identified who represented the diversity
necessary to establish a cohesive cross-systems, advisory committee.
These individuals became the core of the local Advisory Committee on
Employment (ACE). The Local ACE participated in regular meetings
to discuss strategies to mitigate the barriers it identified in the local
community to the employment of persons with disabilities.

COMMUNITY OUTREACH

Each local ACE oversaw the delivery of various outreach activities.
During the project period, educational outreach sessions were
regularly scheduled, advertised and presented within the CareerLinks
and throughout the community. Over 600 persons attended
orientations focused on the Ticket-to-Work, Medical Assistance for
Workers with Disability (MAWD), and Benefits Counseling. Examples
of activities of the local ACE included:

     Collaboration with transportation providers, including making bus
      passes available at the CareerLink, and advocacy to expand a
      bus route in Schuylkill County to facilitate employment with a
      new employer;
     “A Resource Guide to Support the Employment of Persons with
      Disabilities” was developed for each target community, including
      hard copy, and CD.



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     A prominent wall map was placed at the CareerLinks which
      included locations of various social service and disability
      organizations;
     Active involvement with the Chamber of Commerce and
      businesses regularly promoted hiring of persons with disabilities
      through seminars, promotion material, and other assistance;
     Collaboration with local Transition Councils and Intermediate
      Units, including the coordination of Transition Fairs for young
      adults with disabilities who are leaving high school for
      employment or post secondary education or training;
     Participation in the Rapid Response Personal Assistance Back-
      up pilot conducted by the PA Council on Independent Living
      (PCIL) individuals who are working or seeking employment;
     In an effort to target minorities and other underserved
      populations a faith-based initiative was begun, including
      presentations hosted by faith-based groups at which information
      about Benefits Counseling, MAWD, and the Ticket to Work was
      presented.

Summary of One-Stop Pilots

The participation of local Advisory Committees on Employment led to
improved practices at targeted one-stop centers. Nevertheless, the
Project had difficulty in determining how many persons with disabilities
were served through the One-Stop CareerLink system in the target
communities.

As a result of the insertion of a staff resource – serving in a navigator
capacity – the local one stop centers did engage SSA beneficiaries
through general orientations to the Ticket to Work, MAWD, and
Benefits Counseling. Nevertheless neither of the participating one-
stops, nor others in the state, have taken an active step to serve as an
“Employment Network” through the Ticket to Work initiative.

It is hoped that future collaboration among DPW, SSA, and the one-
stops can include continuation of community orientations – at minimum
-in order to address a crucial state workforce development issue which
includes over 500,000 working aged individuals in PA (SSA 2004).



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Personal Attendant – Back-up Service

The purpose of this demonstration project is to develop a model that
will ensure reliable coverage of attendant care services for consumers
who are working or attempting to become employed.

The Pennsylvania Council on Independent Living (PCIL) was
contracted to work with the two local Advisory Committees on
Employment to develop and test the back-up model. This project
called the Rapid Response Backup Personal Assistance Service
(RRBPAS) was completed in July 2005.

    PCIL surveyed the existing PA providers to determine their
     method of assuring reliable back-up personal assistance
     services especially as it relates to persons who are employed
    PCIL conducted a survey of PAS consumers to determine the
     consumers view of the reliability of the system
    PCIL surveyed other states for best practices
    PCIL developed a workable system of service supports to
     existing providers of attendant care services.

While the model was made available to local consumers in the
targeted communities (i.e. Schuylkill County, Pittsburgh) and promoted
through participating provider agencies, no consumers
used the RRBPAS during the demonstration period.




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