Working Healthy Participants: Earning More & Costing Less

This Policy Brief summarizes research findings about the earnings, taxes paid, and Medicaid expenditures of people enrolled in Working Healthy using recently published data (Kurth, Fall, & Hall, 2008). In a nutshell, participants' earnings increased, as did the amounts of taxes and premiums they paid, while Medicaid costs per person decreased over tim

Transition to Medicare Part D: An Early Snapshot of Barriers Experienced by Younger Dual Eligibles With Disabilities

Transition to Medicare Part D affected not only 35.4 million elderly enrollees but also 6.4 million younger enrollees with disabilities, 2.5 million of whom have low incomes and previously obtained medications through Medicaid. Because Part D was conceived primarily as a benefit for elders, we sought to examine its effects on a dually eligible, younger group of beneficiaries who have significantly different, more expensive, and often unstable health conditions

Assessing factors associated with social connectedness in adults with mobility disabilities

Background People with mobility disabilities are likely to report limitations in community participation and social connectedness for a variety of reasons, including inaccessible physical environments, health issues, transportation barriers, and limited financial resources. Improving social connectedness is a public health issue and research shows its relation to overall health and life expectancy. Objective The purpose of this study was to (1) assess social activity, isolation, and loneliness among people with mobility disabilities compared to those with non-mobility disabilities and (2) understand factors associated with social connectedness among people with mobility disabilities. Methods An observational, cross-sectional analysis was conducted using data from Wave 2 of the National Survey on Health and Disability (NSHD) to test for differences between adults age 18–64 with mobility disabilities (n = 621) and those with other disabilities (n = 1535), in addition to tests within the mobility disability group. Results Adults with mobility disabilities were less likely than respondents from other disability groups to report feeling isolated (30.2% versus 35.2%), but these groups did not differ on measures of social activity or loneliness. Within the mobility disability group, being unemployed and in fair or poor health were predictive of greater loneliness, more isolation, and less satisfaction with social activity. Conclusions Social connectedness is an important public health issue. This research helps to inform service providers and medical professionals about the personal factors affecting social connectedness among people with mobility disabilities

Asset building: One way the ACA may improve health and employment outcomes for people with disabilities

Working-age individuals with disabilities are often forced to live in poverty to maintain Medicaid coverage. This study explored the relationship between having assets in excess of usual Medicaid limits and health and quality of life in a sample of Medicaid Buy-In participants. Using self-reported survey data, we compared groups with US$2,000 or less in cash assets (the usual Medicaid limit) and those with more than US$2,000. Participants with higher assets had significantly better health status and quality of life. Males, younger respondents, and respondents with intellectual disabilities were most likely to have higher assets. Although many Buy-Ins allow assets greater than US$2,000, assets are still capped for most individuals. The Affordable Care Act’s Medicaid expansion does not limit assets in determining eligibility. Especially for younger individuals with disabilities, expansion coverage might allow greater asset accumulation and better health and quality of life, while avoiding lifelong dependence on disability programs.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The contents of this article were developed under a contract with the Kansas Department of Health and Environment (KHPA2007-055) and a grant from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) Grant H133G100082

Employment as a Health Determinant for Working-age, Dually-eligible People with Disabilities

Background: Individuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research. Objective: This study examined the relationship of employment to health and quality of life among people with disabilities. Methods: Self-reported survey data and secondary claims data analyses of 810 Kansans ages 18 to 64 with disabilities who were dually-eligible for Medicare and Medicaid; 49% were employed, with 94% working less than 40 hours per week. Statistical analyses included ANOVA for differences between the employed and unemployed groups’ health status, risk scores, and disease burdens; chi-square analyses for differences in prevalence of health risk behaviors and differences in quality of life by employment status; and logistic regression with health status measures to determine factors associated with higher than average physical and mental health status. Results: Findings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less. Employment, even at low levels, was associated with better health and health behaviors as well as lower costs. Participants reported being discouraged from working by medical professionals and federal disability policies. Conclusions: Although cause-effect cannot be established from this study, findings strongly support changes to provider practices and federal disability policy to support employment at all levels for people with disabilities.Kansas Department of Health and Environment (KHPA2007-055), U.S. Department of Education, NIDRR grant number H133G10082-1

Effect of Medicaid Expansion on Workforce Participation for People With Disabilities

OBJECTIVES: To use data from the Health Reform Monitoring Survey (HRMS) to examine differences in employment among community-living, working-age adults (aged 18-64 years) with disabilities who live in Medicaid expansion states and nonexpansion states. METHODS: Analyses used difference-in-differences to compare trends in pooled, cross-sectional estimates of employment by state expansion status for 2740 HRMS respondents reporting a disability, adjusting for individual and state characteristics. RESULTS: After the Affordable Care Act (ACA), respondents in expansion states were significantly more likely to be employed compared with those in nonexpansion states (38.0% vs 31.9%; P = .011). CONCLUSIONS: Prior to the ACA, many people with disabilities were required to live in poverty to maintain their Medicaid eligibility. With Medicaid expansion, they can now enter the workforce, increase earnings, and maintain coverage. Public Health Implications. Medicaid expansion may improve employment for people with disabilities

Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18–64, uses both question sets and contains other disability questions. We compared ACS-6 and WG-SS responses with self-reported disability types. The ACS-6 and WG-SS failed to identify 20 percent and 43 percent, respectively, of respondents who reported disabilities in response to other NSHD questions (a broader WG-SS version missed 4.4 percent of respondents). The ACS-6 and the WG-SS performed especially poorly in capturing respondents with psychiatric disabilities or chronic health conditions. Researchers and policy makers must augment or strengthen federal disability questions to improve the accuracy of disability prevalence counts, understanding of health disparities, and planning of appropriate services for a diverse and growing population

Medicaid managed care: Issues for beneficiaries with disabilities

Background: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. Objective: To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. Methods: During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. Results: Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. Conclusions: As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs

Discrepancy among Behavioral Risk Factor Surveillance System, Social Security, and functional disability measurement

This article was published as a Brief, without the abstract.The Affordable Care Act (ACA) of 2010 (P.L. 111-148) Section 4302 requires the development of federal standards for the measurement of disability status in order to monitor health disparities and quality of care among this population. The validity and reliability of disability measurement instruments are important to all those who will use these data. The construct validity of BRFSS disability items is examined using a sample of adults who met the more stringent SSA definition of disability and compared to a seven-part functional disability question. Findings show that among 368 working-age adults with SSA-determined disabilities, the BRFSS disability questions had a sensitivity of 80.7%; 19.3% would not have been included in the state’s BRFSS disability prevalence estimate.Kansas Health Policy Authority (#KHPA2007-055

Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities

Objectives: To inform policy with better information about the oral health-care needs of aMedicaid population that engages in employment, that is, people ages 16 to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In program. Methods: Statistically test for significant differences among responses to aMedicaid Buy-In program satisfaction survey that included oral health questions from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the state’s general population and the US general population. Results: All measures of dental care access and oral health were significantly worse for the study population as comparedwith a state general population or aUS general population. Differences were particularly pronounced for the OHIP measure for difficulty doing one’s job due to dental problems, which was almost five times higher for the study population. Conclusions: More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage