The Kansas Demonstration to Maintain Independence and Employment: Preventing or Forestalling Disability Among Participants in the Kansas High Risk Insurance Pool

Section 204 of TWWIIA authorized the development of another program targeted at disability prevention. Demonstrations to Maintain Independence and Employment (DMIEs) provide health care coverage to working people iwth potentially disabling conditions to test the hypothesis that providing health care and other supports can prevent or forestall the onset of full disability and eventual dependence on federal disability program

Historical Disability Outcomes of Enrollees in the Kansas High Risk Pool: A White Paper presented to CMS by the Kansas DMIE Project January, 2006

This white paper reports the historical rates of disability outcomes (e.g., transition to Social Security disability status) for people enrolled in Kansas' state high-risk health insurance pool.Centers for Medicare & Medicaid Services; Kansas Health Policy Authorit

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

Health Care Behaviors and Decision-Making Processes Among Enrollees In A State High Risk Insurance Pool: Focus Group Findings

Purpose-To better understand the relationship between health insurance coverage and health care behaviors of persons with potentially disabling conditions enrolled in a state high risk insurance pool. Approach or Design-Six focus groups with risk pool enrollees in two sites. Setting-Suburban areas in the state of Kansas. Participants-Forty-two individuals ages 29 to 62 years, all with potentially disabling physical or mental health conditions. Method-Qualitative analysis of focus group transcripts using pile sorting and theme identification. Results-High premiums and deductibles limit participants’ ability to afford basic health services and access to prescription medications despite their middle-class socioeconomic status. Participants report delaying or forgoing needed medical care due to lack of coverage and/or out-of-pocket costs. They employ numerous and potentially dangerous strategies to minimize costs, especially for prescription medications. Some report “saving up” needed procedures until their total costs will exceed that year’s deductible. Conclusion-Individuals in the risk pool were making medical decisions on the basis of cost rather than need. Many shared stories of medical complications as a result of delayed care and most expressed stress related to the difficulty of making decisions about their care and use of prescribed medications. The individual, nongroup insurance market, with its higher out-of-pocket costs, may not meet the needs of people with chronic health conditions.Kansas Health Policy Authority, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (11-P-92389/7-01

Unintended Consequences: The Potential Impact of Medicare Part D on Dual Eligibles with Disabilities in Medicaid Work Incentive Programs

Common sense suggests that a safety net is required for situations in which enrollees are unable to obtain critical or life-sustaining medications. Such situations can arise when either the drug is not on formulary and/or is being used off-label and the appeals process has been exhausted, or when patients cannot afford the co-payments for the numerous medications they need. Given the vulnerability of this population, immediate action is needed to address these issues in the short time remaining before Part D is implemented

Preventing Disability Among Working Participants in Kansas’ High-risk Insurance Pool: Implications for Health Reform

Health conditions that prevent individuals from working full time can restrict their access to health insurance. For people living in the 35 states that offer high-risk pools, coverage is available but premiums are 125–200% of standard rates. Additionally, high cost-sharing means enrollees often defer needed care because they must pay large amounts out of pocket. Lack of access may lead to poor health outcomes and disability. The Kansas DMIE investigated whether improving insurance coverage for such a group would improve their health status and reduce their risk of transition to full Social Security disability. Half of the 508 participants received enhanced benefits and nurse case management, the other half received usual risk pool coverage. Outcomes were measured through telephone surveys, focus groups, and claims analysis. Utilization of services increased and health status stabilized for the intervention group, while health status of the control group significantly declined. These findings have broad implications because some plans to be offered under the Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) have similarly high out-of-pocket costs. Considering the long-term cost of full disability, providing adequate health insurance benefits for individuals at high risk of disability may be cost effective.Kansas Health Policy Authority, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (no. 11-P-92389/7-01)

Impact of current health care reform proposals on people with chronic illnesses

Outlines the most challenging issues facing people with special health care needs. There is a need for the Medicaid Infrastructure Grants and other grants to identify cost effective strategies for providing access to coverage for individuals with chronic conditions

Medicaid's Expenditures for Newer Pharmacotherapies for Adults with Disabilities

This is the publisher's version, also available electronically from http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/List-of-Past-Articles-Items/CMS1206484.html?DLPage=1&DLFilter=2007&DLSort=2&DLSortDir=descending.Medicaid's drug expenditures have grown at double-digit inflation rates since 2000. These prescription drug costs are important contributors to increasing health care costs for disabled persons. In spite of this knowledge, little has been reported about specific patterns of medication use among disabled enrollees. We analyzed Kansas Medicaid data to describe trends in medication use patterns across 3 years among disabled beneficiaries.The authors are with the University of Kansas. The research in this article was supported by the Kansas Department of Social and Rehabilitation Services under Contract Number KAN30700/30705. Sally K. Rigler received salary support from the National Institute on Aging under Contract Number K08 AG019516. The statements expressed in this article are those of the authors and do not necessarily reflect the views or policies of the University of Kansas, Kansas Department of Social and Rehabilitation Services, the National Institute on Aging, or the Centers for Medicare & Medicaid Services (CMS)

Realizing Health Reform’s Potential Early Implementation of Pre-Existing Condition Insurance Plans: Providing an Interim Safety Net for the Uninsurable

The Pre-Existing Condition Insurance Plan (PCIP) is a temporary program implemented under the Patient Protection and Affordable Care Act to make health insurance coverage available to uninsured individuals with preexisting conditions until 2014, when exchange-based health insurance becomes available to all. The PCIP program began enrolling applicants in July 2010. This issue brief examines enrollment trends, early changes to plan structures and premiums, and estimates of out-of-pocket costs by utilization pattern and type of plan. It also provides information about the age and medical conditions of early PCIP enrollees. Although PCIP enrollment has been lower than expected due to affordability issues, a lack of public awareness, and the requirement that applicants be uninsured for six months, the plans are nonetheless playing an important role in making coverage available to otherwise uninsurable Americans with preexisting conditions

Medicaid’s expenditures for newer pharmacotherapies for adults with disabilities

Medicaid's drug expenditures have grown at double-digit inflation rates since 2000. These prescription drug costs are important contributors to increasing health care costs for disabled persons. In spite of this knowledge, little has been reported about specific patterns of medication use among disabled enrollees. We analyzed Kansas Medicaid data to describe trend in medication use patterns across 3 years among disabled beneficiaries. The marked shifts toward newer medications and disproportionate contributions of newer, more expensive medications to overall prescription costs for antipsychotics, antidepressants, anticonvulsants, antiulcer medications, anti-inflammatory agents, and opioids have implications for both policy and practice