1 Medicaid Infrastructure Grant: 101 Effie R. George, Ph.D. CMS Division of Advocacy and Special Initiatives

2 The Ticket to Work and Work Incentives Improvement Act of 1999 Address obstacles that people with disabilities face as they seek sustained employment Demonstrate the value of providing health care benefits and other services to support people in employment

3 Medicaid Infrastructure Grant Established under Section 203 of TWWIIA Authorized for 11 years Appropriated $150 million for first 5 years Funding amount for based on previous year’s funding amount & CPI

4 MIG To facilitate enhancements to state Medicaid programs and services, to promote linkages between Medicaid and other employment-related service agencies, and to develop a comprehensive system of employment supports for people with disabilities

5 Basic MIG Develop Medicaid Buy-In programs Increase availability of PAS through Medicaid SPA or waiver programs Assure access to other health care supports that may support the employment of people with disabilities

6 Comprehensive MIG Maximize employment Increase the state’s labor force through inclusion Protect and enhance workers healthcare, other benefits, and needed employment supports

7 Medicaid Buy-In eligibility Individuals age who meet eligibility requirements for SSI but for higher earning or resources & disabled according to SGA Medically Improvement Group- for people in the first group who are determined to be medically improved by Continuing Disability Review

MIG 40 states including District of Columbia 16 Comprehensive, 21 Basic, 3 Conditional 33 of 40 MIGs have Medicaid Buy-In Enrollment approximately 90,000

9 MIG Almost every state has obtained MIG funds for at least one year since the program’s inception in Number of awarded MIGs increased from 25 in 2001 to 40 in 2008 MIG funding increased from $17 million in 2001 to $40 million in 2008.

10 MIG Impact: Medicaid Buy-In Number of MIG states with a Medicaid Buy-In program doubled from 16 to 33 from 2001 through Nationally, 41 States have a MBI. Number of Buy-In participants enrolled at the end of each calendar year rose from 29,711 in 2001 to approx. 90,000 in 2008.

11 MIG Impact: Medicaid Buy-In, Cont’ Buy-In participants in 2006 reported positive earnings ($8,237 annually on average). Top 10 percent of earners made at least $16,205 annually and $25,231 on average.

12 MIG Impact: Medicaid Buy-In, Cont’ Combined annual earnings of all Buy-In participants increased from $222 million in 2001 to more than $556 million in Buy-In participants were charged more than $22 million in premiums in 2006, which helped to pay for the Medicaid coverage.

13 MIG Impact: Expansion of PAS MIGs have motivated states to expand PAS offered through their Medicaid State Plan and waivers, because the level of MIG funding a state can receive is tied to the PAS offered through the state Medicaid program.

14 MIG Impact: Expansion of PAS, Cont’ For grants awarded in years 2001 to 2006, 20 states expanded their coverage of PAS, as indicated by their movement into a higher MIG eligibility category. All MIGs must meet PAS eligibility requirements signaling that PAS is available statewide at a level to sustain full-time competitive employment.

15 MIG Impact: Other Employment Supports (examples) Promote Supported Employment Develop programs or waivers targeting specific subgroups of PwDs (e.g. people with mental illness, youth in transition) Provide work incentives benefits counseling Establish peer networks

16 MIG Impact: Improvement of Infrastructure (examples) Collaborate with other agencies and work incentive programs (SSA WIPAs, ENs, DOL DPNs) Conduct outreach and provide training to consumers and service providers Build partnerships with employers/business organizations Develop data capacity and conduct research and evaluation

17 Summary The Medicaid Buy-In program has made great strides in achieving MIG goals States have made improvements to PAS and interest in MIG has been sustained As MIGs evolve, focus is shifted away from Medicaid Buy-In to a variety of other activities Efforts underway to better capture diverse MIG activities and measure their outcomes

18 CMS Resources Joe Razes: Effie George: MBI Eligibility Questions – Brenda Sheppard: