Determining Disability Medicaid Work Requirements and the Limits of Digital Health Rachel Gershon October 16, 2018

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Medicaid work requirement status Pending Approved Invalidated by a court Based on Kaiser Family Foundation, State Health Facts, Approved Section 1115 Medicaid Waivers and Pending Section 1115 Medicaid Waivers, September 28, 2018

How can states ensure that they are exempting all recipients who are unable to work?

Not determined disabled Disability and work Determined Disabled Not Able to Work; Not determined disabled Able to Work

Example 1: Quick determination Determined Disabled Not Able to Work; Not determined disabled Able to Work

Example 2: Slow determination Not Able to Work; Not determined disabled Determined Disabled Able to Work

Example 3: Retains ability to work Not Able to Work; Not determined disabled Determined Disabled Able to Work

Example 4: In and out of ability to work Not Able to Work; Not determined disabled Determined Disabled Able to Work

Example 5: Not able to work Not determined disabled Determined Disabled Able to Work

Not determined disabled Disability and work Not Able to Work; Not determined disabled Determined Disabled Able to Work

Data Matches for disability determinations Social Security Administration Veteran’s Affairs SNAP Other federal and state agency determinations

Data match for disability determinations Not Able to Work; Not determined disabled Determined Disabled Able to Work

Consequences of Medicaid loss Access to health care Financial protection Access to employment Access to disability determinations Access to medical professional Substantial gainful activity

Example 2: slow determination Not Able to Work; Not determined disabled Determined Disabled Able to Work

Access to medical professional Not Able to Work; Not determined disabled Determined Disabled Able to Work

Substantial gainful activity Not Able to Work; Not determined disabled Determined Disabled Able to Work

Data Matches for disability applications

Data match for disability applications Not Able to Work; Not determined disabled Determined Disabled Able to Work

Who is not applying for SSA benefits? Including disability income applicants mitigates the substantial gainful activity issue, but leaves other populations out. Not yet gathered the information to apply Does not meet SSA disability standards

Consequences of Medicaid loss Not Able to Work; Not determined disabled Determined Disabled Able to Work

Claims analytics Diagnoses Medical expenditures Social determinants of health

Not determined disabled Claim analytics Not Able to Work; Not determined disabled Determined Disabled Able to Work

Consequences of Medicaid loss Medicaid as a work support “A large majority of employed Group VIII enrollees (83.5%) reported that Medicaid made it easier to work; most unemployed enrollees (60.0%) reported that Medicaid made it easier to look for work.” “[Medicaid] allows me to get surgery which has allowed me to return to work.” -Ohio Group VIII evaluation

Consequences of Medicaid loss Not Able to Work; Not determined disabled Determined Disabled Able to Work

Example 5: Not able to work Not determined disabled Determined Disabled Able to Work

Going analog Self-report Process for analyzing self-report Who bears the burden of uncertainty?

Are work requirements worth it? Needle in a haystack Medicaid as a work support Potential for disrupting disability determination process

Discussion Standards for determining disability Processes for determining disability Role of technology Effectiveness of work requirements

Thank you!