Disabling Conditions, Activity Limitations and Work Outcomes among Adults with Disabilities in the Massachusetts Medicaid Buy-in Program Findings from the MassHealth Employment and Disability Survey, 2003 Alexis Henry, Steven Banks, Lobat Hashemi, Robin Clark and Jay Himmelstein Center for Health Policy and Research University of Massachusetts Medical School

Background Unemployment and underemployment are significant problems among adults with disabilities –Many adults with disabilities want to work Person level barriers to employment –Severity of disabling condition and/or functional limitations –Disrupted education or limited work history Environment level barriers to employment –Stigma –Inaccessible workplaces or transportation –Complexity of public disability benefit programs Fear of loss of health insurance with work Person and environment effects are difficult to disentangle

Study Goals To examine the relationships of health characteristics to work outcomes among adults with disabilities enrolled in a Medicaid Buy-in program –Designed to promote work and higher earnings –Provide health insurance and access to services –Should eliminate fear of loss of health insurance Health characteristics : –types of disabling condition –type of functional or activity limitations Work outcomes: –Work status (working vs. not) of all members –Annual earnings over $10,000 (over SGA) among working members –Future work intentions among non-working members

The Massachusetts Medicaid Buy-in Program: MassHealth CommonHealth First buy-in in the US, created in 1988 Funded under a Medicaid 1115 Waiver since 1997 Provides health insurance for those who meet SSA criteria for disability but have family income too high to qualify for MassHealth Standard –Those working 40 hours/month pay income adjusted premium –Those not working or working under 40 hours/month meet a one-time deductible and pay income adjusted premium The CommonHealth program has no income or asset limit

Method: The MassHealth Employment and Disability Survey, 2003 Examined disability, health, employment status among MassHealth members with disabilities –136 item survey; developed with stakeholder input –Fielded in summer-fall 2003 –Mailed with telephone follow-up; English and Spanish versions SAMPLE –1933 randomly selected CommonHealth members with disabilities across the state –ages –Enrolled for at least 6 months 1093 respondents – 57% response rate

Self-reported member characteristics: Members reported a variety of disabling conditions and current activity limitations N=1093. Source: MassHealth Employment and Disability Survey, 2003

Disabling conditions Rates of working varied among members reporting different types of disabling conditions Source: MassHealth Employment and Disability Survey, 2003

Odds of working, earning over $10K, and intending to work in the future for members with differing disabling conditions

Activity limitations Rates of working varied among members reporting different types of activity limitations Self-reported current activity limitationN% Working No limitations34268% One limitation Concentrating, chores, self-care (non-mobility limitations)16562% Moving inside home, going outside home (mobility limitations)3928% Multiple limitations Combinations of non-mobility limitations7755% Combinations with at least one mobility limitations34428% All five limitations12619% N=1093

Across three disability groups, members with mobility limitations were significantly less likely to work than those with non-mobility limitations* (n=955) *common OR =.28; 95%CI = ; p<.0001 % working

Across three disability groups, non-workers with mobility limitations were significantly less likely to intend to work than those with non-mobility limitations* (n=547) *common OR =.58, 95%CI = , p<.005 % intending future work

Across three disability groups, only workers co-occurring psychiatric and physical disabilities and mobility limitations with were less likely to earn over $10K* (n=501) % earning over $10K OR=1.07 OR=1.43 OR=0.30 *OR for co-occurring group significantly less than pooled ORs for other two groups (p<.005)

Summary of Findings Health characteristics are associated with work outcomes among CommonHealth members –Type of disabling conditions and type of current activity limitations Working and earning are not equivalent outcomes –Some conditions/limitations may make it difficult to enter the workforce; others may make it difficult to have higher earnings People with co-occurring psychiatric and physical disabilities have the poorest work outcomes Activity limitations moderate the impact of disabling conditions on work outcomes –Mobility limitations are generally associated with poorer work outcomes regardless of disabling condition Exception to this patterns is in terms of earnings

Implications for MICEO Evaluation of the impact of buy-in programs –Needs to take health characteristics into account How can MICEO grants work to remove barriers –Rehabilitation interventions target activity limitations –Break-down “silos” to address needs of those with co-occurring psychiatric and physical conditoins

Acknowledgements This work is funded by a grant from the Centers for Medicare and Medicaid Services (CFDA #93-768) and administered by UMASS Medical School, Center for Health Policy and Research; UMASS Boston, Institute for Community Inclusion; and the Massachusetts Executive Office of Health and Human Services. For more information visit: We thank Fred Hooven, Leslie Olin, David Jarzobski, Allard Dembe, Ann Lawthers, Raymond Glazier, John Butterworth, Tina Edlund, Pamela Hanes, David Stapleton Gina Livermore, Patricia Gallagher, Vickie Stringfellow, Ellie Shea-Delaney and Annette Shea for their contributions to the development of the MHEDS I. For more information on MHEDS I: