1. A Descriptive Profile of Medicaid Buy-In Participants from Linked Multi-Agency Data Su Liu Henry T. Ireys Craig Thornton AcademyHealth Annual Research Meeting Seattle, WA June 25 2006 Su Liu Henry T. Ireys Craig Thornton AcademyHealth Annual Research Meeting Seattle, WA June 25 2006

2. 1 Overview of Presentation Description of Medicaid Buy-In program Data construction Highlights from descriptive profile of participants Concluding comments Description of Medicaid Buy-In program Data construction Highlights from descriptive profile of participants Concluding comments NOTE: research is conducted under a contract from the Centers for Medicare and Medicaid Services (CMS) (Contract no. 500-00-0047 05)

3. 2 The Medicaid Buy-In Program Encourages work by allowing individuals with disabilities to “buy into” Medicaid without giving up higher earnings or assets Optional state program under Medicaid Currently offered by 31 states More than 120,000 individuals enrolled Encourages work by allowing individuals with disabilities to “buy into” Medicaid without giving up higher earnings or assets Optional state program under Medicaid Currently offered by 31 states More than 120,000 individuals enrolled

4. 3 Medicaid Buy-In: State Variation Enacting legislation give states flexibility to –Set income and asset limitations –Establish premium rate structure –Require income verifications –Conduct outreach programs Enacting legislation give states flexibility to –Set income and asset limitations –Establish premium rate structure –Require income verifications –Conduct outreach programs

5. 4 Study Purpose To develop quantitative measures of participation in the Buy-In program –Enrollment –Expenditures –Earnings To develop quantitative measures of participation in the Buy-In program –Enrollment –Expenditures –Earnings

6. 5 Medicaid eligibility and claims Medicare eligibility and claims Social security disability Integrated Individual-Level Analytical File Data Integration Process Annual reported earnings MBI participants finder files from states CMS data systems SSA data systems

7. 6 Number of States and Participants in Medicaid Buy-In Program, 1999-2005 NOTE: Enrollment as of 12/31/05 includes estimated number of participants in AZ, IN and MS, because of missing data. DATA SOURCE: Quarterly Medicaid Infrastructure Grant (MIG) reports from states

8. 7 Distribution of Impairments Among Buy-In Participants, 27 States, 2000-2004 DATA SOURCE: Buy-In finder files from 27 states and SSA’s Ticket Research File

9. 8 Distribution of Prior SSI and SSDI Status Among Buy-In Participants, 27 States, 2000-2004 DATA SOURCE: Buy-In finder files from 27 states and SSA’s Ticket Research File

10. 9 Medicaid and Medicare Combined PMPM Expenditures ($) Among Buy-In Participants in 2002, by States DATA SOURCE: Buy-In finder files from 22 states, MSIS claims files, and Medicare enrollment database and claims files

11. 10 Percent of Buy-In Participants with Reported Earnings Earning Above 100% FPL, by States, 2004 DATA SOURCE: Buy-In finder files from 27 states and SSA’s Master Earnings File

12. 11 Demographic Distribution: High Earners vs. All Participants, 27 States, 2004 2004 Buy-In Participants with Top 10 Percent Earnings ($16,205+) All 2004 Buy-In Participants NumberPercentNumberPercent Total6,254100 94,963100 Age <21 1412 1,1421 Age 21-44 3,74960 42,66545 Age 45-64 2,31537 50,03253 Age 65+ 491 1,1051 White 3,80861 74,71579 Non-White2,32937 18,45319 DATA SOURCE: Buy-In finder files from 27 states and SSA’s Master Earnings File

13. 12 Concluding Comments Many factors will shape future enrollment in Medicaid Buy-In program –Fiscal status of state Medicaid programs –Medicare Part D –Other public and private insurance initiatives –Support and advocacy from disability community –Changes in definition of disability –Statutory changes –Broad employment trends Many factors will shape future enrollment in Medicaid Buy-In program –Fiscal status of state Medicaid programs –Medicare Part D –Other public and private insurance initiatives –Support and advocacy from disability community –Changes in definition of disability –Statutory changes –Broad employment trends

14. 13 Future Direction State-Based Research Resource Center –Identify states’ research interests and needs –Facilitate access to resources and coordinate research activities –Enhance states’ research capacity and quality State-Based Research Resource Center –Identify states’ research interests and needs –Facilitate access to resources and coordinate research activities –Enhance states’ research capacity and quality

15. Questions/Comments? SLiu@Mathematica-mpr.com Sign up to receive email updates on future Medicaid Buy-In and disability research issue briefs