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Determining Disability
Medicaid Work Requirements and the Limits of Digital Health Rachel Gershon October 16, 2018
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4,353
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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
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How can states ensure that they are exempting all recipients who are unable to work?
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Not determined disabled
Disability and work Determined Disabled Not Able to Work; Not determined disabled Able to Work
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Example 1: Quick determination
Determined Disabled Not Able to Work; Not determined disabled Able to Work
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Example 2: Slow determination
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Example 3: Retains ability to work
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Example 4: In and out of ability to work
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Example 5: Not able to work
Not determined disabled Determined Disabled Able to Work
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Not determined disabled
Disability and work Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Data Matches for disability determinations
Social Security Administration Veteran’s Affairs SNAP Other federal and state agency determinations
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Data match for disability determinations
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Consequences of Medicaid loss
Access to health care Financial protection Access to employment Access to disability determinations Access to medical professional Substantial gainful activity
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Example 2: slow determination
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Access to medical professional
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Substantial gainful activity
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Data Matches for disability applications
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Data match for disability applications
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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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
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Consequences of Medicaid loss
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Claims analytics Diagnoses Medical expenditures
Social determinants of health
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Not determined disabled
Claim analytics Not Able to Work; Not determined disabled Determined Disabled Able to Work
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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
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Consequences of Medicaid loss
Not Able to Work; Not determined disabled Determined Disabled Able to Work
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Example 5: Not able to work
Not determined disabled Determined Disabled Able to Work
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Going analog Self-report Process for analyzing self-report
Who bears the burden of uncertainty?
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Are work requirements worth it?
Needle in a haystack Medicaid as a work support Potential for disrupting disability determination process
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Discussion Standards for determining disability
Processes for determining disability Role of technology Effectiveness of work requirements
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Thank you!
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