Maine's CHOICES CEO Project
Priority #7: Improving Work Incentives for People with Disabilities Who Receive Benefits, Especially "MaineCare (Medicaid) Option for Workers with Disabilities"
Maine was one of the first states in the country to help people with disabilities work more hours and earn higher wages without the fear of losing their Medicaid benefits. Started in 1999, the MaineCare Option for Workers with Disabilities (WWD) program provides full MaineCare (Medicaid) coverage for people with disabilities who would otherwise be ineligible for MaineCare because of the wages they earned from work.
Results from the program have been encouraging. In 2004, first time enrollees earned an average of 30 percent more than they did during the previous year.
CHOICES CEO and its partners are helping more MaineCare enrollees with disabilities explore competitive employment and seek health insurance from their employer. Only when this happens — and it has for many people — can workers and their families enjoy a financial life above poverty levels.
Technical support for WWD — including support to its operation, analyses of its effect, and the public's understanding of the program — has been a central focus of CHOICES CEO since the project began in 2000. Our work provides the information needed to make improvements to the WWD program. It also helps improve how WWD connects with related services and incentives (e.g. Social Security, benefits counseling).
Nationally, programs like WWD are referred to as "Medicaid Buy-in Programs." Authorized by federal legislation as an optional Medicaid program in 1997, these buy-in programs have been adopted by more than 30 states. As of December 2004, the program has covered over 125,000 people nationwide.
Activities
- The CHOICES CEO project has updated the MaineCare for People Who Have Disabilities and Who Work brochure to include the new federal poverty-level information, which was released in January 2008. This information is also available in a fact sheet: Word.
- Each year, CHOICES CEO staff sends updated information about Maine WWD to the federal Centers for Medicaid and Medicare Services (CMS). This data will be merged with a new federal integrated database that is being used to study the effectiveness of Medicaid supports for employment (for example, the work of Mathematica Policy Research referenced below). The federal integrated database includes:
- Buy-in program data from other states
- The Ticket Research File (TRF) from the Social Security Administration (SSA)
- The Master Earnings File (MEF) from SSA
- Medicaid Statistical Information System (MSIS) from CMS
- Medicare Enrollment Data Base (EDB) and Claims Files from CMS
Resources for Maine
- MaineCare Option for Workers with Disabilities: This is the Maine Department of Health and Human Services web page on the WWD program. Information on eligibility is provided.
- Participation in the Medicaid Buy-In Program: A Statistical Profile from Integrated Data (PDF): This extensive report was released by the Centers for Medicare and Medicaid Services in May 2006. Please note that this is a large PDF file. Maine-specific data is available in a reader's guide (Word format) produced by the CHOICES CEO project.
- MaineCare Personal Assistance Services in the Workplace Report (PDF): This report focuses on personal assistance services provided with MaineCare funding, with a specific focus on services in the workplace. It provides a basis for further research on personal assistance needs, demand, cost, benefit, and the impact of policies or practices. It was produced by the CHOICES project at the Muskie School for Public Service, University of Southern Maine. This report is also available in Word.
- MaineCare and Other Supports for Workers with Disabilities: A Summary Report of Focus Group Findings (PDF): In 2002, the CHOICES project gave funds to community organizations to hold focus groups. People with disabilities and others discussed experiences with employment service systems, and important employment supports such as MaineCare. This report provides a summary of these in-depth discussions.
- Evolving Supports for Workers with Disabilities: The MaineCare Workers with Disabilities Option Phone Survey (PDF): This slide presentation reports findings from a 2003 survey of the MaineCare Workers with Disabilities Option enrollees. Information on disability, reported earnings and use of work-related supports is presented.
- MaineCare Services for Workers with Disabilities Chartbook (PDF): This Chartbook describes the MaineCare Workers With Disabilities Option program and the people who enrolled in since it's beginning in 1999. It also contains general information about disability in Maine and the nation. The Chartbook is also available in Word.
Resources from Other States and National Organizations
- Many other states have Medicaid Buy-in programs. Visit their program web sites: California, Minnesota, New Hampshire, and Vermont.
- Mathematica Policy Research (MPR) is a national contractor of the Centers for Medicare and Medicaid Services. The organization is conducting significant research related to employment and disability. MPR recently published a series of "Working with Disability" briefing papers that focus on Medicaid buy-in programs:
- The National Coalition of Health Systems Development Library offers helpful resource materials on Medicaid Buy-In programs and related work incentives. To quickly find these materials, select "Categories," select "Medicaid Buy-in/Medicaid" from the drop-down list, and then click "Run Search."
Quick Facts
Some Facts about Maine's Medicaid Buy-in Program
- Maine was the third state to implement a Medicaid Buy-in program for workers with disabilities.
- When compared to other early implementation states, Maine's program had a higher than average growth rate in the first two years that were studied (2001 and 2002), followed by growth rate that was either the same or smaller in the next two years (2003 and 2004).
- Maine has higher than average annual earnings among Medicaid Buy-in participants.
- Maine was among the 19 states in which program participants increased their earnings during the first year of enrollment.
- In 2004, the annual incomes of first-time enrollees in the MaineCare Workers with Disabilities Option were, on average, 30 percent higher than their incomes during previous year.
The above facts were pulled from the CHOICES CEO reader's guide to the federal report, Participation in the Medicaid Buy-In Program: A Statistical Profile from Integrated Data.
A series of "Working with Disability" briefing papers, developed by Mathematica Policy Research, focus on Medicaid buy-in programs — which refers to Medicaid options like the MaineCare Workers with Disabilities Option. Several interesting findings about the MaineCare option can be found in these briefs:
- How Much Are Medicaid Buy-In Participants Earning? (PDF). One interesting finding reported is that the average annual earnings for a MaineCare Workers Option enrollee is about $8300, well above the national average of $7246.
- "Do Participants Increase Their Earnings After Enrolling in the Medicaid Buy-In Program?" One interesting finding reported in this brief is that Maine is among the top eight states where more than 50 percent of participants increased their earnings after they enrolled in the Buy-In program. Maine does not provide a grace period for those who lose work, which may signal that work is a strict condition for participation, thus attracting
participants who are more likely to work. - "How Do Medicaid Buy-In Participants Compare with Other Medicaid Enrollees with Disabilities?" One interesting finding reported in this brief is that, on average, Buy-In participants cost Medicaid $984 per-member per-month (PMPM) in 2000, almost 40 percent lower than the cost of other Medicaid enrollees with disabilities
