Economic Evaluation of
New Hampshire’s Medicaid for
Employed Adults with
Disabilities (MEAD) Program
February 2002 – January 2003
Robin Clark, Ph.D.
Center for Health Policy and Research
University of Massachusetts Medical School
Karin Swain, M.S.
William Peacock, M.S.
Dartmouth Medical School
Eligibility
•
•
•
•
•
Age 18-64
Must be employed
Must meet disability standards
Income less than 450% of poverty level
Countable resources less than $20,560
(single) $30,840 (couple)
• Premium required if above 150% of poverty
Goals of Evaluation
• Measure State costs of MEAD
• Measure MEAD’s impact on participant’s
earnings
Chart 1. MEAD Enrollment February, 2002 through January, 2003
1000
900
Number of MEAD Participants
800
700
600
500
400
300
200
100
0
Feb '02
Mar '02
Apr '02
May '02
June '02
July '02
Aug '02
Months
Sep '02
Oct '02
N ov '02
Dec '02
Jan '03
MEAD Demographics
• Mean age 43 years
• 48% women
• 56% were “Medically Needy”
Selected Diagnostic Groups
Diagnosis
MEAD %
Non-MEAD with
Disabilities %
Mental Retardation
3.4
15.8
Schizophrenia/Psychoses
38.6
12.7
Affective Disorders
36.5
32.7
Central Nervous System
4.7
15.0
Injuries/Poisonings
8.4
19.7
Cardiovascular
8.3
21.0
Immune/Nutrition/Blood Diseases
8.3
15.2
Blind
4.4
4.8
Musculoskeletal
12.5
24.4
$2,500.00
Chart 2. Average Monthly Medicaid Payments for MEAD and
Others with Disabilities
(in 2002 dollars)
$2,000.00
$1,500.00
$1,000.00
$500.00
$0.00
Non-MEAD Disabled: February, 2002 - January,
2003
Inpatient
Nursing Home
Outpatient/ Physician **
MEAD Enrolled
Total Home Based Care
** Includes Dental and HMO Expenses. Includeds all provider claims paid through June, 2003.
Pharmaceuticals
Chart 3: Medicaid Expense While Enrolled in MEAD
$1,600
$1,200
$800
$400
$0
No Prior Medicaid Eligibility (N=122)
Inpatient
Nursing Home
Outpatient/ Physician **
**Includes Dental and HM0 Expenses.
Prior Medicaid Eligibility (N=863)
Total Home Based Care
Pharmaceuticals
Costs Measured
• Increased provider payments
• Costs of determining eligibility for new
MEAD applicants
• Net premium payments (premiums minus
administrative expenses)
• Comparisons are in 2002 dollars
Table 4: State General Fund Costs Including
Payment Increases for MEAD Participants with
Prior Medicaid Eligibility: February 1, 2002 through
January 31, 2003*
General Fund Costs
Medicaid payments for
MEAD participants
without prior Medicaid
eligibility (state portion)
$264,020.50
Additional Medicaid
payments for Participants
with Prior Enrollment
(State portion only)
$193,184.34
MEAD eligibility
determination
2,236.62
Premium collection
19,586.00
Total Costs
$479,027.46
Total Premiums Collected
-$43,077.09
Net Cost
$435,950.37
Chart 4. Income Sources for MEAD Enrolled People in 2002 Dollars
$1,200
$1,000
$800
$600
$400
$200
$0
Prior to MEAD Enrollment
Total Unearned Income
MEAD Enrolled
Earned Income
Earnings increased by $1.4
million during the first year of
MEAD
Program expenditures were
$ .4 million
$0
Earned Income
Self-Employed Income
Unearned Income
Total Income
MEAD Month 12 (N=203)
MEAD Month 11 (N=283)
MEAD Month 10 (N=395)
MEAD Month 9 (N=486)
MEAD Month 8 (N=537)
MEAD Month 7 (N=578)
MEAD Month 6 (N=622)
MEAD Month 5 (N=672)
MEAD Month 4 (N=724)
MEAD Month 3 (N=769)
MEAD Month 2 (N=807)
MEAD Month 1 (N=844)
Prior 1 Month (N=832)
Prior 2 Months (N=821)
Prior 3 Months (N=820)
Prior 4 Months (N=810)
Prior 5 Months (N=802)
Prior 6 Months (N=793)
Prior 7 Months (N=783)
Prior 8 Months (N=775)
Prior 9 Months (N=773)
Prior 10 Months (N=763)
Prior 11 Months (N=758)
Prior 12 Months (N=541)
Prior Medicaid Eligibility: Monthly Client Income
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
Earned Income
Self-Employed Income
Unearned Income
Total Income
MEAD Month 12 (N=22)
MEAD Month 11 (N=38)
MEAD Month 10 (N=48)
MEAD Month 9 (N=60)
MEAD Month 8 (N=66)
MEAD Month 7 (N=76)
MEAD Month 6 (N=81)
MEAD Month 5 (N=82)
MEAD Month 4 (N=92)
MEAD Month 3 (N=94)
MEAD Month 2 (N=97)
MEAD Month 1 (N=100)
Prior 1 Month (N=73)
Prior 2 Months (N=69)
Prior 3 Months (N=67)
Prior 4 Months (N=63)
Prior 5 Months (N=62)
Prior 6 Months (N=55)
Prior 7 Months (N=53)
Prior 8 Months (N=48)
Prior 9 Months (N=48)
Prior 10 Months (N=47)
Prior 11 Months (N=47)
Prior 12 Months (N=34)
No Prior Medicaid Eligibility: Monthly Client Income
$1,400
$1,200
$1,000
$800
$600
$400
$200
Income
• People with schizophrenia earned $60 less per
month
• Those with prior Medicaid status earned $83 less
per month
• Those with prior Medically Needy status earned
$71 less per month
• Earnings decreased with age ($4/mo/yr)
• Prior earnings strongly predict future earnings