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
Chart 1. MEAD Enrollment February, 2002 through January, 2003
Goals of Evaluation
1000
900
• Measure State costs of MEAD
• Measure MEAD’s impact on participant’s
earnings
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
Sep '02
Oct '02
N ov '02
Dec '02
Jan '03
Months
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
1
$2,500.00
Chart 2. Average Monthly Medicaid Payments for MEAD and
Others with Disabilities
(in 2002 dollars)
Chart 3: Medicaid Expense While Enrolled in MEAD
$1,600
$1,200
$2,000.00
$800
$1,500.00
$400
$1,000.00
$0
$500.00
No Prior Medicaid Eligibility (N=122)
Inpatient
Nursing Home
Outpatient/ Physician **
Prior Medicaid Eligibility (N=863)
Total Home Based Care
Pharmaceuticals
$0.00
Non-MEAD Disabled: February, 2002 - January,
2003
Inpatient
Nursing Home
Outpatient/ Physician **
MEAD Enrolled
Total Home Based Care
**Includes Dental and HM0 Expenses.
Pharmaceuticals
** Includes Dental and HMO Expenses. Includeds all provider claims paid through June, 2003.
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
Chart 4. Income Sources for MEAD Enrolled People in 2002 Dollars
$1,200
$1,000
$800
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
Earnings increased by $1.4
million during the first year of
MEAD
$600
$400
$200
$0
Prior to MEAD Enrollment
Total Unearned Income
MEAD Enrolled
Program expenditures were
$ .4 million
Earned Income
2
Earned Income
$0
Self-Employed Income
Unearned Income
Earned Income
$0
Self-Employed Income
Unearned Income
M E AD M on th 1 2 (N =22 )
M E AD M on th 1 1 (N =38 )
M E AD M on th 1 0 (N =48 )
M EA D M o nth 9 (N =60 )
M EA D M o nth 8 (N =66 )
M EA D M o nth 7 (N =76 )
M EA D M o nth 6 (N =81 )
M EA D M o nth 5 (N =82 )
M EA D M o nth 4 (N =92 )
M EA D M o nth 3 (N =94 )
M EA D M o nth 2 (N =97 )
M E AD M on th 1 (N =1 00 )
Prio r 1 M on th (N =73 )
P rio r 2 M o nth s (N =69 )
P rio r 3 M o nth s (N =67 )
P rio r 4 M o nth s (N =63 )
P rio r 5 M o nth s (N =62 )
$200
P rio r 6 M o nth s (N =55 )
$400
P rio r 7 M o nth s (N =53 )
Prior Medicaid Eligibility: Monthly Client Income
P rio r 8 M o nth s (N =48 )
$600
P rio r 9 M o nth s (N =48 )
$800
Prior 10 M o nth s (N =47 )
$1,000
Prior 11 M o nth s (N =47 )
$1,200
Prior 12 M o nth s (N =34 )
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)
$1,400
$1,400
No Prior Medicaid Eligibility: Monthly Client Income
$1,200
$1,000
$800
$600
$400
$200
Total Income
Total Income
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
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