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
Overview of Presentation

Description of Medicaid Buy-In program

Data construction

Highlights from descriptive profile of
participants

Concluding comments
1
NOTE: research is conducted under a contract from the Centers for Medicare and
Medicaid Services (CMS) (Contract no. 500-00-0047 05)
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
2
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
3
Study Purpose

To develop quantitative measures of
participation in the Buy-In program
– Enrollment
– Expenditures
– Earnings
4
Data Integration Process
CMS
data systems
MBI participants
finder files from
states
SSA
data systems
Medicaid
eligibility
and claims
Social
security
disability
Medicare
eligibility
and claims
Annual
reported
earnings
Integrated
Individual-Level
Analytical File
5
Number of States and Participants
in Medicaid Buy-In Program, 1999-2005
35
90,000
32
76,679
27
80,000
71,357
70,000
25
Number of states
25
60,000
60,132
20
50,000
16
15
44,228
40,000
13
30,000
10
8
22,094
Number of participants
30
31
20,000
15,452
5
10,000
7,168
0
0
1999
2000
2001
2002
States with a Buy-In program
2003
2004
2005
Enrollment as of December 31
6
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
Distribution of Impairments Among Buy-In
Participants, 27 States, 2000-2004
25%
30%
21%
12%
2%
9%
Mental Illness/Disorders
Mental Retardation
Musculoskeletal System
Sensory Disorder
All other
Unknown
7
DATA SOURCE: Buy-In finder files from 27 states and SSA’s Ticket Research File
Distribution of Prior SSI and SSDI Status
Among Buy-In Participants, 27 States, 2000-2004
26%
3%
2%
SSDI Only
69%
SSI Only
SSI/SSDI Concurrent
No SSI or SSDI
8
DATA SOURCE: Buy-In finder files from 27 states and SSA’s Ticket Research File
Medicaid and Medicare Combined PMPM Expenditures ($)
Among Buy-In Participants in 2002, by States
3500
3000
2500
2000
1500
1000
0
WA
OR
PA
NE
VT
NM
IL
NJ
CA
ME
WI
MA
AK
IA
AR
SC
CT
MO
MN
NH
UT
IN
500
Paid by Medicaid
Paid by Medicare
9
DATA SOURCE: Buy-In finder files from 22 states, MSIS claims files, and
Medicare enrollment database and claims files
Percent of Buy-In Participants with Reported Earnings
Earning Above 100% FPL, by States, 2004
60
50
40
30
20
0
WV
SC
AK
MA
AR
LA
CA
NM
PA
NE
ME
MI
NJ
OR
NY
WA
CT
VT
IN
IL
MO
NH
MN
UT
KS
WI
IA
10
10
DATA SOURCE: Buy-In finder files from 27 states and SSA’s Master Earnings File
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
Number
6,254
Percent
100
Number
94,963
Percent
100
141
2
1,142
1
Age 21-44
3,749
60
42,665
45
Age 45-64
2,315
37
50,032
53
49
1
1,105
1
White
3,808
61
74,715
79
Non-White
2,329
37
18,453
19
Total
Age <21
Age 65+
11
DATA SOURCE: Buy-In finder files from 27 states and SSA’s Master Earnings File
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
12
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
13
Questions/Comments?
SLiu@Mathematica-mpr.com
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