The Medicaid medically improved group: losing disability status and growing earnings

Abstract

OBJECTIVES: Under the Ticket to Work and Work Incentives Improvement Act (PL 106-170), states may extend Medicaid Buy-In coverage to a medically improved group. Improved group coverage allows adults with disabilities to retain Medicaid coverage even once they lose disability status due to medical improvement, as long as they retain the original medical impairment. The goal of this paper is to describe who participated, the patterns of their participation, and employment outcomes. METHODS: The study population consists of all individuals (n = 315) who participated in medically improved group coverage 2002-2009 in the seven states with coverage by 2009 (Arizona, Connecticut, Kansas, New York, North Carolina, Pennsylvania, and West Virginia). Linked data from state Medicaid Buy-In finder files and Social Security Administration Ticket Research and Master Earnings Files were used to describe improved group participants and their patterns of enrollment. RESULTS: Although enrollment has been limited, with 255 participants in 2009, it has doubled annually on average with little churning and drop-out. Participants' earnings grew nearly 200 dollars per month after two years, likely reflecting increased work hours and/or higher pay rates. CONCLUSIONS: Improved group participants represent an unusually successful group of individuals with disabilities, many of whom have recently moved off Social Security cash benefit rolls or who were diverted from them. Specifics of insurance eligibility and coverage for improved group participants are uncertain under the Affordable Care Act. The challenge remains to provide a pathway for adults with disabilities to increase work and assets without loss of adequate health insurance.