minnesota’s medicaid buy-in medical assistance for employed persons with disabilities (ma-epd)...

Minnesota’s Medicaid Buy-In

Medical Assistance for Employed Persons with Disabilities (MA-

EPD)

Established July 1999

MN Statute: 256(B).057, subd. 9

• The goal of the program is to establish a continuum of access, regardless of earnings, to the full range of medical, mental health and long term care benefits,and

• Promote competitive employment and the economic self-sufficiency of people with disabilities.

Medical Assistance for Employed Persons with Disabilities

MA-EPD Goals

Background• Eligibility:

– Ages 16-64– Certified disabled by SSA or SMRT– Be employed– Meet the asset limit ($20,000)– Pay a monthly premium

• Services Covered:– Comprehensive benefits under State Plan – MN provides almost every optional services– 40% of MA-EPD enrollees are on MN’s four

1915(c) waivers (CADI, CAC, TBI, DD)


General Enrollment Data


Data Source: MMIS

MA-EPD Enrollment from September 1999 to December 2008

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Sep-

99

Mar

-00

Sep-

00

Mar

-01

Sep-

01

Mar

-02

Sep-

02

Mar

-03

Sep-

03

Mar

-04

Sep-

04

Mar

-05

Sep-

05

Mar

-06

Sep-

06

Mar

-07

Sep-

07

Mar

-08

Sep-

08

Month of Enrollment

Num

ber o

f Enr

olle

es

Demographics Medical Assistance for Employed Persons with Disabilities

2002 2005 2008

Mental Health 28.2% 40.6% 35.9%

Physical, Sensory, Chronic/Long-Term Illness

53.4% 39.3% 43.2%

DD/RC 15.9% 17.5% 18.5%

TBI, HIV/AIDS 2.7% 2.5% 2.3%

Source: MMIS

Enrollee Earnings Medical Assistance for Employed Persons with Disabilities

Average Taxable Income (MA-EPD and SSI 1619ab) 2003-2007

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

CY2003

CY2004

CY2005

CY2006

CY2007

Years

Ta

xa

ble

In

co

me

in

D

oll

ars

($

)

1619a & 1619b

MA-EPD

Source: MN Dept. of Revenue

MA-EPD Average monthly earned income Q3 2009: $541


Changes in MA-EPD Policy

EARLY MA-EPD POLICY1999

WORK INCENTIVE POLICY2004

EARNEDINCOME

Total gross monthly earned income of $1.00 or higher to qualify

(No earned income requirements)

$65 earned income disregard (More than $65 total gross

monthly earned income to be eligible)

Effective 1/01/04PREMIUMPAYMENT

Premium payment for individuals whose combined total monthly gross income meets or exceeds 100% FPG. Payments begin at $7/month.

Effective 11/01/01

$35 minimum premium payment for all enrollees using current premium structure

Effective 1/01/04

UNEARNEDINCOME OBLIGATION

No additional fee tied to unearned income

Enrollees must pay one-half of one percent of total monthly unearned income

Effective 11/01/03

TAXWITHHOLDIN

G

Certain employers are exempt from withholding taxes (sheltered workshops and day activity centers)

Effective 11/01/01

To be considered employment, Social Security and Medicare taxes must be withheld

Effective 1/01/04

MEDICAREPART B

All Medicare Part B premiums reimbursed using State funds for enrollees not QMB/SLMB eligible (county reimburses enrollee, state reimburses county

Medicare Part B premiums reimbursed only if enrollee is not eligible for QMB/SLMB and has total income at or below 200% FPG

Effective 11/01/03


Changes in MA-EPD Policy

EARLY MA-EPD POLICY1999

WORK INCENTIVE POLICY2004


Name ofProgram

Incomeguideline

s

AssetGuidelines

WorkRequirement

CostSharing

EarnedIncomeDisregards

MedicalAssistance

(MA)

100% FPG$903 single$1215

couple

$ 3000 single$ 6000 couple

None MA with spend down (if above $903

single,must spend down to75% FPG = $677single)

First $65 ½ of

remaining

MedicalAssistance forEmployedPersons withDisabilities(MA-EPD)

No upper income limit

$20,000 perindividual; alsoexcludes

spouse’sassets,

retirementaccounts, andmedical expenseaccounts set up

byan employer

Must be employed

or self-employed,

earning more than

$65 (average)monthly, and Medicare andSocial Securitytaxes paid orwithheld

Sliding fee scalepremium based onincome and

householdsize. Minimum of

$35

Unearned incomeobligation (½% ofgross unearnedincome)

First $65

Compare: MA and MA-EPD

Expenditure Trends Medical Assistance for Employed Persons with Disabilities

Per Member Per Month Expenditures (MA-EPD & MA-Disabled) 1999-2003

$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

1999* 2000 2001 2002 2003

MA-EPD

MA-Disabled

Source: MMIS, DHS Data warehouse

Expenditure Trends Medical Assistance for Employed Persons with Disabilities


Per Member Per Month Expenditures (MA-EPD & MA-Disabled) 2000, 2003, 2008

$0.00

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

2000 2003 2008

MA-EPD

MA-Disabled

Expenditure Trends (2008)


Program Total PMPM Cost

SSI 1619(a)(b)

$106 million

$2,033

MA-EPD $177 million

$2,036

MA-Disabled $2.3 billion

$2,542


Taxes & Premiums Medical Assistance for Employed Persons with Disabilities

State Taxes & Premiums Paid by MA-EPD & SSI Enrollees (2003-2007)

$0$1$2$3

$4$5$6$7

2003 2004 2005 2006 2007

Mil

lio

ns

Years

To

tal

in D

oll

ars

($)

Amount of State TaxesPaid (MA-EPD)

Annual Premiums Billed(MA-EPD)

Total Dollars Paid Backto MN (MA-EPD)

Total Dollars Paid Backto MN (SSI)

Source: MMIS, MN Dept. of Revenue, DHS Data warehouse

What’s Next• Maximize the use of the buy-in

as a work incentive• Generate revenue• Integrate lessons from the

Demonstration to Maintain Independence & Employment

– “Paycheck therapy is better than talk therapy. I feel so much better when I am working. I really want to be a success story for this program.” – DMIE Enrollee


Further information• Beth Grube, Policy Consultant

[email protected]

• MaryAlice Mowry, Director, Pathways to Employment [email protected]


www.positivelyminnesota.com/pte

MA-EPD Statistical Information 2005 MA-EPD Evaluation

minnesota’s medicaid buy-in medical assistance for employed persons with disabilities (ma-epd)...

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