VI. State Comprehensive Employment
Initiatives & Medicaid Buy-In Programs
A.
New Principles Guiding the
Development of Medicaid Buy In and Income Assistance Demonstrations:
Enabling
persons with severe disabilities to be better off financially if they
work is a goal of States' work incentive initiatives. From an analysis
of the development of policies in those states which have been developing
comprehensive employment initiatives, including Medicaid Buy In program
for persons with significant disabilities, themes and broad policy
'principles' can be seen as implicitly or explicitly driving the policies
in state law, regulations, service delivery structures and administrative
procedures. These principles include: providing the option for at
least partial self support; being responsive to changing ability to
work; and providing the option to accumulate assets to increase financial
security and independence.
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B.
Eligibility Criteria for the Optional Medicaid Buy In Program:
Federal
Guidelines and Examples of State Responses States are utilizing the
new options to develop Medicaid Buy In programs to create a variety
of policies under the broad Federal policies established in Federal
law and guidelines. The various States' Medicaid Buy In programs reflect
the significant differences among the States in their current Medicaid
program and the policies they have adopted under the Federal policies.
Examples of the States explanations of their programs can provide
an overview of some of the policy options available to states.
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C.
Medicaid Buy In Programs: General Policy Criteria & Policy Tradeoffs:
A
primary goal of work
incentive initiatives is a significant increase in the percentage
of current SSI and SSDI recipients with earnings in any particular
month. States have and will be required to determine the best tradeoffs
among a variety of general policy criteria they might use in devising
the most effective and equitable Medicaid Buy In programs. The general
policy criteria being used by States include tradeoffs among: keeping
it simple; make cost sharing under Medicaid Buy In programs progressive
related to level of income; providing consistency with eligibility
methodology in other Medicaid programs; making it similar to private
health insurance; and provide for cost sharing which targets the program
and enables the state to control enrollment and costs. There are considerable
variations among the states as to the weight given to each criterion.
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D.
Specific Financial Eligibility & Cost Sharing Policies:
From
the weights given to the 'general policy criteria.'
States have developed specific financial eligibility and cost
sharing policies. These policies are further refinements of these
general policies. These policy criteria are also driving State initiatives
to seek complementary SSI and SSDI demonstration projects in their
state and related Medicaid and housing waivers to reduce work disincentives.
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E.
Policy Development for Financial Security & Independence : Assets
and Resources:
States'
Medicaid Buy In programs and their requests for complementary Federal
demonstration projects provide that persons with severe disabilities
who choose to work have the opportunity to not only increase their
disposable income for daily living costs but also to increase their
sense of financial security and independence. The goal is ensure more
independence by having assets and resources which will enable them
to respond to short term financial emergencies, save for achieving
more independence in housing and other personal goals and to be able
to save for retirement.
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F.
Protections Sought for SSDI and SSI Recipients Participating in Medicaid
Buy In Programs:
Obtaining
and providing protection against loss of disability status under the
SSI, SSDI and Medicaid programs for individuals who choose to go to
work and use a State's Medicaid Buy In program is a high priority
for persons with disabilities, advocates and State officials who are
developing and implementing state work incentive initiatives.
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G.
A Framework to Examine the Complementary Relationships Among States
Proposed Medicaid Buy In
Program Policies and Proposals for Medicaid Waivers and SSI and SSDI
Demonstration Projects:
States
in the early implementation stages of work incentive initiatives are
recognizing that the initiatives must be person-centered and comprehensive.
This means that Medicaid buy-in programs are necessary components
of a work incentive initiative, but they are not sufficient; there
must be complementary income assistance and demonstration projects
which affect the SSDI and SSI programs.
A framework is provided for examining the potential complementary
relationships among various Medicaid and income assistance policies
and policies governing other long term services and supports that
States have or are proposing to include in their comprehensive employment
policies.
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H. "Ticket
to Work: Medicaid Buy-In Options for Working People with Disabilities"
By Julie Scales (NCSL), Donna Folkemer (NCSL), and Allen Jensen (GWU).
National Conference of
State Legislatures monograph sent to State Legislatures.
At the National Conference
of State Legislatures website.
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