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Minnesota’s Medicaid Buy-In. Medical Assistance for Employed Persons with Disabilities (MA-EPD) Established July 1999 MN Statute: 256(B).057, subd. 9. Medical Assistance for Employed Persons with Disabilities. MA-EPD Goals. - PowerPoint PPT Presentation
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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)
Medical Assistance for Employed Persons with Disabilities
General Enrollment Data
Medical Assistance for Employed Persons with Disabilities
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
Medical Assistance for Employed Persons with Disabilities
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
Medical Assistance for Employed Persons with Disabilities
Changes in MA-EPD Policy
EARLY MA-EPD POLICY1999
WORK INCENTIVE POLICY2004
Medical Assistance for Employed Persons with Disabilities
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
Source: MMIS, DHS Data warehouse
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)
Medical Assistance for Employed Persons with Disabilities
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
Source: MMIS, DHS Data warehouse
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
Medical Assistance for Employed Persons with Disabilities
Further information• Beth Grube, Policy Consultant
Beth.grube@state.mn.us651-431-2412
• MaryAlice Mowry, Director, Pathways to Employment Maryalice.mowry@state.mn.us651-431-2384
Medical Assistance for Employed Persons with Disabilities
www.positivelyminnesota.com/pte
MA-EPD Statistical Information 2005 MA-EPD Evaluation
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