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The Medicaid Medically Improved Group: Losing Disability Status and Growing Earnings
Hall, Jean P. ; Thomas, Kathleen C.
Hall, Jean P.
Thomas, Kathleen C.
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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.
Description
Date
2014
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Publisher
Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics
Research Projects
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Keywords
disability, Medicaid, earnings, Affordable Care Act