Performance and Outcome Measures
of Medicaid Infrastructure Grants:
What Do We Know?
Su Liu
Jody Beauchamp
2008 MIG/DMIE Employment Summit:
Melding Data and Policy
New Orleans, LA
April 22, 2008
The Legislative Intent of MIGs:
A Refresher
“For individuals with disabilities, the fear of losing
health care and related services is one of the
greatest barriers keeping these individuals from
maximizing their employment, earnings potential
and independence.” (Ticket Act, 1999)
Employment Among People with Disabilities

Broad measures do not vary much by MIG status;
in 2006:
– 37% of PwD were working
– 1% of SSDI workers had benefits withheld or
terminated because of substantial work
– 2% of SSI disabled beneficiaries were working under
1619(a) or 1619(b)

Challenging to observe effect of MIGs on employment
outcomes of PWD:
– Effects are indirect and gradual
– Part of broader systemic change
– Variety of activities supported
Source: 2007 GPRA Report
Most Quantifiable Individual-Level
Outcome Measures of MIG

Medicaid Buy-In Program
–
–
–
–
Enrollment
Expenditures
Employment
Earnings
Medicaid Buy-In Continues to Enroll New
Participants
110,758
120,000
Enrollment
100,000
77,475
80,000
60,000
40,000
97,491
96,996
54,588
29,398
20,000
0
2001
(n=16)
2002
(n=24)
2003
(n=26)
Recruitment
2004
(n=31)
2005
(n=30)
Retention
Source: The Three E’s: Enrollment, Employment, and Earnings in the Medicaid Buy-In
Program, 2006
2006
(n=32)
PMPM Medicaid
Expenditures
Medicaid Expenditures Are Lower for Buy-In
Participants, Regardless of the Type of Condition
$2,000
$1,800
$1,600
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
$1,749
$1,583
$1,395
$984
$869
$1,158
$809
$601
Overall
One Psychiatric
Condition
Buy-In Enrollees
Source: Working with Disability Issue Brief # 5
One NonPsychiatric
Condition
Multiple
Conditions
Other Medicaid Recipients
Most Medicaid Buy-In Participants Had Positive
Earnings, Some with Increased Earnings

In 2006,
– 69% of Buy-In participants had positive earnings
– Average annual earnings: $8,237
– $22.5 million charged in total Buy-In premiums

40% of new participants between 2000 and 2003
increased their earnings after enrollment
– Median increase in enrollees’ earnings was $2,582 over
two years (inflation-adjusted)

Participation in SSA work incentive programs is
higher among Buy-In enrollees than other PwD
Source: The Three E’s: Enrollment, Employment, and Earnings in the Medicaid Buy-In
Program, 2006; the 2007 GPRA Report; and Working with Disability Issue Briefs #4 and #7.
Program Characteristics Affect the Employment
and Earnings of Buy-In Participants
Employment
60%
40%
20%
26%
38%
Earnings
$1,000
27%
-52%
$800
$503
$600
0%
$386
$400
-20%
-40%
$200
-60%
$0
BBA
Earned
Income
Grace
Work
Period Verification
$975
$71
BBA
Earned
Income
Grace
Work
Period Verification
Note: Estimates for BBA are relative to Ticket Act and 1115 waiver states; work verification is relative to "no
verification requirement."
Source: The Three E’s: Enrollment, Employment, and Earnings in the Medicaid Buy-In
Program, 2006
Some Personal Characteristics Affect the
Employment and Earnings of Buy-In Participants
Employment
50%
Earnings
43%
40%
30%
20%
10%
-5%
-2%
3%
Male
Nonwhite
-4%
0%
-10%
Age
Exper.
Max.
Earnings
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
-$200
$1,253
$279
-$91
Age
-$61
Male
Nonwhite
Exper.
$90
Max.
Earnings
Note: Estimates for male and non-white are relative to female and white, respectively, age and
experience reflect a one-unit increase in that variable, maximum earnings are earnings in thousands.
Gender and race employment effects are not statistically different from zero.
Source: The Three E’s: Enrollment, Employment, and Earnings in the Medicaid Buy-In
Program, 2006
The Type of Disabling Condition Greatly Affects
Employment and Earnings of Buy-In Participants
Earnings
Employment
200%
188%
$1,500
$1,000
150%
$500
84%
83%
100%
50%
-$1,004
-$500
8%
Severe Other Sensory
All
MI
Mental
Other
-$379
-$205
-$1,000
-$1,500
MR
$343
$0
52%
0%
$1,133
MR
Severe Other Sensory
All
MI
Mental
Other
Note: All estimates are relative to individuals with a musculoskeletal condition. Earnings effect for
other mental disorders is not statistically different from zero.
Source: The Three E’s: Enrollment, Employment, and Earnings in the Medicaid Buy-In
Program, 2006
Summing Up: What Do We Know?

The Medicaid Buy-In program has made great
strides in achieving MIG goals
– Determinants of employment, earnings and expenditures
among Buy-In participants are better understood

Based on evolution in MIG eligibility categories,
states have made improvements to PAS

State interest in MIG has been sustained since 2001
What’s Left to Learn?

Current measures do not capture all aspects of
MIG performance or outcomes

As MIGs evolve, focus is shifted away from Buy-In
implementation to a variety of other activities
– How to better measure expansion of PAS, benefits
counseling, and other system-level changes?

Efforts underway to modify reporting system to
better capture diverse and evolving MIG activities