Disability And Employment

Findings from a survey of Massachusetts Medicaid Buy-In Program enrollees with disabilities

Alexis D. Henry, ScD; Frederick Hooven, MMHS; Lobat Hashemi, MS; Jay Himmelstein, MD, MPH

Center for Health Policy and Research

Commonwealth MedicineUniversity of Massachusetts Medical School

INTRODUCTION• Adults with disabilities are at significant risk

for unemployment

• Many adults with disabilities want to work, but face barriers at both individual and environmental levels– Individual barriers may include type and severity of

disability, lack of education and poverty– Environmental barriers may include lack of relevant

services, stigma, and real and perceived disincentives in the disability benefit systems

• Because of high health care costs, many people with disabilities fear losing health insurance (Medicare and Medicaid) if earnings from work are too high

• Federal legislation – BBA of 1997 and TWWIIA of 1999 – aimed to reduce this barrier by encouraging states to create Medicaid buy-in programs

• Buy-in programs allow people with disabilities who work to “buy into” Medicaid through premiums and deductibles

The MassHealth CommonHealth Program

• Massachusetts’ Medicaid buy-in program• Created in 1988 under Governor Dukakis• Provides health insurance for adults with

disabilities with income too high to qualify for standard Medicaid (over 133% FPL)– Those working 40 hours/month pay income adjusted

premium– Those not working or working under 40 hours/month

pay one time, income adjusted deductible

STUDY GOALTo examine relationship between type of

disability and indices of participation in employment among CommonHealth enrollees

Specific Research Questions1. Does disabling condition predict current

employment status among CommonHealth enrollees?

A. Among currently employed enrollees, does disabling condition predict work effort?

B. Among currently unemployed enrollees, does disabling condition predict past work and future work intention?

2. Does disabling condition continue to be a significant predictor of employment participation even after demographic variables are controlled for?

METHOD• Conducted under the Massachusetts Medicaid

Infrastructure Grant (MMIG)– Funded by Centers for Medicare and Medicaid Services– Promotes employment of people with disabilities and

access to CommonHealth

• The MassHealth Employment and Disability Survey (MHEDS)– Designed to gather data on disability, health,

employment status and barriers to employment among MassHealth members with disabilities

• Administration of the MHEDS– 136 item Survey– Developed with stakeholder input– Fielded by Center for Survey Research at UMass-

Boston in summer-fall 2003– Mailed with telephone follow-up; English and

Spanish versions

• SAMPLE– 1952 randomly selected CommonHealth members

with disabilities across the state– ages 18-64– Enrolled for at least 6 months

• 1166 respondents – 60% response rate

RESULTS Table 1: Respondent Characteristics (n=1166)

Employed n=563 (48%)

Unemployed n=603 (52%)

P value

Demographic Characteristics Mean age (sd, range)

43.8 (11.4, 20-64)

47.1 (9.4, 20-64)

<.0001

Male 47% 51% n.s. Caucasian 93% 92% n.s. Latino 4% 3% n.s. English speaking 94% 92% n.s. Living with spouse 24% 33% .001 Some college or more 53% 44% .005 Receiving SSDI/SSI 44% 70% <.0001 Disabling Conditions

Mental or emotional disorder 52% 62% .0007 Physical or mobility disorder 34% 67% <.0001 Long term illness 28% 41% <.0001 Head Injury 8% 9% n.s. Developmental disability 12% 5% <.0001 Sensory disorder (blind or deaf) 5% 4% n.s.

Table 2: Work Participation Among Respondents % Current Work Effort of Employed members ( n=563) Hours working/week (n=549) 10 or fewer 12% 11-20 37% 21-30 16% 31-40 and over 34% Earnings in past year (n=524) $10K or less 56% $10,001 to $20K 22% $20,001 to $30K 13% $30,001 to $40K 8% $40,001 to $50K or more 4% Tenure at current job (n=557) Less than 6 months 8% 6 months to 1 year 7% 1 year or more 86% Past Work and Future Work Intentions of Unemployed members (n=603) Worked in the past (n=603) Yes 91% Length of unemployment (n=539) Less than 1 year 8% 1 to 2 years 9% 2 to 5 years 32% More than 5 years 51% Intends to work in future (n=591) Yes 38%

Table 3. Predicting employment status from disabling conditions* (n=1166)

Disabling Conditions Odds Ratio (95% CI) Physical/Mobility Problem

0.26

(0.20-0.34)

Mental/Emotional Problem

0.46

(0.35-0.60)

Long Term Illness

0.74

(0.56-0.98)

Developmental Disorder

2.03

(1.20-3.41)

Sensory Disorder

1.14

(0.61-2.12) ns

Head Injury

0.89

(0.56-1.41) ns

Note. * Demographic variables controlled in the regression analysis include education, age, gender, marital status, race, ethnicity, and primary language. Significant ORs less than one are bolded; significant ORs greater than one are bolded and italicized.

Table 4: Predicting work effort from disabling condition* (n=563)

Current Work Effort Hours Working Per

Week (n=549) Earnings in Past

Year (n=524) Job Tenure

(n=557) Disabling Conditions

OR

95% CI

OR

95% CI

OR

95% CI

Physical/mobility

0.70

(0.50-0.99)

0.80

(0.55-1.17)

1.18

(0.69-2.03)

Mental/emotional

0.52

(0.38-0.73)

0.41

(0.28-0.59)

0.45

(0.26-0.76)

Long term illness

1.01

(0.71-1.45)

1.33

(0.90-1.95)

0.91

(0.52-1.59)

Developmental

0.52

(0.30-0.88)

0.47

(0.24-0.91)

1.36

(0.55-3.32)

Sensory disorder

1.30

(0.61-2.76)

1.11

(0.51-2.41)

1.34

(0.32-5.67)

Head Injury

0.69

(0.38-1.25)

0.69

(0.34-1.36)

0.62

(0.28-1.38)

Note. * Demographic variables controlled in the regression analysis include education, age, gender, marital status, race, ethnicity, and primary language. “Hours per week”: 1 = < 10 hours; 2 = 11-20 hours; 3 = = 21-30 hours; 4 = 31-40 or more hours. “Earnings in past year”: 1 = < $10,000; 2 = $10,001-$20,000; 3 = $20,001-$30,000; 4 = $30,001-$40,000; 5 = $40,001 - $50,000 or more. “Job tenure”: 1 = < 6 months; 2 = 6 months to 1 year; 3 = 1 year or more. Significant ORs less than one are bolded.

Table 5: Predicting past work and future work intention from disabling condition* (n=603)

Past Work and Future Work Intention Ever Worked for

Pay (n=603) Length of

Unemployment (n=539)

Intends to Work in Future (n=591)

Disabling Conditions

OR

95% CI

OR

95% CI

OR

95% CI

Physical/mobility

1.14

(0.60-2.18)

1.51

(1.05-2.16)

0.57

(0.39-0.83)

Mental/emotional

1.66

(0.89-3.08)

0.85

(0.59-1.21)

0.89

(0.60-1.28)

Long term illness

1.48

(0.76-2.89)

0.88

(0.63-1.24)

0.81

(0.55-1.18)

Developmental

0.13

(0.05-0.34)

0.35

(0.14-0.86)

1.18

(0.51-2.74)

Sensory disorder

0.25

(0.09-0.68)

1.29

(0.49-3.36)

0.95

(0.38-2.38)

Head Injury

0.55

(0.22-1.38)

1.24

(0.67-2.26)

1.67

(0.91-3.07)

Note. * Demographic variables controlled in the regression analysis include education, age, gender, marital status, race, ethnicity, and primary language. “Ever worked” and “Intends to work in future”: 1 = yes, 0 = no. “Length of unemployment”: 1 = < 1 year; 2 = 1 to 2 years; 3 = 2 to 5 years; 4 = > 5 years. Significant ORs less than one are bolded; significant ORs greater than one are bolded and italicized.

DISCUSSION• Among people with disabilities in a Medicaid

buy-in program, type of disability does predict participation in employment, even after controlling for demographic variables

• At the greatest risk for unemployment– People with physical/mobility problems– People with mental/emotional problems– People with long-term illnesses

• Most likely to work– People with developmental disabilities

• Among those currently employed – People with physical disabilities, mental

disorders and developmental disorder are more likely to work fewer hours than those with other disabling conditions

– Across disabling conditions, work effort appears least favorable for people with mental disorders, who are more likely to work fewer hours, have lower earnings and shorter job tenure than those with other conditions

• Among those currently unemployed– People with developmental disabilities and

sensory disorder are much less likely to have ever worked than those with other conditions

– People with physical disabilities are more likely to have a longer period of unemployed and are less likely to intend to work in the future than those with other conditions

– People with mental disorders who are not currently working are no less likely to have worked in the past or intend to work in the than those with other conditions

CONCLUSION• Disabling condition is an important

predictor of participation in employment among people with disabilities, and should be considered in evaluations of the impact of Medicaid Buy-In Programs

• People with different types of disabling conditions may need different types of services to support their employment efforts

• Our study shows people are earning less than 10K, which is under SGA,

• Given the part time hours and low earnings reported by many workers, it appears that obstacles to full employment and economic self-sufficiency remain, even for participants in a Medicaid buy-in program, which is designed to removed a major barrier to employment for people with disabilities

• Next steps will be to examine include looking at other factors to employment.

Acknowledgements

• We thank the following colleagues for their contributions to this project:– Center for Health Policy and Research

• Abbie Averbach, Steven Banks, Robin Clark, David Jarzobski, Jennifer Katz, Susan Murray, Leslie Olin, Jaiying Zhang

– Center for Survey Research, UMass-Boston• Patricia Gallagher, Vickie Stringfellow, Carol Cosenza

– Executive Office of Health and Human Services, Office of MassHealth

• Ellie Shea-Delaney, Annette Shea