As a follow-up to the previous
article about the MA-EPD program, we are looking at the results of
a survey conducted in 2004 about how the Medical Assistance for Employed
Persons with Disabilities (MA-EPD) program is working for consumers
in Minnesota. The MA-EPD program is Minnesota's Medicaid buy-in program
which allows working people with disabilities to pay a premium to
retain their Medical Assistance coverage.
The Disability Services Division contracted with Wilder Research Center
to conduct a telephone survey of 450 MA-EPD consumers, a representative
random sample of the nearly 6,000 consumers on the program.
This survey is part of an overall evaluation of the MA-EPD program.
The overall evaluation will be available on the Disability Services
Division public web site at www.dhs.state.mn.us/dsd . The goals of
the MA-EPD survey were as follows:
To gather baseline program information from a random sample of 450
enrollees in the MA-EPD program;
To establish consumer priorities for MA-EPD program improvements through
analysis of the consumer survey;
To identify barriers to finding and keeping employment for people
with disabilities;
To obtain information and identify barriers to personal assistance
services in the workplace; and
To provide information
for the Pathways to Employment’s program
evaluation to the Centers for Medicaid & Medicare Services (CMS).
Sampling, Survey Method,
and Participants
A total of 456 interviews were completed, which resulted in an 80
percent response rate and a sampling error of +/- 5 percent. All of
the consumers in this survey are between the ages of 22 and 65. A vast
majority (95 percent) of the MA-EPD consumers who participated in this
survey are Caucasian. Half are male and half are female. Consumers
reported being in three main disability categories: mental health (38
percent), physical disability (33 percent), and cognitive or developmental
disability (27 percent).
Survey results show that participants
generally express high levels of satisfaction with the MA-EPD program.
In fact, 72 percent of respondents reported they would be unable
to work without MA-EPD. However, they also expressed a variety of
needs and expectations for more information and support. Some of
the key findings that emerged from this survey are outlined below.
Experiences with the MA-EPD Program
Nearly half (43 percent) of the respondents said they first found
out about the MA-EPD program through their county case managers or
service coordinators. Another 25 percent found out about the program
through their county financial workers.
The most common reasons reported by respondents for being on the MA-EPD
program were: good health care or prescription drug benefits (28 percent)
and health problems or disabilities (22 percent).
Respondents expressed high levels of satisfaction with various aspects
of the MA-EPD program including: getting on the program (70 percent),
the amount of the premium (81 percent) and being informed by their
county financial worker about how to stay eligible for the program
(77 percent).
Working appears to have improved the quality of life for most respondents:
97 percent reported feeling better about themselves when they are working,
92 percent said that working allows them to give something back to
their community, and 83 percent said that working increases their available
spending money.
On the other hand, 45 percent of respondents feel that it will be hard
for them to re-qualify for Social Security disability benefits and
43 percent are concerned about losing their Social Security cash benefits
as a result of working.
When asked about their additional needs, 53 percent of respondents
reported a need for more information about how working affects the
health insurance benefits they receive and 15 percent said they would
lower the premiums or make the program more affordable.
Consumer Characteristics and Supports
Service and maintenance
jobs were the most common types of jobs, reported by 44 percent
of MA-EPD respondents. Nearly two-thirds (64 percent) reported
working 20 hours per week or less. Most (79 percent) felt they
were working “about the right number of
hours.”
Most respondents reported having support from their employers (75
percent) and co-workers (70 percent).
More than one-quarter (28 percent) of respondents reported using disability
accommodations in the workplace, with the most common being flexible
work schedules (64 percent of those who used accommodations).
Two-thirds (65 percent)
of respondents reported having other health insurance, mostly Medicare,
in addition to Medical Assistance. Only seven percent of respondents’ additional
insurance coverage is through their employers.
Only four percent of respondents use personal care assistance services
at work. Most respondents (88 percent) who did not report using PCA
services at work said the reason why they do not use PCA services is
that they do not need them.
Health Problems and Other Barriers to Working
Almost half (44 percent)
of respondents said their health was “about
the same” at the time of the survey compared to when they started
working, 36 percent said their health was “better” and
21 percent said their health was “worse.”
Health-related issues were the most frequently reported barriers to
working by respondents. Forty-eight percent of all respondents reported
physical health problems and 30 percent reported mental health problems
that had prevented them from working during the last year.
Some respondents (14 percent) reported problems with transportation
that had prevented them from working during the last year. In addition,
22 percent of respondents said they were unable to afford transportation
costs to get to and from work. Nearly half (48 percent) of respondents
drive themselves to work and 21 percent use a special transportation
service for people with disabilities.
Most respondents (92 percent) reported that their housing arrangements
at the time of the survey met their needs. Only two percent of respondents
reported housing-related problems that had prevented them from working
during the last year.
Recommendations
Overall, respondents
are satisfied with the MA-EPD program. The results of this survey
indicate that the participants’ quality of life
and ability to maintain gainful employment has improved as a result
of their participation in the program. In general, it appears that
the respondents’ disabilities or health conditions pose significant
barriers to working. In fact, health-related barriers were far more
commonly reported than other types of barriers, such as housing or
transportation. Most frequently reported physical health problems
were weakness, being tired and fatigue. The second most commonly
reported mental health problems were stress, anxiety, panic attacks
and nervous breakdown.
One concern expressed
by respondents throughout the survey was the amount of their premiums
and co-payments. Legislation was enacted in 2003 to require MA-EPD
to be a true “buy-in” program
and to address budget constraints. This change resulted in increased
premiums for most consumers in the month before surveying took place,
which may have affected the frequency or intensity with which these
issues were raised. On the other hand, most respondents did agree
that the amount of their premium is reasonable. Consumers would likely
benefit from any reduction in their out-of-pocket expenses since,
despite working, MA-EPD recipients are still predominantly low-income
individuals.
Given the low number of people of color on the MA-EPD program, doing
specific outreach and marketing of the MA-EPD program to people of
color is recommended. Counties should also focus on marketing to communities
of color, since most people find out about the MA-EPD program through
county personnel.
This survey indicates that there is a need to create additional incentives
to work for people with disabilities, as evidenced by respondents who
expressed concerns about losing Social Security benefits as a result
of going to work. One possibility is to be an early implementation
state for a program currently being demonstrated by the Social Security
Administration. This program would allow working individuals on Social
Security Disability Income (SSDI) to keep $1 of every $2 they earn,
creating an incentive to work.
The complete survey
report is available under "Reports and Publications" on
the Disability Services Division web site at www.dhs.state.mn.us/dsd.
