Effects of a Medicaid Buy-In Program on health care services use and cost: the Iowa MEPD evaluation

E. Momany, PhD; K.D. Carter, BS; H. Schartz, PhD, JD; P. Nguyen, PhD; A. Strong, PhD

RESULTS: Enrollment Trend 2000-2011

BACKGROUND
Nationally and locally, comparisons of costs for people with disabilities
who work and those who do not work have indicated that working people
have lower health care costs. These preliminary findings suggest that
working increases productivity while decreasing costs.
The Iowa Medicaid Buy-In Program, Medicaid for Employed People with
Disabilities (MEPD), applies to adults under 65 who are disabled and have
income from work or are self employed. Currently work is loosely defined
as any work for which someone is paid, regardless of the status of the
employer. For example, the person paying for the work is not required to
have an EIN. Enrollees pay a premium for health coverage if their monthly
income is over $1,354.

Number of people enrolled in MEPD

Total costs with Medicare

enrolled months included

16,000

14,000

12,000

10,000

8,000

6,000

4,000

IowaCare the Medicaid extension for adults

Data Analysis
Linear regression of monthly cost with person and month fixed effects

CONCLUSIONS & IMPLICATIONS

People enrolled in MEPD have a greater proportion of Medicare months

MEPD results in Medicaid savings, which may be due to the higher

proportion of MEPD participants enrolled in Medicare

Savings remain, but are reduced when Medicare months are not included
in the regression
Further work is still being done to address outcomes and costs

Nov-11

Jul-11

Mar-11

Nov-10

Jul-10

Mar-10

Nov-09

Jul-09

Mar-09

Nov-08

Jul-08

Mar-08

Nov-07

Jul-07

Mar-07

Nov-06

Jul-06

Mar-06

Nov-05

Jul-05

Mar-05

Nov-04

Jul-04

Mar-04

Nov-03

Jul-03

Mar-03

Nov-02

Jul-02

Mar-02

Nov-01

Jul-01

Mar-01

Nov-00

Jul-00

Where we got the data

Iowa Medicaid Claims and enrollment files: 2000-2011
Units of analysis
3,554,314 per member months for 66,014 enrollees
Who we included
Enrollees with a disability
18-64 years of age
Months we excluded
When the enrollee resided in a facility or group home
When the enrollee was on Medicare Part A and/or Medicare Part B
When the enrollee was in a program with reduced funding such as

2,000

Mar-00

METHODS

RESULTS: Linear Regression Models

Since the inception of the program, in March 2000,

30,586 people have been enrolled for at least one
month in the program
113 people have been enrolled for the entire study
period 3/2000-12/2011

11,086 people who entered the Medicaid program on

MEPD, were never in another Medicaid eligibility
category
Though many people switched to MEPD from another
category or after a gap in coverage following some
other category of coverage, very few went to another
category after MEPD

11,086 came directly into MEPD

7,390 entered from SSI related Medicaid
5,058 entered from spend down
2,722 entered from Medicaid expansion
1,036 entered from Family Medical Assistance Program

922 went to ICF/MR level of care/waiver

894 went to SSI related Medicaid
843 went to SSI-D related 300%, NF level of care
837 went to SSI-A, NF, eligible for payment

age
age2
post1
post2
post3
post4
post5
post6
post7
post8
post9
post10
post11
post12
post13
post14
post15
post16
post17
post18
post19
post20
post21
post22
post23
post24
post25
post26
post27
post28
post29
post30
post31
post32
post33
post34
post35
post36
post37
post38
post39
post40
post41
post42
post43
post44
post45
post46
post47
post48
post49
post50
post51
post52
post53
post54
post55
post56
post57
post58
post59
post60
post61
trend
Observations

(1)
tot_reimburs
-17.8***
0.23***
-33.5
40.2
-69.2*
-37.2
28.5
-39.4
-31.6
-119.0***
-156.6***
-52.9
-109.7***
-139.7***
-141.7***
-162.8***
-94.0**
-145.4***
-152.2***
-74.2
-195.5***
-204.5***
-294.3***
-297.7***
-312.9***
-385.0***
-391.5***
-397.4***
-422.5***
-413.4***
-429.2***
-440.5***
-442.8***
-455.3***
-452.9***
-467.8***
-465.9***
-447.8***
-459.9***
-471.1***
-473.3***
-471.2***
-477.5***
-482.9***
-427.1***
-201.0
-479.3***
-483.0***
-483.2***
-468.2***
-479.7***
-476.0***
-490.5***
-492.3***
-491.1***
-500.2***
-506.1***
-477.8***
-512.4***
-524.8***
-511.8***
-515.3***
-540.8***
-0.22
2010161

(-3.27)
(5.42)
(-0.78)
(0.83)
(-1.65)
(-1.01)
(0.63)
(-0.98)
(-0.70)
(-2.97)
(-3.71)
(-1.15)
(-2.99)
(-2.93)
(-3.13)
(-5.77)
(-2.12)
(-3.97)
(-4.26)
(-0.68)
(-5.01)
(-5.45)
(-10.96)
(-9.97)
(-8.46)
(-12.31)
(-13.03)
(-11.89)
(-16.57)
(-13.73)
(-16.20)
(-18.40)
(-17.27)
(-18.36)
(-18.07)
(-19.81)
(-19.65)
(-18.27)
(-19.02)
(-20.26)
(-20.17)
(-19.27)
(-19.18)
(-20.28)
(-9.27)
(-0.72)
(-18.71)
(-20.58)
(-20.75)
(-18.40)
(-21.00)
(-19.90)
(-20.73)
(-20.47)
(-20.84)
(-21.74)
(-21.32)
(-15.08)
(-21.61)
(-22.50)
(-21.15)
(-22.69)
(-23.63)
(-0.45)

statistics in parentheses
* p<0.10, ** p<0.05, *** p<.01

Total costs w/o Medicare

enrolled months
age
age2
post1
post2
post3
post4
post5
post6
post7
post8
post9
post10
post11
post12
post13
post14
post15
post16
post17
post18
post19
post20
post21
post22
post23
post24
post25
post26
post27
post28
post29
post30
post31
post32
post33
post34
post35
post36
post37
post38
post39
post40
post41
post42
post43
post44
post45
post46
post47
post48
post49
post50
post51
post52
post53
post54
post55
post56
post57
post58
post59
post60
post61
trend
Observations

(1)
tot_reimburs
-38.3***
0.47***
-162.3
158.7
-15.1
67.9
313.4
-89.1
-149.9
-576.5*
-822.8**
48.9
215.7
-480.2
-362.2
-288.7*
92.4
144.4
-279.4**
-246.8
-67.7
154.8
-370.4***
-202.2
-302.3
329.8
196.3
-114.2
-121.6
209.4
-398.0***
-403.2***
-128.8
-402.8***
-433.8***
-444.7***
-433.1***
-76.4
-293.9*
-407.1***
-400.6**
-421.4***
-208.9
-262.4
1860.4
10995.8
-75.0
-118.8
-256.1*
48.7
-196.1
41.5
-83.6
-207.4
-48.0
-456.3**
-277.7
-361.8
-634.7**
-694.4***
-210.3
-754.4***
-539.3***
-0.063
968977

(-4.00)
(6.30)
(-0.96)
(0.57)
(-0.05)
(0.29)
(0.95)
(-0.37)
(-0.66)
(-1.84)
(-2.34)
(0.15)
(0.70)
(-1.13)
(-0.74)
(-1.87)
(0.36)
(0.43)
(-2.15)
(-1.38)
(-0.38)
(0.68)
(-3.28)
(-1.53)
(-1.35)
(0.62)
(0.61)
(-0.87)
(-0.57)
(0.41)
(-3.28)
(-3.50)
(-0.48)
(-3.04)
(-3.55)
(-3.55)
(-3.46)
(-0.25)
(-1.75)
(-2.86)
(-2.29)
(-2.99)
(-1.26)
(-1.57)
(1.23)
(0.99)
(-0.40)
(-0.58)
(-1.83)
(0.13)
(-1.23)
(0.15)
(-0.29)
(-0.50)
(-0.14)
(-2.30)
(-0.75)
(-1.22)
(-2.57)
(-2.62)
(-0.46)
(-3.02)
(-2.85)
(-0.07)