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Iowa’s Medicaid Buy-In. Matthew Haubrich NASMD Fall Conference – Session H November 10, 2009. Iowa Medicaid Overview. Iowa currently has approximately 357,000 Medicaid Members eligible for full benefits in a given month Child – 200,000 Adult – 57,000 Aged – 30,000 Disabled – 70,000

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Iowa’s Medicaid Buy-In


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iowa s medicaid buy in

Iowa’s Medicaid Buy-In

Matthew Haubrich

NASMD Fall Conference – Session H

November 10, 2009

iowa medicaid overview
Iowa Medicaid Overview
  • Iowa currently has approximately 357,000 Medicaid Members eligible for full benefits in a given month
    • Child – 200,000
    • Adult – 57,000
    • Aged – 30,000
    • Disabled – 70,000
  • Additional 55,000 in limited benefit programs
  • Another 15,000 kids in T-XXI Medicaid Expansion
  • Total Medicaid Services ~$230m per month
buy in program overview
Buy-In Program Overview
  • Started in 2000
  • Current enrollment approximately 13,000
iowa s buy in
Iowa’s Buy-In
  • Eligible up to 250% of FPL
    • Beyond 150%, monthly premium is charged
    • About 24% pay a premium
  • Must have some earned income each month
    • Earned income tends to be modest
      • Average = $161/month (median = $30/mo)
    • Majority are self-employed
      • Child care, cleaning, chores
    • Most work less than 10 hours per week
do mbi members have different costs than other disabled members
Do MBI members have different costs than other disabled members?
  • Examined claims data
    • Working age adult recipients (age 18 – 64)
    • 36 claims months (July 2007 – June 2009)
  • Average for ALL recipients was $906/month
  • Non-MBI disabled recipients average $1752/month
  • MBI recipients average $526/month
  • Based on this analysis, it appears that MBI members are more similar to non-disabled adult members, at least in terms of cost per recipient.
do those who earn more have lower healthcare costs
Do those who earn more have lower healthcare costs?
  • Looked at MBI members paying a premium vs. those not paying a premium
    • Premium kicks in over 150% FPL
  • Premium paying recipients cost the Medicaid program approximately $65/mo less than those MBI recipients not paying a premium
do those who earn more have lower healthcare costs1
Do those who earn more have lower healthcare costs?
  • Looked at MBI members earning less than $50/month (61% of all members)
  • Within the range of $0 - $50 per month in earnings, each additional dollar earned is correlated with $1.05 less in monthly healthcare costs to Medicaid
    • No evidence for causality
does working reduce healthcare costs
Does working reduce healthcare costs?
  • Examined claims data
    • Recipients both on MBI and a non-MBI disability eligibility category
    • Approximately 5,000 members met the criteria
  • While on MBI, monthly costs per recipient were approximately $250/month less than when the same members were not in the buy-in (and presumably not working)
    • It appears that working and healthcare costs are negatively correlated
    • Can’t necessarily say that there is a causal relationship
summary
Summary
  • Much research over the years has shown the link between work and health
    • Analysis of Iowa’s data suggests evidence for this link, although not proof that work leads to lower healthcare costs
  • Buy-In members costs are more like those of the general working-age adult Medicaid population than other disabled members
  • Buy-In members with greater earnings appear to have lower healthcare costs
  • Members who have been on the Buy-In program have significantly lower costs while on the Buy-In than when not on the Buy-In
thank you
Thank You!

Contact:

Matthew Haubrich

Bureau Chief

Bureau of Research and Statistics

Division of Results Based Accountability

Iowa Department of Human Services

mhaubri@dhs.state.ia.us

o: (515) 281-5232

f: (515) 281-4243