Mathematica Policy Research

Find here a profile of enrollment, employment, and earnings in the 32 states with both a Medicaid Buy-In program and a Medicaid Infrastructure Grant (MIG) in 2006. Specifically, the report identifies how employment and earnings are influenced by the characteristics of participants and state programs.

This report examines experiences of Beneficiaries, State Vocational Rehabilitation Agencies (VR), Employment Networks (ENs), and the Social Security Administration (SSA) during the TTW rollout period from 2002–2004. Overall, Mathematica found that the Ticket to Work Program did not have a significant impact on the way VR does business or on the practices of ENs in the community. TTW did, however, begin a fundamental shift within SSA toward focusing on improving the earnings of beneficiaries.

This final report summarizes the findings from five years of research on how each of the three demonstration states implemented its program, and on how the programs have affected the consumers who participated, the consumers’ paid and unpaid caregivers, and the costs to Medicaid. The analysis is based on an experimental design to ensure that the estimates of program effects are unbiased, and has sample sizes that are adequate to detect program effects of policy-relevant magnitudes.

To assist the CMS in monitoring the Medicaid Buy-In program, Mathematica has developed a series reports and policy briefs that present quantitative measures of participation in the program. For both the issue briefs and the statistical profile, researchers built a new longitudinal person-level database on Buy-In participants that contains information provided by the states as well as data from the SSI and SSDI programs and from Medicaid and Medicare programs.

This report, the latest in a series on participation in the Medicaid Buy-In program, presents a snapshot of the program in 2005 that captures the interplay of policy features, enrollment trends, and participant characteristics that have made the program what it is today. Moving away from the aggregated data used in previous studies, the analysis for this report is based on individual-level data provided by states to CMS through “finder files.”

This study examines how a new service delivery model of consumer direction affected Medicaid and Medicare service use and costs. Of particular interest were the program's effects on expenditures for the services that the program \"costed-out\" (that is, those services for which an allowance was provided instead) and on total expenditures for all Medicaid services.

This report assesses the appeal of the Cash and Counseling demonstration by: (1) estimating the proportions of eligible beneficiaries that participated and comparing the characteristics of participants and nonparticipants; (2) describing beneficiaries’ most common reasons for agreeing or declining to participate; and (3) examining whether the demonstration affected the number of beneficiaries accessing personal care services or home and community-based services over time.

Assessing the well-being of workers hired under consumer direction and addressing their concerns is critical, because the model is sustainable only if workers are satisfied. While care recipients who manage their own care appear to be much more satisfied than others, the primary reason given for dropping out is difficulty finding or keeping a worker. Moreover, tapping consumers’ family members and friends as additional sources of labor could help solve the serious worker shortage.

Advances in medicine and technology plus changes in social attitudes have improved employment opportunities for working-age adults with disabilities. Despite progress there are still barriers to employment. The Medicaid Buy-In program is an important component of the federal effort to make it easier for people with disabilities to work without losing health benefits. This report, the third in a series offers a profile of the 28 states with both Buy-In programs and Medicaid Infrastructure Grants.

This report assesses the experiences of personal assistance workers in the first Cash and Counseling demonstration project, Arkansas’ IndependentChoices. It describes the types and amount of care that paid workers provide, the training and supervision they receive, their working conditions, and their well-being. It also looks at how the worker-consumer relationship affects key outcomes, comparing the experiences of agency workers to those of directly hired workers.