Volume 11, Number 1
August, 2011
Working Healthy: The Same Program--With a New Home
By Mary Ellen O'Brien Wright, Working Healthy Senior Manager
On July 1, 2011, Working Healthy became a program within the Kansas Department of Health and Environment (KDHE). During the 2011 legislative session, Governor Brownback signed an executive reorganization order transferring the operation of the Kansas Health Policy Authority (KHPA) to KDHE. The executive order moved the responsibility for administering the Medicaid program and the State Employees’ Health Benefit Plan to the new Division of Health Care Finance (DHCF) within KDHE. As part of the Medicaid program, Working Healthy and its personal assistance program, WORK, will be administered by the DHCF.
Eligibility for Working Healthy will continue to be determined by the Department of Social and Rehabilitation Services (SRS). Working Healthy Benefits Specialists will operate under the direction of the Benefits Specialist Team Leader at the KDHE.
The Kansas Employment First Initiative Act
By Mary Ellen O'Brien Wright, Working Healthy Senior Manager
On May 11th, 2011, Governor Brownback signed House Bill 2336, the Kansas Employment First Initiative Act, into law. The new law requires state programs and services to promote the employment of youth and adults with disabilities by coordinating and collaborating to ensure that state programs, policies, procedures and funding support competitive, integrated employment. The bill authorizes state agencies to adopt rules and regulations to implement the act. The bill also:
• defines the terms competitive and integrated;
• instructs state agencies to share data and information across systems, when feasible, to track progress;
• establishes a five member commission that will issue an annual report to the governor and legislature; and
• requires all state agencies to fully cooperate with and provide data and information to assist the commission in carrying out its duties.
House Bill 2336 will move Kansas toward achieving Goal I of the Kansas Strategic Plan to Support the Competitive Employment of Individuals with Disabilities, developed in 2006-07 by Working Healthy staff with input from consumers with disabilities, family members of people with disabilities, other stakeholders and later supported by the Employment First Task Force. Goal I states:
“Currently there is no clear vision or mission regarding employment of people with disabilities in Kansas. Several state agencies bear a major responsibility for the employment of people with disabilities, while others have a peripheral role. No central body exists however, that is responsible for establishing employment goals in Kansas, determining the number of people with disabilities who are employed and unemployed, ensuring that employment initiatives are coordinated across state agencies, that these initiatives result in increased numbers of people becoming employed, and resources are allocated to the best advantage. In order for a comprehensive employment initiative to be successful, it will be crucial for state programs to establish a shared vision for employment of people with disabilities and for a coordination of efforts with the goal of eventually achieving that vision. Ideally, to ensure participation and accountability, this initiative should be carried out under the auspices of the Governor.”
Sluggish Economy Impacts Working Healthy
By Shawna Chapman, Ph.D, KU Research & Evaluation team
Many people have been negatively affected by the economic slowdown in recent years, and Working Healthy enrollees are no exception. Each year, participant comments from the annual Working Healthy Satisfaction Survey are analyzed and grouped into themes. Working Healthy enrollees, despite being employed at various levels, are feeling the effects of the economic decline. The following themes regarding economic barriers were observed in the 2010 satisfaction survey:
• A lack of available jobs - When participants were asked if anything prevented them from increasing their level of work the second most cited reason for not increasing work, after their health, was the economy and being unable to find a new or better job. One participant wrote, “No jobs out there.” Another explained there is “a lack of positions for disabled people.”
• Difficulties paying Working Healthy premiums - Participants also indicated they sometimes struggled to pay their premiums. Despite the fact that fixed premium amounts have not changed since 2002, one participant complained that his/her income level remains fixed (no raises), while other living costs continue to rise. Another explained, “Premiums too high. [You] do not get help when you can’t pay bills.”
• Limited assistance from caseworkers - Participants were also frustrated with limited assistance from case managers who were often said to have caseloads that are too large coupled with high rates of case manager turnover. One respondent explained, “Better access to SRS caseworkers is needed but I understand budget and heavy caseloads.”
Through their comments, participants repeatedly tell us that Working Healthy is a vital program that improves their lives. However, even with the assistance this program provides, participants sometimes struggle to find adequate employment, pay bills, and meet all of their needs.
New Working Healthy Data Published
By Noelle K. Kurth, M.S., KU Research & Evaluation Team
In July, Working Healthy (WH) research and evaluation staff at the University of Kansas (KU) published the “Working Healthy Data Chartbook 2nd Edition: Kansas Medicaid Buy-In Research & Evaluation 2002-2010.” The Chartbook contains over 100 tables and figures of data regarding WH and WORK enrollees’ demographics, employment, quality of life, satisfaction with the program, and Medicaid costs.
The line graph in Figure 1 shows the steady increase in Working Healthy enrollment over time. Currently, as of June 2011, enrollment is at 1250 individuals. Of these enrollees, 78% have countable income above the federal poverty level and are consequently paying a monthly premium for their Medicaid through Working Healthy (see Figure 2). Enrollees pay, on average, $79 per month. Not only does the increasing number of people paying premiums indicate that Working Healthy enrollees are earning more, but data from the Kansas Department of Revenue shows enrollees are earning, on average, twice as much per month as other Medicaid beneficiaries with disabilities who are not on Working Healthy.
The age of Working Healthy enrollees ranges from 18-64 with an average age of 47. Fifty-three percent of enrollees are female, 90% are White and 3% are Hispanic/Latino(a). The self-reported primary disability of enrollees has changed slightly since the inception of WORK in 2007. Since 2007, the percent of enrollees with mental illness has decreased from 46% to 36%, while those with a physical or intellectual disability has increased from 27% to 35%.
Finally, Medicaid costs for Working Healthy enrollees are 73.5% less than the costs of other Kansas Medicaid beneficiaries with disabilities. Additonally, the total per member per month (pmpm) Medicaid costs for enrollees decreased by 22% from 2006 to 2009. KU staff are currently conducting further research to fully understand the possible reasons these differences in Medicaid expenditures vary between Working Healthy enrollees and those who are not enrolled.
Figure 1: Working Healthy Enrollment, by Month, July 2002-December 2010
July 2002: 247
August 2002: 308
September 2002: 369
October 2002: 424
November 2002: 467
December 2002: 499
January 2003: 531
February 2003: 551
March 2003: 571
April 2003: 584
May 2003: 598
June 2003: 613
July 2003: 609
August 2003: 624
September 2003: 637
October 2003: 648
November 2003: 677
December 2003: 682
January 2004: 694
February 2004: 706
March 2004: 724
April 2004: 736
May 2004: 760
June 2004: 764
July 2004: 775
August 2004: 785
September 2004: 804
October 2004: 830
November 2004: 835
December 2004: 843
January 2005: 853
February 2005: 873
March 2005: 895
April 2005: 921
May 2005: 928
June 2005: 944
July 2005: 967
August 2005: 998
September 2005: 993
October 2005: 1001
November 2005: 1023
December 2005: 1016
January 2006: 1007
February 2006: 1013
March 2006: 1000
April 2006: 984
May 2006: 983
June 2006: 988
July 2006: 989
August 2006: 983
September 2006: 985
October 2006: 986
November 2006: 994
December 2006: 998
January 2007: 1017
February 2007: 1024
March 2007: 1028
April 2007: 1036
May 2007: 1036
June 2007: 1049
July 2007: 1042
August 2007: 1043
September 2007: 1040
October 2007: 1052
November 2007: 1045
December 2007: 1022
January 2008: 1037
February 2008: 1042
March 2008: 1047
April 2008: 1056
May 2008: 1066
June 2008: 1060
July 2008: 1079
August 2008: 1089
September 2008: 1093
October 2008: 1097
November 2008: 1100
December 2008: 1101
January 2009: 1088
February 2009: 1105
March 2009: 1111
April 2009: 1111
May 2009: 1136
June 2009: 1137
July 2009: 1144
August 2009: 1141
September 2009: 1126
October 2009: 1122
November 2009: 1114
December 2009: 1115
January 2010: 1110
February 2010: 1103
March 2010: 1096
April 2010: 1109
May 2010: 1123
June 2010: 1134
July 2010: 1126
August 2010: 1147
September 2010: 1156
October 2010: 1172
November 2010: 1175
December 2010: 1183
Note: Does not include retroactive enrollment months, therefore subject to increase.
Source: Kansas Medicaid Management Information System (MMIS)
Figure 2: Percentage of Working Healthy Enrollees Paying Premiums, by Year
2002 (N=499): 53.1%
2003 (N=682): 61.7%
2004 (N=843): 59.3%
2005 (N=1016): 66.5%
2006 (N=998): 66.3%
2007 (N=1022): 69.9%
2008 (N=1101): 79.4%
2009 (N=1115): 78.3%
2010 (N=1183): 77.9%
Source: Kansas Automated Eligibility Child Support Enforcement System (KAECSES)
Working Healthy is published quarterly by the University of Kansas CRL, Division of Adult Studies and the KDHE Division of Health Care Finance.
Alternate format and print copies are available upon request by writing the University of Kansas Division of Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence, KS 66045, by phone 785-864-7085, by emailing: pixie@ku.edu
KU Research Team:
Jean P. Hall, Principal Investigator
Noelle K. Kurth, Editor & Senior Research Assistant
Natalie Peters, Graduate Research Assistants
Carolisa Watson, Student Assistant
Kansas Health Policy Authority:
Mary Ellen O'Brien Wright, Senior Manager
Nancy Scott, WORK Program Manager
Steve Curtis, Benefits Specialist Team Leader