Volume 2, Number 4
April, 2003
Personal Assistance Services for Working Healthy in Progress
Kansas Medicaid Proposal for an Independence Plus Waiver to Provide Personal Assistance Services for Medicaid Buy-in Enrollees
By Mary Ellen O’Brien Wright, Working Healthy Director
Working Healthy, the Kansas Medicaid Buy-In program, began on July 1, 2002. As of March 2003, 537 consumers had enrolled in the program. Consumers with disabilities requiring Personal Assistance Services (PAS) to become employed or maintain employment are unable to enroll at this time, however, as these services are not available for Working Healthy enrollees. In order to provide this service to Working Healthy enrollees, the Kansas Department of Social and Rehabilitation Services (SRS) has decided to submit an 1115 Independence Plus Waiver to the Centers for Medicare and Medicaid Services (CMS). An Independence Plus Waiver allows states more flexibility in terms of program design. This type of waiver also allows states to provide services for people with different types of disabilities.
SRS Community Supports and Services and Working Healthy staff, advocates, consumers, and providers are in the process of designing this waiver. If approved, this waiver will include PAS, assistive technology services, and possibly other services necessary to maintain and increase independent living and employment for people with developmental disabilities, physical disabilities, and head injuries. The proposed waiver would go beyond consumer self-direction to consumer control of services by allowing consumers to handle their own finances and determine what services they need, within established parameters, to support independent living and employment.
Eligibility for services through this waiver would include all of the eligibility requirements of Working Healthy, as well as a demonstrated need for attendant services in order to support living and working in the community. In order to receive services through this waiver, consumers would have to live in the community in a residence of their choice and be competitively employed in an integrated environment a minimum of 40 hours per month. Consumers who have not achieved this level of employment will have an established time frame to do so.
Some of the possibilities for this waiver include a “cash and counseling” model, where consumers would be given the funds necessary to purchase their services from providers chosen by them. Consumers may also be able to act as their own fiscal agent, or choose to hire a fiscal intermediary. Whatever method they chose, they would still be required to make all appropriate federal and state deductions. If consumers do not spend all of their funds on their personal assistance services, they may be permitted to save these funds to purchase technology or services that would enhance or increase their independent living and/or employment. They may also have the opportunity to deposit these savings in an Individual Development Account (a matched savings account) to increase their savings.
The projected start date for this waiver is January 2004, however this is dependent upon how long it requires for CMS to approve this new waiver.
Benefits Specialist Corner
This issue’s featured Specialist is Madeleine Anthony from the Wichita Area Office. One of Maddie’s main goals is to assist people with disabilities to be better informed and to increase their opportunities to work. Maddie is originally from Bournemouth, England, where she worked with adults with mental retardation. Since her move to the U.S., Maddie has worked with various populations, including juvenile offenders and adults with severe and persistent mental illness, as well as an employment consultant. She has been part of the Working Healthy team as a Benefits Specialist since October. Maddie can be contacted by email, WMZA@srskansas.org or by phone 316-337-6427. She looks forward to hearing from you soon!
I was thinking of what to write when a wave of thoughts flooded through and I was really content with the theme and content. Now I come to write it down and the sparks have deserted me. As happens so many times, we think we have a path to follow and it ends, leaving us feeling lost and unsure. At that point it’s up to us to take the initiative and make something happen to further our journey. I have heard how some individuals have had a successful work life and through no fault of their own end up on disability. These individuals do their best to adjust to a new way of life, one that is often much poorer. Not only does a major change in expectations happen, but also the sense of self changes. Fears and real concerns can become barriers to deciding on which path to take. It’s not only about the right thing to do, it’s about negotiating the hurdles and developing new skills to tolerate so much more than ever before.
It has been my good fortune to discover the Ticket to Work and Working Healthy programs. The knowledge of these programs has given me a new sense of positive activity. Here is a program that not only can work, but also provides services to assist individuals in accessing vital information necessary for them to make healthy choices.
Having been in this position for several months now, I am experiencing the impact of the program on enrollees and service providers. Enrollment is up – people are discovering a program that doesn’t work miracles but does afford them the opportunity to work, maintain health coverage and manage their benefits. People are testing their work tolerance, people are beginning to think of their retirement options, people are thinking about promoting their well-being again. This program is not just about work and health insurance – it’s about living. It gives individuals the choice to live how they want to, not what they are restricted to. For some providers it has meant the difference in being paid instead of working out how long they can offer a service that they cannot afford to maintain. Many people can now purchase their medications instead of trying to qualify for indigent plans, leaving those resources for those who have lower income. Through the Working Healthy program, enrollees have not only found a path but have also had a powerful impact on our economy, service provision and the resources of the state.
I hope that the program will improve, grow and continue to demonstrate that positive actions have positive impact on more than just the individual. Happy trails! -Madeleine Anthony, Benefits Specialist
Enrollment and Survey News
Working Healthy enrollment continues to increase and premium payers continue to constitute more than half of all enrollees (see bar chart). In January, KU staff mailed a satisfaction survey to 128 people who have been enrolled in the program since July or August of 2002. Some of the questions and most frequent responses are listed below.
Bar chart information:
Title: KS Working Healthy Total Monthly Enrollment
July 2002: Total enrollment = 241, 53% of which are paying a premium
September 2002: Total enrollment = 361, 59% of which are paying a premium
November 2002: Total enrollment = 459, 58% of which are paying a premium
January 2003: Total enrollment = 513, 62% of which are paying a premium
March 2003: Total enrollment = 537, 64% of which are paying a premium
Note: Enrollment figures are based on SRS information from April 2003 that includes retroactive enrollees. Due to Working Healthy eligibility guidelines, some people have enrollment dates that are effective 3 months prior to enrolling.
Source: Kansas Medicaid Management Information System (MMIS)
WH Enrollee Responses:
Please list any suggestions you have on how to improve Working Healthy and related services
• More information about the program and its features is needed by consumers, including how to contact Benefits Specialists, having case managers explain more, and providing classes (only 29% of respondents had met with a Benefits Specialist)
• Dental coverage, eye checks, and spousal coverage need to be included
• Small increase in earnings causes people to be “bumped” to next premium level
Please list any ways your quality of life has improved since you began participating in Working Healthy
• Helps pay for medicine and medical bills
• No spenddown
• Able to get ahead financially
• Self-esteem improved a lot, I have belief in myself, more positive
• Less stress on finances, helps my stress level
• Future goals are attainable
• I can work more hours
• Able to participate in more social activities
• Now can set real goals, not afraid of losing health care with more work
• Medications have helped relieve my symptoms
• Don’t have to worry about needs being met
• Feel better about self & have insurance for health and meds
Please list any ways that your quality of life has worsened since you began participating in Working Healthy
• Since I got married my premium went up, but my coverage is the same
• No dental coverage
• Scared that SSDI will be cut off
• Can’t pay for the program
• Working Healthy needs to include vision insurance
Frequently Asked Questions
Q: Why does Working Healthy have an age limitation of 64?
A: While states are allowed a great deal of flexibility in designing their Medicaid Buy–In program, the age limit of 64 was established in the federal statute, the Ticket to Work - Work Incentives Improvement Act. This federal statute would have to be changed in order for states to raise the age limit. Consumers concerned about this age limitation may want to consider contacting their federal representatives.
Benefits Specialists are keeping track of people who are “aging out” of the program, and will follow-up with consumers to discuss what options might be available.
Q: When considering household income, including a spouse’s income can really increase the Working Healthy enrollee’s premium, as well as the spouse’s spenddown. It may even jeopardize the spouse’s health care coverage. Why does the spouse’s income need to be included?
A: Many Medicaid programs look at total household income, not just the income of the one individual enrolling in a program. Some income is disregarded for both the enrollee and spouse. In light of the present budget situation in Kansas, it would be difficult to justify disregarding all of the spouse’s income for Working Healthy enrollees. SRS staff will continue to review this issue and consider possible changes. We encourage consumers who have questions about spousal income to work with their local Benefits Specialist to determine what income disregards may be possible.
Outreach Activities. . .
Working Healthy Benefits Specialists provide comprehensive outreach to SRS offices, community-based organizations, consumer-run organizations and individuals within their respective areas. This outreach provides information regarding the Working Healthy Program and its benefits for Kansans with disabilities who are employed or seeking employment. Benefits Specialists provide information to agencies within their communities and offer informed choices to persons with disabilities, who are already working or seeking employment, regarding the impact of working on their benefits.
Outreach by Benefits Specialists takes many forms. Oftentimes, outreach is done through phone, mail or email at the request of a consumer or caseworker. However, the specialists also conduct tailored presentations at the request of organizations and interested parties, along with presenting Working Healthy information at pertinent statewide conferences. Below is a list of presentations/sessions that Benefits Specialists will be conducting over the course of the next several months. This information will be updated when new sessions are requested or added. Please contact the Benefits Specialist in your area (see box below for contact information) if you or someone in your area has questions about Working Healthy or is interesting in hosting an outreach presentation. You can also contact the Benefits Specialist Team Leader, Nancy Scott, by email at nas@srskansas.org or feel free to contact us toll free at 1-800-449-1439.
-- COMING ATTRACTIONS --
If you are interested in hearing a presentation on the Working Healthy Program, the following is a list of some of the upcoming conferences and information-sharing meetings that Working Healthy Benefits Specialists will be participating in:
April 14, Labette County Mental Health Center, Parsons, KS
April 15 , Class LTD., Parsons, KS
April 29 , Social Security Workshop, Lawrence Public Library
June 4-6, Recovery Conference, Wichita, KS
August 6- 8, Kansas Disability Caucus, Topeka, KS, Capitol Plaza Hotel
September 2003, Kansas Case Management Conference
Working Healthy is published quarterly by the KU Department of Health Policy and Management, in cooperation with the KU Division of Adult Studies and the Kansas Department of Social and Rehabilitation Services. Additional copies and copies in alternate formats are available upon request by writing the University of Kansas Department of Health Policy and Management, c/o Division of Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence, KS 66045, by phone 785-864-7085, by email: pixie@ukans.edu
KU Research Team
Michael Fox, Co-Principal Investigator
Jean Hall, Co-Principal Investigator
Noelle Kurth, Editor
Erin Rink, Research Assistant
Cindy Pressgrove, Research Assistant
SRS, Division of Health Care Policy
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader
Many people with disabilities want to work but worry that doing so could jeopardize their vital health and long term care coverage. Working Healthy offers people with disabilities who are working or interested in working the opportunity to get or keep Medicaid coverage while on the job. Through Working Healthy people can earn more, save more, achieve their career goals, and still maintain their health coverage.