Conclusions
Alaska was the first state to pass a Medicaid Buy-In Bill and the second state to implement a buy-in program (April, 1999). In June 2000 fifty-six persons with disabilities participated in the buy in program. In April 2004 189 persons with disabilities identified by DSHS as participants of the program were sent survey questionnaires.
Overall, almost 60% of respondents reported they were participating in the Medicaid Buy-In program at the time they completed the survey, with 55% reporting they were employed. The apparent discrepancy between those participating in the program and their employment status is probably due to Alaska’s regulations that allow spouses of people with disabilities to work without affecting the person with a disability’s eligibility for the program. Overall, respondents in the program had a relatively long employment history prior to participation with almost 70% reporting employment of six or more years. Almost 90% of respondents had been on the program for one year or less. Specific information about the 40% who indicated they were no longer in the program was not obtained. One possible explanation might be deteriorating health; since 48% of respondents indicated that their disability occurred gradually. In general, respondents were just as satisfied with their employment after participation on the program as before.
One of the objectives of the survey was to determine how well the Medicaid Buy -In Program worked for participants. The vast majority of respondent participants reported being satisfied with the program. The cost of the program was generally perceived to be fair by over 60% of participants, and 15% indicated it didn’t cost as much as they expected. Current asset limits for the program are $2,000 for an individual or $3,000 for a couple. Almost all of the participants (91%) indicated they would like the limits to be increased. An equal number indicated they would like the ability to use asset-building accounts such as an Independent Account (savings for a down payment on home and/or goods or services that enhance your independence and employment potential), a Retirement Account, or a Medical Savings Account. While only 15% of participants reported they received Adult Public Assistance, all of them indicated they would be willing to lose that benefit in order to be able to save more than the current limit.
Adult Public Assistance, Benefits Counselors and Planners, and health care providers were the primary sources of information for participants learning about the program. Yet, 80% of participants indicated that eligibility for the program did not affect their decision to work. This was an interesting finding since the Working Disabled Medicaid Buy-In is a work incentive program for people with disabilities.
Information about the importance of service and supports to obtaining and maintaining employment found four areas were the most important to respondents: interpersonal support (i.e., family, friends, employers and co-workers); transportation (i.e., reliable, affordable, and accessible); affordable housing; and benefits (i.e., affordable health insurance, life insurance, paid time off, retirement plan). In addition to health or disability, the most important barrier to employment for respondents was the affect of wages on their ability to participate in the Working Disabled Medicaid Buy-In program.
