As a follow-up to the previous article about the MA-EPD program, we are looking at the results of a survey conducted in 2004 about how the Medical Assistance for Employed Persons with Disabilities (MA-EPD) program is working for consumers in Minnesota. The MA-EPD program is Minnesota’s Medicaid buy-in program which allows working people with disabilities to pay a premium to retain their Medical Assistance coverage.

The Disability Services Division contracted with Wilder Research Center to conduct a telephone survey of 450 MA-EPD consumers, a representative random sample of the nearly 6,000 consumers on the program.

This survey is part of an overall evaluation of the MA-EPD program. The overall evaluation will be available on the Disability Services Division public web site at www.dhs.state.mn.us/dsd . The goals of the MA-EPD survey were as follows:

To gather baseline program information from a random sample of 450 enrollees in the MA-EPD program;

To establish consumer priorities for MA-EPD program improvements through analysis of the consumer survey;

To identify barriers to finding and keeping employment for people with disabilities;

To obtain information and identify barriers to personal assistance services in the workplace; and

To provide information for the Pathways to Employment’s program evaluation to the Centers for Medicaid & Medicare Services (CMS).

Sampling, Survey Method, and Participants

A total of 456 interviews were completed, which resulted in an 80 percent response rate and a sampling error of +/- 5 percent. All of the consumers in this survey are between the ages of 22 and 65. A vast majority (95 percent) of the MA-EPD consumers who participated in this survey are Caucasian. Half are male and half are female. Consumers reported being in three main disability categories: mental health (38 percent), physical disability (33 percent), and cognitive or developmental disability (27 percent).

Survey results show that participants generally express high levels of satisfaction with the MA-EPD program. In fact, 72 percent of respondents reported they would be unable to work without MA-EPD. However, they also expressed a variety of needs and expectations for more information and support. Some of the key findings that emerged from this survey are outlined below.

Experiences with the MA-EPD Program

Nearly half (43 percent) of the respondents said they first found out about the MA-EPD program through their county case managers or service coordinators. Another 25 percent found out about the program through their county financial workers.

The most common reasons reported by respondents for being on the MA-EPD program were: good health care or prescription drug benefits (28 percent) and health problems or disabilities (22 percent).

Respondents expressed high levels of satisfaction with various aspects of the MA-EPD program including: getting on the program (70 percent), the amount of the premium (81 percent) and being informed by their county financial worker about how to stay eligible for the program (77 percent).

Working appears to have improved the quality of life for most respondents: 97 percent reported feeling better about themselves when they are working, 92 percent said that working allows them to give something back to their community, and 83 percent said that working increases their available spending money.
On the other hand, 45 percent of respondents feel that it will be hard for them to re-qualify for Social Security disability benefits and 43 percent are concerned about losing their Social Security cash benefits as a result of working.

When asked about their additional needs, 53 percent of respondents reported a need for more information about how working affects the health insurance benefits they receive and 15 percent said they would lower the premiums or make the program more affordable.

Consumer Characteristics and Supports

Service and maintenance jobs were the most common types of jobs, reported by 44 percent of MA-EPD respondents. Nearly two-thirds (64 percent) reported working 20 hours per week or less. Most (79 percent) felt they were working “about the right number of hours.”

Most respondents reported having support from their employers (75 percent) and co-workers (70 percent).

More than one-quarter (28 percent) of respondents reported using disability accommodations in the workplace, with the most common being flexible work schedules (64 percent of those who used accommodations).

Two-thirds (65 percent) of respondents reported having other health insurance, mostly Medicare, in addition to Medical Assistance. Only seven percent of respondents’ additional insurance coverage is through their employers.

Only four percent of respondents use personal care assistance services at work. Most respondents (88 percent) who did not report using PCA services at work said the reason why they do not use PCA services is that they do not need them.

Health Problems and Other Barriers to Working

Almost half (44 percent) of respondents said their health was “about the same” at the time of the survey compared to when they started working, 36 percent said their health was “better” and 21 percent said their health was “worse.”

Health-related issues were the most frequently reported barriers to working by respondents. Forty-eight percent of all respondents reported physical health problems and 30 percent reported mental health problems that had prevented them from working during the last year.

Some respondents (14 percent) reported problems with transportation that had prevented them from working during the last year. In addition, 22 percent of respondents said they were unable to afford transportation costs to get to and from work. Nearly half (48 percent) of respondents drive themselves to work and 21 percent use a special transportation service for people with disabilities.

Most respondents (92 percent) reported that their housing arrangements at the time of the survey met their needs. Only two percent of respondents reported housing-related problems that had prevented them from working during the last year.

Recommendations

Overall, respondents are satisfied with the MA-EPD program. The results of this survey indicate that the participants’ quality of life and ability to maintain gainful employment has improved as a result of their participation in the program. In general, it appears that the respondents’ disabilities or health conditions pose significant barriers to working. In fact, health-related barriers were far more commonly reported than other types of barriers, such as housing or transportation. Most frequently reported physical health problems were weakness, being tired and fatigue. The second most commonly reported mental health problems were stress, anxiety, panic attacks and nervous breakdown.

One concern expressed by respondents throughout the survey was the amount of their premiums and co-payments. Legislation was enacted in 2003 to require MA-EPD to be a true “buy-in” program and to address budget constraints. This change resulted in increased premiums for most consumers in the month before surveying took place, which may have affected the frequency or intensity with which these issues were raised. On the other hand, most respondents did agree that the amount of their premium is reasonable. Consumers would likely benefit from any reduction in their out-of-pocket expenses since, despite working, MA-EPD recipients are still predominantly low-income individuals.

Given the low number of people of color on the MA-EPD program, doing specific outreach and marketing of the MA-EPD program to people of color is recommended. Counties should also focus on marketing to communities of color, since most people find out about the MA-EPD program through county personnel.

This survey indicates that there is a need to create additional incentives to work for people with disabilities, as evidenced by respondents who expressed concerns about losing Social Security benefits as a result of going to work. One possibility is to be an early implementation state for a program currently being demonstrated by the Social Security Administration. This program would allow working individuals on Social Security Disability Income (SSDI) to keep $1 of every $2 they earn, creating an incentive to work.

The complete survey report is available under “Reports and Publications” on the Disability Services Division web site at www.dhs.state.mn.us/dsd.