Employment of Adults with Disabilities under the North Carolina Medicaid Infrastructure Grant (MIG)
Kathleen Thomas, Ph.D., Principal Investigator
Joseph P. Morrissey, Ph.D., Co-Investigator
Alan R. Ellis, MSW, Project Analyst
Robert McConville, Research Assistant
The 1997 Ticket to Work and Work Incentives Improvement Act provides Medicaid Infrastructure Grant funds to states through the Centers for Medicare and Medicaid Services (CMS) for the purposes of removing disincentives to work and supporting employment of adults with disabilities. In North Carolina, the Medicaid Infrastructure grant (NC-MIG) is funded through the Division of Vocational Rehabilitation Services, Department of Health and Human Services. The NC-MIG project addresses three goals:
extend personal assistance services to allow people who need them to work,
develop a Medicaid buy-in plan to allow adults with disabilities to work while paying to maintain their Medicaid coverage, and
increase participation in work support programs.
The MIG project at Sheps informs these efforts through a variety of policy analyses, including analysis of Medicaid claims as well as fielding and analysis of a statewide survey of vocational rehabilitation clients.
CMS is encouraging states to make personal assistance available to Medicaid recipients outside the home, and for at least 40 hours per week in order to support work. In 2004, NC broadened the Medicaid state plan service definition to allow care outside the home. Currently, as of winter 2008, work is underway on a similar extension of the state's Community Alternatives Program for disabled adults. The MIG has developed program participation and cost projections to inform these changes.
In 2005 the NC legislature called for development of a Medicaid buy-in plan for NC, called Health Coverage for Workers with Disabilities. To inform this effort, the MIG has developed enrollment and cost projections, including estimates of program growth and the number and volume of premium payments. As of winter 2008, updated estimates are under development with the latest three years of Medicaid claims.
NC provides one-on-one and group education about the variety of work support programs available to individuals with disabilities. In 2007, the MIG developed and began to implement a brief process evaluation to monitor these efforts. A new series of educational conferences, sponsored through the Department of Vocational Rehabilitation Services, is planned for 2008. The MIG project will participate in these conferences, providing background on policy development efforts in NC.