Medicaid Medically Improved Group: A small group of recent Social Security disability beneficiaries with growing earnings

Among Social Security disability beneficiaries who work, earnings are low, only 80% of poverty on average. Increased earnings eventually lead to forfeiture of Medicaid benefits unless a state implements Medically Improved Group coverage through a Medicaid buy-in program. Despite its importance, few states offer improved group coverage, and among those that do, participation is low. This study describes improved group participants to explore who enrolls and how they fare. Medicaid Buy-In Integrated Data from 2001-2009 describe all medically improved group participants from program initiation through 2009 across the US (n=315). Nonparametric statistics describe demographics of participants, patterns of enrollment and earnings. T tests are used to evaluate changes in earnings over time. Forty-five percent of participants have psychiatric impairment. Among 2009 participants, mean earnings were 52% higher than the federal poverty level. Compared to the year prior to enrollment, participant earnings grew 9% in year 1 and 15% by year 2 (p<0.05). Improved group participants represent an unusually successful group of individuals with disabilities who have recently moved off Social Security roles. Their significant level of earnings and growth in earnings over time warrant further study to explore if this program facilitates earnings growth or simply provides an important pathway out of dependence for those ready to work more. These findings underscore the importance of careful consideration of the intersection of Social Security beneficiary status, income eligibility for new Medicaid categories, minimum benefits and reliance on long term supports from Medicaid as details of health reform legislation are ironed out.