This year, several states applied for and received permission from the federal government to implement work requirements in their Medicaid programs. Policy designs vary by state, but all states build in considerations for people with disabilities. These considerations include exemptions and exceptions from work requirements for individuals unable to work due to a disability. Due to the nature of disability and the nature of disability determination processes, states will face limitations in identifying all individuals who are unable to work due to a disability. Medical claims do not necessarily provide enough information to determine a person’s ability to work. Medical diagnoses and disability determinations both can lag symptoms by months or years. As a result, relying on claims or disability determination data could leave out individuals who are unable to work due to a disability. At the same time, waiting for a diagnosis or a disability determination is a critical time period for individuals with disabilities to be able to access health care. This luncheon, co-hosted with the Berkman Klein Center for Internet and Society at Harvard University, discussed the nature of disability and disability determination; the resulting limitations in data availability; and implications for public policy. For more information, please visit our website: http://petrieflom.law.harvard.edu/events/details/5555

1. Determining Disability
Medicaid Work Requirements and the
Limits of Digital Health
Rachel Gershon
October 16, 2018

2. 4,353

3. Medicaid work requirement status
Based on Kaiser Family Foundation, State Health Facts, Approved Section 1115
Medicaid Waivers and Pending Section 1115 Medicaid Waivers, September 28, 2018
Pending
Approved
Invalidated by
a court

4. How can states ensure that they are
exempting all recipients who are
unable to work?

5. Disability and work
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

6. Example 1: Quick determination
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

7. Example 2: Slow determination
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

8. Example 3: Retains ability to work
Able to Work Not Able to Work;
Not determined disabled
Determined
Disabled

9. Example 4: In and out of ability to work
Able to Work Not Able to Work;
Not determined disabled
Determined
Disabled

10. Example 5: Not able to work
Able to Work Not Able to Work;
Not determined disabled
Determined
Disabled

11. Disability and work
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

12. Data Matches for disability
determinations
 Social Security Administration
 Veteran’s Affairs
 SNAP
 Other federal and state agency determinations

13. Data match for disability determinations
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

14. Consequences of Medicaid loss
 Access to health care
 Financial protection
 Access to employment
 Access to disability determinations
 Access to medical professional
 Substantial gainful activity

15. Example 2: slow determination
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

16. Access to medical professional
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

17. Substantial gainful activity
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

18. Data Matches for disability
applications

19. Data match for disability applications
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

20. Who is not applying for SSA
benefits?
 Including disability income applicants
mitigates the substantial gainful activity issue,
but leaves other populations out.
 Not yet gathered the information to apply
 Does not meet SSA disability standards

21. Consequences of Medicaid loss
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

22. Claims analytics
 Diagnoses
 Medical expenditures
 Social determinants of health

23. Claim analytics
Able to Work
Not Able to Work;
Not determined disabled
Determined
Disabled

24. Consequences of Medicaid loss
 Medicaid as a work support
 “A large majority of employed Group VIII
enrollees (83.5%) reported that Medicaid
made it easier to work; most unemployed
enrollees (60.0%) reported that Medicaid
made it easier to look for work.”
 “[Medicaid] allows me to get surgery which
has allowed me to return to work.”
-Ohio Group VIII evaluation

25. Consequences of Medicaid loss
Able to Work Not Able to Work;
Not determined disabled
Determined
Disabled

26. Example 5: Not able to work
Able to Work Not Able to Work;
Not determined disabled
Determined
Disabled

27. Going analog
 Self-report
 Process for analyzing self-report
 Who bears the burden of uncertainty?

28. Are work requirements worth it?
 Needle in a haystack
 Medicaid as a work support
 Potential for disrupting disability determination
process

29. Discussion
• Standards for determining disability
• Processes for determining disability
• Role of technology
• Effectiveness of work requirements

30. Thank you!