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Pennsylvania Medicaid Buy-In

Pennsylvania Medicaid Buy-In. MAWD Medical Assistance for Workers with Disabilities November 2006. Pennsylvania. General Population 12 million or 12,281,054 ( 2000 Census) Medicaid 1.8 million or 1,888,814 (9/30/06) MAWD 8,815 (9/30/06). Pennsylvania MAWD.

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Pennsylvania Medicaid Buy-In

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  1. PennsylvaniaMedicaid Buy-In MAWD Medical Assistance for Workers with Disabilities November 2006

  2. Pennsylvania • General Population • 12 million or 12,281,054 ( 2000 Census) • Medicaid • 1.8 million or 1,888,814 (9/30/06) • MAWD • 8,815 (9/30/06)

  3. Pennsylvania MAWD • Administered by Department of Public Welfare (DPW) • Implemented January 1, 2006 • Ticket to Work • Basic Group • Medically Improved • Tobacco Master Settlement established State Funding

  4. Pennsylvania MAWD • Tobacco Settlement • PA Funding for MAWD is Good • MAWD Program Changes • Made by Internal Policy/Procedures • Waived premiums • Good Cause • Employment/Work Issues

  5. Pennsylvania MAWD • Employed and Disabled • 16-64 Years of Age • Income is 250% of FPL • Resource Limit is $10,000 • Premium is 5% of Monthly Income • Average premium is $41.00

  6. Pennsylvania MAWD • Disability Determination • SSA Determination if Title II • Medical Review Team (MRT) for Others • MRT is DPW Review • Contract with Private Entity • SSA Guidelines

  7. Pennsylvania MAWDMedically Improved • Previously Covered in Basic Group • Disability No Longer Meets SSA • Employed 40 hours or month in Month • Earning at least Minimum Wage • Disability Definition • Severe Medically Determinable Disability • PA Created Definition

  8. Pennsylvania MAWDMedically Improved • Medically Improved Disability Definition • Loss of Health Care Results in loss of Employment • Limits ability to Work/Conduct activities • MH/PH Stabilized by Medication • Organ Transplants/Medication required • Chronic Diseases • Documentation required

  9. Pennsylvania MAWDMedically Improved • Medically Improved • 12/2002 1 • 12/2003 4 • 12/2004 7 • 12/2005 11

  10. Pennsylvania MAWDMedically Improved • Where in Pennsylvania ? • In 8 Counties/PA has 67 Counties • Southeast/ Urban/Suburban 6 • Central /Suburban 3 • Southwest/Rural 1 • Southwest/Urban 1

  11. Pennsylvania MAWDMedically Improved • Medically Improved • Gender • Women 7 • Men 4 • Disability • Mental Illness 50% • Heart Disease

  12. Pennsylvania MAWDMedically Improved • Age • 21 – 29 2 • 30 – 39 1 • 40 – 49 5 • 50 – 59 3

  13. Pennsylvania MAWDMedically Improved • Employed • Full Time 5 • Part Time (100 + Hours) 2 • Part Time ( <100 hours ) 3 • Self-Employment 1

  14. Pennsylvania MAWDMedically Improved • Job Types • Cashiers/Tellers • Bookkeepers/Accounting • Household/Domestic • Truck/Cab Drivers • Sales • Building/Service Related

  15. Pennsylvania MAWDMedically Improved • Premiums • Average Premium $38.00 • Low $16.00 • High $75.00 • $10-$19 2 $20-$29 2 • $30 - $39 2 $40 -$49 3 • $60 - $69 1 $70-$79 1

  16. Pennsylvania MAWDMedically Improved • Length of Time on Medically Improved • 12 Months and Longer 1 • 10 to 12 Months 4 • 4 to 6 Months 3 • 3 Months or Less 3

  17. Pennsylvania MAWDMedically Improved • Benefits Ended • Requested Benefits Closed • Employment Ended • Eligible for Other Medicaid Group • Health Reasons

  18. Pennsylvania MAWDMedically Improved • Most MAWD Remain in Basic • Most MAWD Remain SSA Disabled • Must be Basic Prior to Medically Improved • Basic Group Employment • Full Time – 1752 • Part Time - < 100 Hours 3966 • Part Time- > 100 hours 1416

  19. Pennsylvania MAWDMedically Improved • Questions • Thank You Carol Tooker ctooker@state.pa.us 717-772-7815

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