Expenditures and use of wraparound health insurance for employed people with disabilities
| Autor: | Alexis D. Henry, John Gettens, Denise Hoffman |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Employment Male Work 030506 rehabilitation Self-insurance Pharmacy Medicare Health Services Accessibility Insurance Coverage Young Adult 03 medical and health sciences Nursing Health care Patient Protection and Affordable Care Act Humans Disabled Persons Community Health Services Health policy Health Services Needs and Demand Insurance Health Actuarial science Medicaid business.industry 05 social sciences Public Health Environmental and Occupational Health 050301 education General Medicine Middle Aged United States Massachusetts Work (electrical) Health Care Reform Female Health care reform Health Expenditures 0305 other medical science business 0503 education |
| Zdroj: | Disability and Health Journal. 9:248-255 |
| ISSN: | 1936-6574 |
| DOI: | 10.1016/j.dhjo.2015.12.001 |
| Popis: | Background The Affordable Care Act (ACA) provides health insurance to many working-age adults with disabilities, but we do not expect the new coverage or existing insurance options to fully meet their employment-related health care needs. Wraparound services have the potential to foster employment among people with disabilities. Objective We use Massachusetts, which implemented health care reform in 2006, as a case study to estimate the wraparound health care expenditures and use for workers with disabilities. Methods We identified a group of employed, working-age people with disabilities whose primary health insurance is Medicare or private insurance and who use the Medicaid Buy-In Program for wraparound coverage. We analyzed claims to estimate expenditures and use. Results Wraparound expenditures averaged $427 per member per month. Community-based services for both mental and non-mental health, which are generally not covered by Medicare or private insurance, accounted for 63% of all expenditures. The number who used community-based services was low, but the expenditures were high. The majority of the remaining expenditures were for services usually covered by primary insurance including: inpatient and outpatient, pharmacy and professional services. Expenditures were higher for people with Medicare compared to private insurance. Conclusions This case study suggests that, from a total program cost perspective, wraparound demand is greatest for community-based services. From a member utilization perspective, the demand is greatest for coverage that alleviates out-of-pocket costs for services provided by primary insurance. Additional analysis is needed to further assess the design options for wraparound programs and their feasibility. |
| Databáze: | OpenAIRE |
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