The California Working Disabled Program: Lessons Learned, Looking Ahead
Joanne Jee and Joel Menges of The Lewin Group
May 2003
The California Working Disabled Medi-Cal Buy-In Program (CWD) was implemented in April 2000 to help disabled individuals participate in the workforce without the threat of losing their Medi-Cal coverage. Although a relatively new program, policymakers and advocates have already begun considering programmatic and policy changes that would build on the existing program, expand eligibility, and broaden access to certain services. This study was initiated to better understand the factors affecting enrollment in CWD and to estimate the enrollment and cost impacts of select programmatic changes.
As of 2003, the California Working Disabled program covers individuals with net countable family incomes of up to 250 percent of the federal poverty level (FPL) and assets of up to $2,000 for an individual ($3,000 for a couple). Net countable income is derived by exempting all disability-related income and disregarding the first $65 of earned income, impairment-related work expenses, and approximately half of the disabled person's earned income. Thus, some working disabled people can have overall income well above 500 percent of FPL and still be eligible for the program. Relative to income eligibility requirements for other Medi-Cal aid categories, the income threshold for CWD is quite high; the CWD assets threshold is the same as that used in many other aid categories.
Enrollment in CWD totaled 652 people as of June 2002, far below original enrollment estimates and the number of individuals estimated to be eligible. Prior to implementation, the California Department of Health Services (DHS) estimated that 7,000 to 14,000 individuals would enroll by the end of the second year of the program. Thus, enrollment in the CWD Program has reached only about 10 percent of its estimated level. The modest enrollment made it important to identify whether program design changes are needed to allow larger numbers of disabled individuals in California to work while maintaining health care coverage through Medi-Cal.
The goal of this study was to gain a better understanding of the factors affecting enrollment in CWD and to estimate the enrollment and cost impacts of select programmatic changes. To further study these issues, two sets of analyses were conducted. The first was a qualitative review of stakeholders’ experience with the program. The experiences of CWD enrollees, those eligible but not enrolled (nonenrollees), and county eligibility workers were gathered to lend insight into the factors contributing to the program’s current enrollment trend as well as to solicit suggestions for program improvement. This qualitative research included an enrollee survey, and in some cases follow-up interviews; a teleconference with a group of nonenrollees; and telephone interviews with county eligibility workers. The second effort was a set of quantitative analyses of Census Bureau and DHS data to model program eligibility alternatives that might allow more disabled workers in California to access Medi-Cal coverage. The enrollment and cost implications of these alternatives were also explored.
The full report can be found under Document Downloads below.