Program meant to serve thousands of disabled Texans helps only 69

From the Austin American-Statesman:

Four years after lawmakers approved a program designed to help thousands of Texans with disabilities, the program serves only 69 people across the state, according to state officials.

The program allows adults with disabilities to work and still be eligible for Medicaid, the federal-state health insurance program.

But state officials say they've faced several problems getting people enrolled, including a lack of funding to get the word out and overcoming a perception that working people can't get Medicaid.

"We've recognized this as an issue for a while," said Stephanie Goodman, a spokeswoman for the Health and Human Services Commission. "We've been concerned that enrollment is so low."

Now, Goodman says, the commission is stepping up outreach and has loosened enrollment requirements.

For years, people with disabilities were told that if they went to work, they'd lose their Medicaid benefits, said Jonas Schwartz, the commission's lead staffer for the program.

"They're really hesitant to do anything to jeopardize those benefits," said Schwartz, who urged lawmakers to create the program as part of his former job with an advocacy group. "We really have to overcome that mindset."

That has proved difficult, he said, because lawmakers didn't initially allocate money to do outreach, he said.

This spring, the Legislature approved $140,000 for 2010 and $250,000 for 2011 to spread word of this "buy-in" program as well as a new Medicaid buy-in program for children, Goodman said. And in 2008, the Texas Department of Assistive and Rehabilitative Services started receiving federal grant money to do outreach for the adult Medicaid buy-in program and other programs, said Glenn Neal, a spokesman for that department.

Dennis Borel, executive director of the Coalition of Texans with Disabilities, said the adult program "is virtually unknown."

"Or even if people have heard of it, they don't understand what it is," said Borel, whose group has done contract work for the state to educate Texans about the program.

A decade ago, Congress authorized such programs, and Texas' began in 2006.

"If you're a person with a chronic illness or permanent disability, would you be willing to give up your health coverage to take a job?" asked Borel. "That's the kind of disincentive that existed prior" to the program.

When state lawmakers were considering the program in 2005, the commission estimated that it would serve 3,397 people by 2008. "Obviously, we missed the mark," Goodman said.

The state expected to spend $10.4 million a year in state dollars on the program once it was up and running; last year, they spent $428,515, Goodman said. The rest of the money that was supposed to go to the program went to other Medicaid costs instead, she said.

State Sen. Bob Deuell, R-Greenville, a physician, was the author of the bill that created the Texas program.

"We need to look into it," Deuell said of the low enrollment. "If there are more people that would like to work, we need to make sure and let them know" about the program.

Borel said that with thousands of people across the country in Medicaid buy-in programs, it's clear there is a demand. Last year, there were 90,000 people in 40 states in such programs, according to the federal Centers for Medicare & Medicaid Services.

"It's simply a matter of connecting the right people with this program," Borel said. "I'm confident this can happen."

The program provides the same benefits as those given to other Medicaid recipients, including doctor visits, hospital stays, X-rays, vision and hearing services and prescription drugs.

State officials in January made the program cheaper, lowering the maximum monthly premium to $500, down from $1,100. The premium depends on income; some people pay nothing.

People could be eligible if they earn up to $27,096 a year, though there are many things that can be deducted from income for eligibility purposes, so it's possible that someone making twice that could qualify, Goodman said.

And the state is seeking federal permission to allow people in the program to stay in other Medicaid programs that provide services such as home modifications, transportation and aides to help with meals.

The children's program will allow certain families of children with disabilities to pay to join Medicaid even if they earn more than the limit. Officials say they don't anticipate problems with enrolling children in that program.

Because children don't work, and those who would qualify for the program typically don't have insurance, the state won't have to persuade them they can work and receive health benefits.