New Hampshire's Medicaid for Employed Adults with Disabilities (MEAD)

New Hampshire is one of six New England states under the Northeast Partnership (NEP) that meets on a regular basis to create the infrastructure that promotes competitive employment for individuals with disabilities. New Hampshire, known as the “Granite State” has been working to remove barriers to employment for individuals with disabilities since 2001 under the Medicaid Infrastructure Grant (MIG), which is awarded by the Centers for Medicare and Medicaid Services and approved for an 11-year grant period under the Ticket to Work and Work Incentives Improvement Act of 1999 and under the New Freedom Initiative of 2001.

One of the major accomplishments made by New Hampshire is the implementation of the Medicaid Buy-In Program called MEAD (Medicaid for Employed Adults with Disabilities) on February 1, 2002, under New Hampshire legislation called the Work Incentive Act, RSA 167:6, IX, effective June 15, 2001. The MEAD program, designed to delink poverty from Medicaid, allows individuals to increase their employment earnings while maintaining their Medicaid coverage. As of January 2008, MEAD has had an enrollment of 1,433 individuals working, with approximately 10% paying an insurance premium.

In addition to the NEP, partnership building has been an important focus of the grant. The Leadership Council under the MIG has been endorsed under a Governor's Task Force for Employment and Economic Opportunities, represented by state and local agencies, community organizations, advocates, and consumers. State and national partnerships have also come together to help facilitate state-to-state information sharing to improve state Medicaid Buy-Ins and further their work in creating comprehensive employment systems. Under the MIG, the Center for Healthy Policy and Research at the UMass Medical School, has continued to provide New Hampshire with data research and economic evaluations over the years. The NEP and National Consortium for Health Systems Development have provided the technical assistance forums by which New Hampshire and other states have learned from each other to utilize best practices and create initiatives that are tailored to each state.

Following is a description of New Hampshire's Medicaid Infrastructure Grant Objectives from 2001 through 2008. Our goal is to change the perception of disability; delink poverty from Medicaid health coverage; facilitate the collaboration amongst individuals with disabilities, employers/businesses, local communities, and state organizations, and continue to develop employment initiatives that support competitive employment for people with disabilities.

New Hampshire's MIG Web site:
http://www.dhhs.state.nh.us/DHHS/BDS/mig-ceo.htm

Economic evaluation report – web site link:
http://www.dhhs.state.nh.us/DHHS/MEDICAIDPROGRAM/ LIBRARY/Program+Report-Plan/mead-report.htm

Year I: Development of the Medicaid Infrastructure Grant began in 2001 to implement a Medicaid Buy-In that aimed to remove employment barriers for persons with disabilities to help individuals become competitively employed, increase their earnings, and keep their Medicaid coverage. Under the MIG, New Hampshire passed legislation to enact the "Work Incentive Act", improved access to personal care services, and made improvements to change the perception of disability by a statewide education and outreach campaign.

Year II: In 2002, the MIG was instrumental in getting the Medicaid Buy-In called MEAD (Medicaid for Employed Adults with Disabilities) implemented. Efforts to continue statewide education and training on MEAD continued, including increasing access to consumer- directed personal care services and research to conduct an economic evaluation of the MEAD program.

Year III: Education and outreach for the MEAD Program continued in year 2003, including piloting consumer-directed personal care services, benefits counseling and outreach, creating employment infrastructure to assist individuals at local One-Stop locations, conducting an economic evaluation report on New Hampshire's Medicaid Buy-In program, and performing a longitudinal survey study. Collaboration with NH Vocational Rehabilitation and other agencies on the new "Ticket" to SSI and SSDI beneficiaries helped to further the employment focus.

Year IV: Year 2004 infrastructure was aimed at developing initiatives to support competitive employment for people with disabilities, which included: 1) the Governor's Ability Bridge Program, which develops the capacity of employers to recruit employees with disabilities, 2) the Read-to-Work Skills program and Leadership Training Series for Youth initiatives by Granite State Independent Living, 3) the Mental Health Peer Support and customized employment to help build capacity at adult day habilitation programs initiatives by the Institute on Disability at the University of NH, and 4) the Labor Force and Employment Study initiative by the Southern NH University.

Year V: The Medicaid Infrastructure Grant activities in 2005 were designed to promote a cohesive and systematic approach to supporting people with disabilities. Initiatives undertaken by the MIG included: 1) A workforce development research initiative by the Institute on Disability/University of NH aimed at improving access to employment for adults with disabilities and developing customized employment strategies and 2) an initiative by NH Vocational and the Center for Community Economic Development and Disability at Southern NH University aimed at improving the service delivery of employment support services to create better employment outcomes.

Year VI: The focus of the 2006 MIG proposal continued to build upon a cohesive employment network system statewide that facilitated the employment opportunities for individuals with disabilities. An Employment Workgroup was developed by the DHHS/Bureau of Medicaid Administration to increase discussions on employment at the state and local agency level. Access to personal care services was increased by creating a certification process for new agencies, improving statewide education and outreach efforts, and establishing a quality and assurance monitoring mechanism. Resource mapping will begin to help identify which regions of the state deliver employment services. This information, along with the Employment Workgroup, helped to identify gaps and barriers to employment. Research and evaluation of the Medicaid Buy-In continued to evaluate the impact on participants’ employment earnings and health care utilization, and on state expenditures.

Year VII: In Year 2007, the Granite State Employment Project was established to create a comprehensive employment system under the MIG. The vision was to establish two pilot projects that would incorporate local communities that made up steering committees, consultants, and workteams to create an integrated, consumer-driven and outcome-based local employment system over the course of a four-year period. The local planning teams would then bring best practices and offer technical assistance to other regions of the state. The focus would include: local leadership and collaboration, outreach to employers and the business community, outreach to school systems, training and staff development, and data and information technology issues. A State Project Team would be formed to oversee the process, including a State Steering Committee. The Governor’s Task Force for Employment and Economic Opportunities has become the MIG’s Leadership Council.

Year VIII: In year 2008, the Granite State Employment Project is in its second year with two pilot projects that have been established as Lead Agencies to take the lead to systems integration and create best practice models that can be utilized and customized by other regions of the state to address employment barriers. A five-year Strategic Plan has been developed and is available to the public on the state’s DHHS web site. Implementation of employment activities will begin this year A Business Leadership Network is being developed to engage employers and provide resources. Educational forums for each region will begin this year that will target individuals with SSDI, SSI, and Medicaid Buy-In enrollees to competitive employment opportunities.

Contact Information:
Denise St. Onge
Project Director
TWWIIA Medicaid Infrastructure Grant
NH Department of Health and Human Services
Bureau of Development
105 Pleasant St.
Concord, NH 03301
(603) 271-7224
Denise.G.StOnge@dhhs.state.nh.us

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