title: Expenditures and use of wraparound health insurance for employed people with disabilities.
abstract: 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.
authors.affiliation: University of Massachusetts Medical School, Center for Health Policy and Research, 333 South Street, Shrewsbury, MA 01545, USA. Electronic address: jack.gettens@umassmed.edu.
authors.forename: John
authors.initials: J
authors.lastname: Gettens
authors.affiliation: Mathematica Policy Research, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Hoffman
authors.affiliation: University of Massachusetts Medical School, USA.
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Henry
mesh_terms: D000328:Adult; D003153:Community Health Services; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D018166:Health Care Reform; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008404:Massachusetts; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States; D014937:Work; D055815:Young Adult
keywords: Disability; Employment; Health care needs; Health insurance