Promoting Readiness of Minors in SSI (PROMISE): Medicaid Expenditure Patterns and Impacts with a Focus on Youth with High Medical Needs

Promoting Readiness of Minors in SSI (PROMISE): Medicaid Expenditure Patterns and Impacts with a Focus on Youth with High Medical Needs

Published: Jan 11, 2023
Publisher: Mathematica
Key Findings
  • Average annual Medicaid expenditures for PROMISE youth in the year before they enrolled in the study ($16,236) were lower than those for all youth under age 18 with disabilities participating in Medicaid ($19,339), potentially because the program attracted relatively healthy youth who were interested in receiving employment-related services.
  • The PROMISE programs had limited impacts on overall Medicaid expenditures and on specific types of Medicaid expenditures. The most notable finding related to Medicaid expenditures is that PROMISE reduced prescription drug expenditures for youth with intellectual or developmental disabilities by about $21 per person per month (or 28 percent) over five years.
  • PROMISE had different impacts on employment for youth with high medical needs (defined as having Medicaid expenditures greater than the 75th percentile of youth in their respective program during the year before PROMISE enrollment) relative to other youth. The pattern across programs, however, was inconsistent.

The Promoting Readiness of Minors in Supplemental Security Income (PROMISE) demonstration sought to improve the outcomes of youth receiving Supplemental Security Income (SSI) and their families related to employment; education; income and earnings; and participation in SSI and other public assistance programs, including Medicaid.

In this report, we examine Medicaid spending patterns in more detail to better understand the impact of PROMISE on Medicaid and the relationship between youth’s health care needs and PROMISE’s impacts.

We begin by reporting the Medicaid spending patterns of PROMISE enrollees. We then examine PROMISE’s impacts on the types of Medicaid services used by youth, overall and by type of impairment. Finally, we examine how the impacts on outcomes (education, employment, earnings, total payments from SSA, health insurance, youth expectations, and self-determination) for both youth and parents differed by the level of youth’s health care needs at enrollment (as measured by their Medicaid expenditures) to determine if high health care needs moderated the programs’ impacts.

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