The Medicaid Buy-In Program: Lessons Learned from Nine Early Implementer States

For many individual Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients, the risk of losing Medicaid coverage linked to their cash benefits is a powerful work disincentive. Eliminating barriers to health care and creating incentives to work can greatly improve financial independence and well being. To support this goal, Congress included a Medicaid Buy-In option in the Balanced Budget Act of 1997 and enacted the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in 1999. These laws authorized states to create Medicaid Buy-In programs to extend Medicaid coverage to persons with disabilities who go to work. This report discusses findings from case studies of nine states operating Medicaid Buy-In programs for working persons with disabilities. The nine states are Alaska, Connecticut, Iowa, Maine, Minnesota, Nebraska, Oregon, Vermont, and Wisconsin. At the time of the study, approximately 13,000 persons were enrolled in the programs in the nine states. The paper gives particular attention to the decisions made by states concerning program eligibility, their approaches to estimating program enrollment and costs, and the patterns of program enrollment to date. The report is designed to assist stakeholders (such as Medicaid directors, state legislators, and cross-disability coalitions) design and implement Medicaid Buy-In programs and related work incentive initiatives. This report is the second in a series of three reports. The first report includes indepth case studies of nine early implementer states entitled Medicaid Buy-In Programs: Case Studies of Early Implementer States. The final report, Policy Frameworks for Designing Medicaid Buy-In Programs and Related State Work Incentive Initiatives, provides policy frameworks describing the interrelationships between health entitlements (especially Medicaid) and cash assistance programs (particularly SSDI, SSI and state SSI supplementation programs)