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Project Description

The Medicaid Buy-In program was enacted to encourage work by reducing work disincentives. Persons with disabilities who wish to enter or remain in the labor force face multiple challenges, including those originating from the nature of their disabilities, the limited availability of employer-based and individual private health coverage, and the risk that higher earnings could cause them to lose public assistance they might receive. This program allows people with disabilities to earn more and still be eligible to obtain Medicaid coverage. Participants buy into the program by paying a premium or co-payment and receive full Medicaid benefits in return. The Buy-In program is one major component of a broad federal and state effort to support the employment of people with disabilities that includes the Americans with Disabilities Act (ADA) of 1990 and the President's New Freedom Initiative. State Buy-In programs are authorized under two separate acts, the Balanced Budget Act of 1997 (BBA) and the Ticket to Work and Work Incentives Improvement Act of 1999 (Ticket Act). Both give states a high degree of flexibility to customize their Buy-In programs according to the state's unique needs and objectives. This flexibility, combined with the state-specific variation in traditional Medicaid programs, means that Buy-In programs vary greatly from state to state.

CMS initiated the study to (1) examine selected policy questions related to participation in the Medicaid Buy-In program, and (2) assess the feasibility of examining these questions using information from federal databases. Specifically, the study addressed the following policy questions: · How many individuals were enrolled in the Buy-In program over the given period, how long they were enrolled, what were their demographic characteristics, and what types of chronic conditions did they have? · What percentage of Buy-In participants were on Medicaid and Medicare before enrolling in the Buy-In program? To what extent did participants who left the Buy-In program also leave Medicaid? · What were the Medicaid and Medicare expenditures for Buy-In participants? · To what extent can structural features of each state's program explain the observed patterns of enrollment and medical expenditures?

Project duration: - Jan 2005

Sites studied include 22 States:
Alaska, California, Connecticut, Illinois, Indiana, Iowa, Kansas, Maine, Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Utah, Vermont, Washington, and Wisconsin.

Each of these states has both a Medicaid Buy-In program and a Medicaid Infrastructure Grant (MIG).

Sample Characteristics and Sites Studied

Medicaid Buy-In participants between 2001 and 2003.

Recent Findings in Brief

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