Medicaid Buy-In for Working People with Disabilities

Since its enactment in 1999, the Ticket to Work and Work Incentives Improvement Act has allowed states to expand Medicaid coverage to people with disabilities through the Medicaid Buy-In program. The program provides people with disabilities an opportunity to work and earn wages while simultaneously maintaining their Medicaid eligibility and coverage. By providing people with disabilities with the opportunity to become or remain employed while keeping their Medicaid coverage, the Medicaid Buy-In program contributes to a more inclusive workforce and better fiscal outcomes within states (Administration for Community Living, 2019). The Medicaid Buy-In program also limits the “churn” of people with disabilities cycling in and out of Medicaid due to being over the income limit. Of note, the Medicaid Buy-In program does not exist in all states; where it’s available, eligibility criteria vary from state to state.

To measure state performance in availability of Medicaid-Buy-in programs, we look at different policies states can choose from with respect to setting income and asset limits for individuals and couples and when monthly premium rates are charged. Higher scoring states are those with policies that maximize enrollment and affordability to allow more working people with disabilities to get and keep their Medicaid benefits. Three states stand out for making Medicaid Buy-In available in the most expansive ways (Arkansas, District of Columbia, and Colorado) and six others are near the top (Illinois, Massachusetts, Minnesota, New Jersey, New York, and Washington). Alabama, South Carolina, and Tennessee do not have a Medicaid Buy-In for this population.

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The percent of state policies governing Medicaid Buy-In programs that promote enrollment.  Kaiser Family Foundation fielded a survey of states on Medicaid financial eligibility & enrollment policies that included data about Medicaid Buy-In program policies. AARP Public Policy Institute analyzed the data on eligibility policies for state Medicaid Buy-in programs for working people with disabilities, and scored states based on eligibility policies related to individual income limits, individual asset limits, spousal asset limits, and premiums. Those scores are the numerator with a top possible score as the denominator, to derive a percent value for the indicator. 

KFF Survey of Medicaid Financial Eligibility & Enrollment Policies for Seniors & People with Disabilities, Kaiser Family Foundation, July 2022.

AARP PI identified set of policy options for program design that promote enrollment.


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