I. Federal Laws & Initiatives

II. Policy Choices & Fiscal Issues in Design

III. Summary tables of State Medicaid Buy-In Programs

IV. Medicaid Buy-In Admin & Evaluations

V. Cross-Disability Coalitions in States

VI. State Programs

VII. WIA, One-Stops, ADA etc.

VIII. SSDI Work Incentive Demos

Comprehensive Person-Centered State Work Incentive Initiatives:

A Resource Center for Developing & Implementing Medicaid Buy In Programs
Related Employment Initiatives for Persons with Disabilities

II. Policy Choices & Fiscal Issues in
Designing a Medicaid Buy-In and other
Work Incentives

A. Policy Frameworks for Designing Medicaid Buy-In Programs and Related State Work Incentive Initiatives

This report provides policy frameworks 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 to enhance the level of economic self-sufficiency of persons with significant disabilities. Of particular focus of the paper are the design decisions affecting enrollment, costs, and a state's fiscal exposure. The policy frameworks describe the interrelationships between federal and state cash assistance programs (particularly SSDI, SSI, and state SSI supplementation programs) and health entitlements (particularly the Medicaid program).

Executive Summary: http://aspe.hhs.gov/daltcp/reports/polfrmes.htm

Full Report:

B. Developing Fiscal Estimates for a Medicaid Buy-in Program: Using Data from Early Implementer States - July 26, 2002

States seeking to develop minimal cost Medicaid Buy-In programs can learn from the data available from early implementer states. This paper presents information from those states that may assist other states in developing enrollment and cost projections for Medicaid Buy-In programs.The primary strategies available to control costs within a Medicaid Buy-In program are the following:

  1. Limit enrollment to persons with higher levels of earnings.
  2. Establish an unearned income limit.
  3. Impose premiums or other cost sharing.

Download a copy of the paper

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

This report compares the details of the Medicaid Buy-In programs in nine early implementer 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.
Executive Summary: http://aspe.hhs.gov/daltcp/reports/EIlesses.htm

Full Report: http://aspe.hhs.gov/daltcp/reports/EIlesson.htm

Downloadable Word files:
Cover & Table of Contents
Main Report





Center for the Study and Advancement of Disability Policy and Center for Health Services Research and Policy at George Washington University

Supported by a grant from the Robert Wood Johnson Foundation with additional support provided by NIDRR of the US Department of Education through the RRTC on Workforce Investment and Employment Policy at the Law, Health Policy and Disability Center at the University of Iowa. (#H133B980042) 

Website created and maintained by the Law, Health Policy and Disability Center at the University of Iowa College of Law. The opinions and analyses set out in the articles on this website are those of the authors and do not necessarily reflect the positions of the Robert Wood Johnson Foundation, the US Department of Education, George Washington University or the University of Iowa.