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Comprehensive Person-Centered State Work Incentive Initiatives:

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


I. Overview of a State's Comprehensive Person-Centered Employment Initiatives

Medicaid Buy-In legislation was enacted in the 2003 legislative session to be implemented by July 1, 2005 if funds are available in the state budget.

A Maryland Coalition for Work Incentive Improvement was organized in January 2000. (See membership of the Coalition under III below.)

II. What's New and Persons to Contact

New -
Medicaid Buy-In legislation was enacted in the 2003 legislative session
Go to Section IV to down load a copy of the legislation (HB630)

New -
Maryland has been approved for a Medicaid Infrastructure Grant and as of September , 2003 the state was in the final stages of selecting a Project Director.

Persons to Contact:
Cathy Lyle
Deputy Director
Maryland Developmental Disabilities Council
300 West Lexington Street, Box 10
Baltimore, MD 21201
Phone: 410-333-3688 Ext. 4
Fax: 410-333-3686

Anne Rea
Director of Community Employment and Resource Management Services
Way Station, Inc.
P.O. Box 3826
Frederick, MD 21705-3826
Phone: 301-694-9945 extension 1240
Fax: 301-694-9932

III. Program Development - Past and Present

  • Executive Branch Leadership, Cross Disability Coalition Leadership and Interagency Working Groups

    Report by the Maryland Coaltion for Work Incentive Improvement to the Maryland legislature related to the development of a Medicaid Buy-In program.
    Download a copy of the complete report

    The following is an excerpt from the Executive Summary of the report by the Coalition
    The Economic Matters Committee ( of the Maryland House of Delegates) , the Maryland Coalition for Work Incentives Improvement, and the Department of Health and Mental Hygience (DHMH) have been actively engaged on the issue for two years. The Coalition and the Department of Health and Mental Hygiene were asked to develop a feasible and fiscally responsive approach to provide the requisite Medicaid coverage for employed persons with disabilities.
    The Coalition reviewed the experience of the other states with Medicaid Buy-In Programs and drafted a strategy that addresses the issues relevant to Maryland. The strategy allows for a carefully phased implementation that recognizes the fiscal realities of Maryland. The cost will be managed by:
    - Phased in eligibility limits over three years for earned and unearned income
    - Income limits of 300% of poverty level and asset limitations
    - Targeting participation in early years to individuals with significant gainful employment

    Participating Organizations in the Maryland Coalition for Work Incentive Improvement
    Download file of membership

  • Initial Planning, Information Gathering and Program and Fiscal Estimates

Download copy of Maryland Survey

Download summary of results of Maryland Consumer survey

Vision of Maryland Coalition of Work Incentive Improvement:
A Maryland with no barriers to employment for persons with disabilities.

To develop and implement a comprehensive plan that reduces barriers to employment for persons with disabilities while preserving and expanding access to health care and benefits. Through efforts of the disability community, this coalition was formed in January 2000. A unique element of this Coalition is the participation by both the disability advocacy organizations and the state agencies. The Coalition's initial activities centered on developing a Medicaid Buy In program for the state of Maryland. The Coalition developed a Consumer survey to provide source information on the interest in and impact of a Medicaid Buy In program.

Maryland Consumer Survey Results
During the summer of 2000, the Maryland Coalition for Work Incentives Improvement conducted a survey of people with disabilities to determine the need for a Medicaid Buy In program and to gather information which would be helpful for designing a Medicaid Buy In program. 853 surveys were returned. See below for a summary of the results of the survey.

IV. State Legislation - Adopted and Pending

Down load a copy of the legislation (HB 630) the Medicaid Buy-In legislation signed into law by the Governor.

The legislation requires, to the extent that funding is available in the State budget, the Department of Health and Mental Hygiene (DHMH) to implement the Employed Persons with Disabilities Program (EPDP) by July 1, 2005.
The bill requires the state agency prior to adopting the regulations to implement a Medicaid Buy-In program to “(I)consult with the Coalition for Work Incentives Improvement and (II) give preference to the recommendations for eligibility criteria developed by the Coalition”.

The recommendations of the Coalition are shown in the crossed out portion of the bill that can be downloaded. The recommendation of the Coalition included: that enrollees in a Medicaid Buy-In program must have earned income of no less than $400 a month (typo in the drafting of the bill) and unearned income of no more than $850 a month.


V. Current State Policies and Program Descriptions

  • State Policies: State Plans, Regulations and Waiver Requests to Federal Agencies - Pending and Adopted Programs
  • Ensuring Informed Choice and Person - Centered Programs: Benefits Counseling, Work Force Investment Act Implementation and Related Educational Services
  • Descriptions for Consumers and Staff Training Activities


VI. Program Data and Impact

  • Medicaid Buy-In Data
  • Consumer Surveys and Evaluation Studies


VII. Comprehensive Employment Initiatives

Comprehensive Employment Project Established under DOL Grant.
Way Station, Inc., a comprehensive mental health service organization in Frederick, Maryland, was awarded a grand by the US Department of Labor for a work incentives project. The following is an excerpt from an executive summary of the Project:

"The Frederich Works project was a comprehensive proposal designed to address the multiple impediments to employment that persons with disabilities must overcome. Consortium partners include: the Workforce Development Board of Frederick County (the local workforce investment board with a majority membership of private businesses), the One-Stop Employment Partnership (OEP) of Frederick County (a team of nine public agencies, including the Maryland State Department of Education Division of Rehabilitation Services), and Way Station, Inc. and Goodwill Industries of Monocacy Valley, Inc. (private, nonprofit, disability services organizations)."

Download a two page executive summary of the Project.

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.