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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

Michigan enacted in 2003 State Medicaid Buy-In legislation with an implementation date of January 1, 2004

NewDownload file of two summary charts
State’s Medicaid Buy-In Program Design Features
- Income Eligibility Criteria
- Resource Limits and Exclusions
- Cost Sharing - Minimum Income Level and Premium or Cost Share Methods
- Work Related Policies and Protections
State’s SSI and Other Medicaid Income Standards for Adults with Disabilities

II. What’s New and Persons to Contact

A Medicaid Buy-In program has passed the legislature and was signed by the Governor. The Department of Community Health projects no new costs from the new program while legislative fiscal analysts project new costs will be “nominal.” Eligibility for the Buy-In Program builds on the state’s current poverty-related category. Under the state’s current poverty level standards, an adult with a disability whose total income is less than the poverty level (about $750 monthly for one person) can qualify for Medicaid. Persons who go to work may have combined SSDI income and income from earnings which exceed the poverty level standard and then must qualify for Medicaid under special rules that require them to spend down to an income of approximately $350 monthly.

To solve this problem, the Buy-In program will count income from earnings and income from other sources in different ways. Income from sources other than work will be compared to the poverty-level standard. Income from earnings will not be counted. A working adult with a disability will qualify for Medicaid without a spend down as long as his non-work income (e.g. SSDI) is less the poverty level

With the unearned income limit in place, the state is likely to experience few new costs due to the program expansion. Persons with SSDI benefits above the poverty level will not qualify for coverage under the program, but a significant number of persons with lower levels of SSDI benefits will be able to go to work and retain Medicaid without a spend down

Persons to Contact
MiJob Coalition Contact
R. Anthony "Tony" Wong
Michigan Association of Centers for Independent Living
1476 Haslett Road
Haslett, MI 48840
Phone: 517-339-0539
Fax: 517-339-0805
E-mail: tony@macil.net

June Morse
Consultant/Ticket Coordinator
Michigan Department of Career Development
Rehabilitation Services
P.O. Box 30010
201 North Washington Square
Lansing, MI 48909
Phone: 517-373-8240
Fax: 517-373-0565
E-mail: morsej1@michigan.gov


III. Program Development - Past and Present

  • Executive Branch Leadership, Cross Disability Coalition Leadership and Interagency Working Groups
    MiJob Coalition active in development of Medicaid Buy-In legislation
    Download Membership of MiJob Coalition
  • Initial Planning, Information Gathering and Program and Fiscal Estimates
    Consumer survey conducted by MiJob Coalition in 2000
    Download survey summary


IV. State Legislation - Adopted and Pending

Download Word file of explanation of Michigan Medicaid Buy-In Legislation

Pdf file of House bill 2003-HNB-4270 as signed by Governor

Pdf file of Senate bill 2003-SNB-0022 as signed by Governor

Pdf file of Senate Fiscal Agency’s analysis and fiscal impact of bill May 2003 SFA 0022


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

    A Medicaid Buy-In Implementation Task Force was established including members of the MiJob Coalition and State agency staff.
  • 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

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.