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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

The Medicaid Buy-In program in Vermont is part of a comprehensive work incentive initiative called the Vermont Work Incentives Initiative Project. The Division of Vocational Rehabilitation runs the Vermont Work Incentive Initiative, a comprehensive effort to remove barriers to employment for people on SSI/SSDI, which also includes benefits counseling, Social Security Administration (SSA) waivers and peer counseling. The DVR partners closely with Medicaid, mental health agencies, the Social Security Administration and other relevant partners.

“Vermont Work Incentive Initiative” A Power Point presentation by staff of the Vermont Division of Vocational Rehabilitation.

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

August 2003
Vermont has joined with Wisconsin and Connecticut in submitting, without solicitation, a proposal to the Social Security Administration to be one of the states which would be the site for a SSDI benefit offset demonstration project
( $1 for $2).

Persons to Contact:

Mary Cross
Vermont Work Incentives Initiatives
Division of Vocational Rehabilitation
Department of Aging & Disability Services
Vermont Agency of Human Services
103 So. Main Street
Waterbury, VT 05671
Phone: 802-241-2127
Fax: 802-241-3359


III. Program Development - Past and Present

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

    For a description of the development of the Vermont program go to the Vermont Case Study prepared by the George Washington University Work Incentives Project with support from ASPE at the Department of Health and Human Services and scroll down and click on to the Vermont study in the Table of Contents

    Or download a Word file of the Vermont Case Study
  • Initial Planning, Information Gathering and Program and Fiscal Estimates

The Vermont Legislature included language in its FY 1995 appropriations bill requiring the Agency for Human Services to prepare a report. The report identified potential methods to increase the number of persons with disabilities who were employed by reducing employment barriers. The Medicaid Buy-In program was among the policy actions taken after release of the report.

When preparing the mandated report, the Department of Aging and Disabilities (DAD) in the Agency for Human Services conducted several focus groups including individuals with disabilities and their families, service providers, employers and employment services, and state legislators and agencies. The Department conducted research on Medicaid's interaction with SSI and SSDI and on related issues of benefits counseling and transportation. The report, released in January 1997, found that only one percent of disabled individuals receiving SSDI return to work. Seventy-eight percent would like to work, but fear losing either cash benefits or Medicaid coverage. Major recommendations included tax credits, increased job training and benefits counseling, improved transportation and support services, outreach efforts to employers, and expanded health care coverage.

Report to the Vermont General Assembly on Work Disincentives   January 1997 “The Barriers to Employment faced by Persons with Disabilities: Problems and Solutions”

Download a Word file of the text of the January 1997 Report


IV. State Legislation - Adopted and Pending

Attendant Services Program Study Legislation:
In 2000, the Vermont Legislature mandated a study on possible use of Medicaid for Attendant Services Program including the components of consumer direction, ability to hire spouses, and enabling employment.


V. Current State Policies and Program Descriptions

  • State Policies: State Plans, Regulations and Waiver Requests to Federal Agencies - Pending and Adopted Programs

    Download Rules for the Vermont Medicaid Buy-In program

  • 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

    456 enrollees in the Medicaid Buy-In program as of June 30, 2003
  • Consumer Surveys and Evaluation Studies

    The Impact of Specialized Benefits Counseling Services on Social Security Administration Disability Beneficiaries in Vermont
    Tim Tremblay, M.S., and James Smith, M.A, Vermont Division of Vocational Rehabilitation
    Haiyi Xie, Ph.D., and Robert Drake, M.D., Ph.D. Dartmouth College
    Download a copy of the article

VII. Comprehensive Employment Initiatives

Comprenhensive and Integrated Benefits Planning Services
Vermont has trained Benefits Counselors who are state employees of the Division of Vocational Rehabilitation (DVR) stationed in DVR offices, Community Mental Health Center offices throughout Vermont and Dept. of Employment and Training (DET) offices throughout the state. Vermont also has a Benefits Planner funded through the BPAO Project that is an employee of the Vermont Center for Independent Living (VCIL). There are also two Employment and Training Specialists who work in the in the DET One Stops who have training in benefits counseling. They work together to provide benefits counseling services. The DVR Benefits Counselors provide the most intensive counseling services and provide training for other agencies and organizations.

Personal Assistance Services
Plans underway to implement a training program for users of PAS services

Youth in Transition Programs
Assistive Technology staff conducts outreach and education workshops at schools, Vocational Rehabilitation offices and Vermont Business Expo

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.