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

VI. State Comprehensive Employment Initiatives & Medicaid Buy-In Programs

A. New Principles Guiding the Development of Medicaid Buy In and Income Assistance Demonstrations:

Enabling persons with severe disabilities to be better off financially if they work is a goal of States' work incentive initiatives. From an analysis of the development of policies in those states which have been developing comprehensive employment initiatives, including Medicaid Buy In program for persons with significant disabilities, themes and broad policy 'principles' can be seen as implicitly or explicitly driving the policies in state law, regulations, service delivery structures and administrative procedures. These principles include: providing the option for at least partial self support; being responsive to changing ability to work; and providing the option to accumulate assets to increase financial security and independence. 

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B. Eligibility Criteria for the Optional Medicaid Buy In Program:

Federal Guidelines and Examples of State Responses States are utilizing the new options to develop Medicaid Buy In programs to create a variety of policies under the broad Federal policies established in Federal law and guidelines. The various States' Medicaid Buy In programs reflect the significant differences among the States in their current Medicaid program and the policies they have adopted under the Federal policies. Examples of the States explanations of their programs can provide an overview of some of the policy options available to states.

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C. Medicaid Buy In Programs: General Policy Criteria & Policy Tradeoffs:

A primary  goal of work incentive initiatives is a significant increase in the percentage of current SSI and SSDI recipients with earnings in any particular month. States have and will be required to determine the best tradeoffs among a variety of general policy criteria they might use in devising the most effective and equitable Medicaid Buy In programs. The general policy criteria being used by States include tradeoffs among: keeping it simple; make cost sharing under Medicaid Buy In programs progressive related to level of income; providing consistency with eligibility methodology in other Medicaid programs; making it similar to private health insurance; and provide for cost sharing which targets the program and enables the state to control enrollment and costs. There are considerable variations among the states as to the weight given to each criterion.

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D. Specific Financial Eligibility & Cost Sharing Policies:

From the weights given to the 'general policy criteria.'  States have developed specific financial eligibility and cost sharing policies. These policies are further refinements of these general policies. These policy criteria are also driving State initiatives to seek complementary SSI and SSDI demonstration projects in their state and related Medicaid and housing waivers to reduce work disincentives.

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E. Policy Development for Financial Security & Independence : Assets and Resources:

States' Medicaid Buy In programs and their requests for complementary Federal demonstration projects provide that persons with severe disabilities who choose to work have the opportunity to not only increase their disposable income for daily living costs but also to increase their sense of financial security and independence. The goal is ensure more independence by having assets and resources which will enable them to respond to short term financial emergencies, save for achieving more independence in housing and other personal goals and to be able to save for retirement.

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F. Protections Sought for SSDI and SSI Recipients Participating in Medicaid Buy In Programs:

Obtaining and providing protection against loss of disability status under the SSI, SSDI and Medicaid programs for individuals who choose to go to work and use a State's Medicaid Buy In program is a high priority for persons with disabilities, advocates and State officials who are developing and implementing state work incentive initiatives.

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G. A Framework to Examine the Complementary Relationships Among States Proposed  Medicaid Buy In Program Policies and Proposals for Medicaid Waivers and SSI and SSDI Demonstration Projects:

States in the early implementation stages of work incentive initiatives are recognizing that the initiatives must be person-centered and comprehensive. This means that Medicaid buy-in programs are necessary components of a work incentive initiative, but they are not sufficient; there must be complementary income assistance and demonstration projects which affect the SSDI and SSI programs.  A framework is provided for examining the potential complementary relationships among various Medicaid and income assistance policies and policies governing other long term services and supports that States have or are proposing to include in their comprehensive employment policies.

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H. "Ticket to Work: Medicaid Buy-In Options for Working People with Disabilities"
By Julie Scales (NCSL), Donna Folkemer (NCSL), and Allen Jensen (GWU).

National Conference of State Legislatures monograph sent to State Legislatures.

At the National Conference of State Legislatures website.

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.