This report profiles Buy-In participation in 2002 and 2003 for 22 states with a Medicaid Buy-In program and a Medicaid Infrastructure Grant. Drawing on states' annual reports on program participation and telephone discussion with state Buy-In personnel, the report offers descriptive information on five topics with important policy implications: enrollment growth, types of people who enter a Buy-In program, participants' earnings, participants' premiums, and participants' Medicaid expenditures.

The study found that enrollment in state Buy-In programs nearly tripled in the two-year period, and that the majority of new Buy-In participants were already linked to public health insurance and disability programs when they enrolled. Participants generally had low earnings, with most earning below the level of substantial gainful activity. The proportion of participants who paid premiums varied widely from state to state, and Medicaid expenditures for enrollees tended to be substantially higher than expenditures for the average Medicaid participant with a disability. The report recommends addressing several key policy questions to further understand the implications of the findings.