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Fishman, E., & Cooper, B. (2002). Medicaid Buy-In options: Helping persons with severe disabilities and chronic conditions to work. New York: Mount Sinai School of Medicine.
Abstract
This report examines the Medicaid Buy-In provisions under federal law and states' experiences in designing and implementing them. Findings were based on interviews with key informants in 15 states representing a range of program designs and enrollment numbers, including states that did not have a Buy-In program at the time.
The study found that Buy-In programs had very strong political support in states that had such programs, but Buy-In adoption by other states was limited by fear of uncontrollable costs, among other reasons. Although the Buy-In program was meant to remove barriers to work primarily for those already eligible for Medicaid as SSI recipients or as "medically needy," most enrollees were beneficiaries of SSDI and Medicare. Overall enrollment among potential enrollees was low, however, due in part to their fear of losing their benefits as a result of work as well as by program design features.
Options for improvement include launching an education campaign conducted by the Federal government, expanding state demonstration authority for states, increasing the federal match for some or all groups of enrollees, eliminating eligibility inconsistencies between state vocational rehabilitation programs and work incentive provisions, and extending federal health coverage to uninsured working people whose disabilities may become work-disabling.
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