By the end of 2004, 32 states operated a Medicaid Buy-In program, with a nationwide enrollment of more than 76,000 people. The Buy-In program allows adults with disabilities to have Medicaid insurance coverage even when they are working. This issue brief describes the earnings of workers with disabilities who participated in the Medicaid Buy-In program in one of 27 states with participant data in 2004. About two-thirds of Buy-In participants (66 percent) reported at least some earned income to the IRS on W-2 forms in 2004. The percentage of Buy-In participants with earned income varied from a low of 38 percent in Missouri to a high of 95 percent in Illinois. Among people who participated in the Buy-In program, average reported annual earnings were $7,246 (about 78 percent of the federal poverty level). Average reported earnings varied greatly from state to state, with a low of $4,337 in Iowa to a high of $14,342 in South Carolina. A number of factors affected earning levels across the states, including program context (e.g. local economies, social service infrastructure), program features (e.g. income limits, asset limits, outreach methods), and participant characteristics (e.g., age, education level, health and disability status, work experience). Although the majority of Buy-In participants are earning income, their earnings are generally low and vary greatly across different states.