The Medicaid Buy-In
Many people with disabilities who wish to work risk the loss of cash
and health benefits under SSI and SSDI. To eliminate this and other
disincentives, Congress enacted legislation authorizing states to
create Medicaid Buy-In programs. This legislation encourages states
to implement programs that provide funding for personal assistance
services that support competitive employment.
A majority of states have either implemented the Buy-In or have enacted
legislation authorizing implementation. There is considerable variation
among these programs in terms of eligibility, income thresholds, and
other criteria. The following tables summarize the implementation
status and design criteria for 28 states.
Summary
status of the implementation by state (Jensen 2003). (MS Word)
Summary
of Design Features (Jensen 2003) (MS Word)
Reports and publications
Benjamin, A.E. (1998). Comparing Client-Directed and Agency Models
for Providing Supportive Services at Home. School of Public Policy
and Social Research, University of California, Los Angeles, Los Angeles,
CA.
Center for Workers with Disabilities (2002). California Governor
Signs Landmark Employment Supports Measure. The American Public
Human Services Association, Washington, DC.
Folkemer, D., & Hinton, D. (2003). InfoBrief: The California
Workforce Inclusion Act. National Collaborative on Workforce and
Disability, Issue 5, September 2003. Washington, DC.
Folkemer, D., Jensen, A., Silverstein, R.,& Straw, T. (2002). The
Medicaid Buy-In Program: Lessons Learned from Nine Early Implementer
States. U.S. Department of Health and Human Services (HHS), Office
of Disability, Aging and Long-Term Care Policy (DALTCP) and George Washington
University, Washington, DC.
Hinton, D. (2003). InfoBrief: Personal Assistance Serices on the
Job. National Collaborative on Workforce and Disability. Issue 6,
Sept. 2003. Washington, DC.
Jee, J., & Menges, L. (2003). The California Working Disabled
Program: Lessons Learned, Looking Ahead. Lewin Group, for the Medical
Policy Institute, Oakland, CA.
Jensen, A., Silverstein, Folkemer, D., & Straw, T. (2002). Policy
Frameworks for Designing Medicaid Buy-In Programs and Related State
Work Incentive Initiatives. U.S. Department of Health and Human
Services, Washington, DC.
Jensen, A. (2003). State Medicaid Buy-In Program Design Features.
George Washington University, Washington, DC.
Ripple, J., & Stoddard, S. (2003). Statewide Independent Living
Needs Assessment: Findings, Part 1. InfoUse, Berkeley, CA.
Silverstein, R. (2003). The Applicability of the ADA to Personal
Assistance in the Workplace. Center for the Study and Advancement
of Disability Policy, Washington, DC.
