How Does the Medicaid Buy-In Program Relate to Other Federal Efforts to Improve Access to Health Coverage for Adults With Disabilities?

The Medicaid Buy-In program enables people with disabilities to work without losing their Medicaid health benefits. The program provides health coverage without cash benefits and each participant pays a premium based on income. States are allowed to customize their Buy-In programs to meet state needs. By the end of 2005, 30 states operated a Medicaid Buy-In program and nationwide nearly 69,000 people were enrolled. The Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA) have implemented a series of demonstration projects to explore routes to expand the Medicaid Buy-In program to specific populations.

The CMS Demonstration to Maintain Independence and Employment (DMIE) is targeted toward employed adults with specific progressive mental or physical conditions. The program covers health services and employment supports. As of July 2006, seven states the District of Columbia, Hawaii, Iowa, Kansas, Minnesota, Mississippi, and Texas had implemented a DMIE. The DMIE projects test the idea that a coordinated health care combined with employment support can delay or prevent loss of employment due to a disabling condition. The SSA demonstrations are the Mental Health Treatment Study (MHTS); Accelerated Benefits Demonstration; and the California HIV/AI Demonstration. Of these three only the MHTS has begun; the others are still in planning phases.