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Medicaid Buy-In Opens Doors to Employment for People with Disabilities

October 29, 2014

As Sharon Lewis, deputy administrator for the Administration for Community Living (ACL), noted in her Disability Employment Awareness Month blog post earlier this month, working is about more than earning a paycheck. It gives purpose and structure to our lives. In the late 1990s, the Medicaid Buy-In program launched historic changes for workers with disabilities. For individuals suppressing their income to gain or maintain access to critical community-based supports, it was life changing.

Today the Medicaid Buy-In program continues to provide workers with disabilities an opportunity to improve their economic well-being and achieve a better life. Inspired through the independent living movement, the Medicaid Buy-In program is an optional State Medicaid benefit group for workers with disabilities who have earnings in excess of traditional Medicaid rules. So people with disabilities who would be ineligible for Medicaid because of earnings can work and access the services and supports they need. Ideally, it means workers with disabilities do not need to choose between healthcare and work.

For many people with disabilities, their health care needs involve access to home and community based services not available through Medicare or private insurance plans. Currently 46 States have a Buy-In program. States have flexibility in regards to the treatment of income and assets for their Medicaid Buy-In programs. Over the past decade more than 400,000 individuals with disabilities have taken part in the Medicaid Buy-In program. Total earnings among all Buy-In participants in 2011 were about $1.15 billion.

ACL celebrates the Medicaid Buy-In program for its role in raising expectations, supporting employment, and empowering people with disabilities to live successfully in their communities.

Research has shown that the program is not just good for beneficiaries and employers; it is also good policy for Medicaid. An analysis of expenditures and services used showed Medicaid Buy-in participants incurred lower annual Medicaid costs than other adult disabled Medicaid enrollees. In a University of Kansas study, findings indicated Medicaid Buy-In participants had a better quality of life while Medicaid expenditures were less.

With the Medicaid Buy-In program, employers are able to attract and retain more workers, support employee skill development, and promote high performers with less concern that a person’s health care needs will impact their ongoing employment. For the business community, this can be a competitive advantage.

Successfully employed individuals with disabilities have less dependency on publicly-funded systems as they work, develop skills, gain experience and are empowered to make decisions about career advancement and independent living. Employing a diverse workforce sends a strong message to all employees that those with health care needs will have the opportunities and support needed to stay employed.

The Medicaid Buy-In program is one of many efforts underway across the federal government to raise employment expectations and empower people with disabilities to live successfully in their communities. Together these initiatives bring us closer to the day when workers with disabilities can achieve their potential through successful employment without needing to choose between healthcare and work. To learn more about the Medicaid Buy-In, please visit

Last modified on 05/06/2020

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