Ticket to Work and the Medicaid Buy-In

Ticket to Work and the Medicaid Buy-In

Updated: August 2003

AT A GLANCE: Under federal authority granted in 1997 and expanded through the 1999 Ticket to Work Act, states have the option of creating new Medicaid eligibility categories for persons with disabilities who work. Prior to the new authority, persons with disabilities who increased their incomes through work often lost their entitlement to Medicaid and with it such essential services as personal assistance and prescription drug coverage. To provide continued Medicaid coverage when persons with disabilities enter the workforce, states may now establish income and asset standards for this group that differ from other categories. If they wish, states may require newly eligible persons to share in the cost of Medicaid coverage ("buy-in") through premiums or other cost-sharing charges. States may elect to extend the new coverage to persons with disabilities or to both persons with disabilities and persons whose medical condition has improved.

NCSL Publications:
When people with disabilities enter the work force, they may lose their eligibility for Medicaid coverage due to earnings that exceed Medicaid eligibility limits. People with disabilities who want to work may be forced to stay out of the work force to retain Medicaid coverage. Find out more at States with Medicaid Buy-In Programs for Workers with Disabilities.

The Medicaid Buy-In Program for Workers with Disabilities: New States Laws in 2003 (June, 2003)

Promising Practices for Health & Community-Based Services (NCSL Report, January 2003)

Medicaid Buy-In Programs for Workers with Disabilities (December 2002)

NCSL Updated Summary of Medicaid Buy-In Program Activities - April 2002

The Ticket to Work & Work Incentives Improvement Act of 1999 - AFI Brief

Summary of State Medicaid Buy-In Program Activities - April 2002

Ticket to Work: Medicaid Buy-in Options - An NCSL Report

Non-NCSL Resources:

Projecting Enrollment in a Medicaid Buy-In Program for Ohio This report, prepared for the Ohio Developmental Disabilities Council, presents a statistical model for estimating the number of people who would enroll in a Medicaid Buy-In program. The American Public Human Services Association (APHSA) has a new newsletter,

Working for Tomorrow. The newsletter is a bi-monthly newsletter that is produced by the APHSA Center for Workers with Disabilities. It covers state and federal policy developments and innovations with implications for state systems serving working individuals with disabilities.

Comprehensive, Person-Centered State Work Incentive Initiatives: A resource center for developing and implementing Medicaid Buy-In Programs and related employment initiatives for people with disabilities:

Some states have made reports to the legislature about their Ticket to Work activities. View two examples:
CO Report
WA Report

Some states have the Medicaid Buy-In in their regulations or rules. View some examples:
CT
OR
IA

Several states have created brochures or information sheets to explain their programs. View some examples:
AK
CT
MN
NM
NJ

HCFA Ticket to Work Information

SSI Disabled Recipients Who Work

SSI Coalition

U.S. Census Information on Disability

Social Security Administration Office of Employment Support Programs

For more information: Donna.Folkemer@ncsl.org or 202-624-8171

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