Ticket to Work

The Center for Medicare & Medicaid Services (CMS) supports the competitive employment of workers with and without disabilities by providing Medicaid services to eligible individuals that enable workers with disabilities to gain and maintain employment. Optional Medicaid eligibility groups, such as the Medicaid Buy-In, allow workers with disabilities to have higher earnings and maintain their Medicaid coverage as more than 150,000 individuals in 42 States were covered under this new eligibility group.

Medicaid Buy-In

Section 201 of Ticket to Work and Work Incentives Improvement Act (TWWIIA) governs the provision of health care services to workers with severe disabilities by establishing a Medicaid state plan buy-in optional eligibility groups. In addition, the Balanced Budget Act of 1997 (BBA) created a separate optional Medicaid eligibility group for working individuals with disabilities. Currently, 46 states provide Medicaid eligibility through the TWWIIAA Buy-In, the BBA Buy-In, or a Section 1115 waiver. Over the past decade more than 400,000 individuals with disabilities have taken part in the Medicaid Buy-In program. Total earnings among all Medicaid Buy-In participants in 2011 were about $1.15 billion.

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. 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.

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.