Among other provisions, the Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 provides states the option to expand eligibility in the Medicaid Program to workers with disabilities who meet the Social Security Administration's definition of disability under the Supplemental Security Income (SSI) Program. Specifically, TWWIIA provides that states may establish a buy-in program for workers with disabilities by eliminating or modifying income, assets, and resource limitations so that workers with disabilities gain access to the Medicaid program without the need to impoverish self and family in order to maintain adequate health care coverage. Prior to the passage of TWWIIA, the 1997 Balanced Budget Act also contained a provision for a Medicaid Buy-In Program for working individuals with disabilities. This paper will report on the experience of five early adapter states that have implemented a Medicaid Buy-In option utilizing either the BBA or TWIIA provision (AK, MN, OR, VT, WI). Program design features including how income disregards and premiums were structured, marketing and outreach strategies, and enrollment experiences (demographic and work experience profiles) will be discussed. The paper will highlight the relative roles that consumer, bureaucratic, and other stakeholder involvement and program design have assumed in shaping how the policy decision to expand access to Medicaid for working individuals with disabilities gets played out in the policy implementation process. Administrative data, program records, enrollee profiles, and stakeholder interviews will be presented and discussed.
Learning Objectives: Session participants will be able to: 1) Describe the policy and political dimensions of Medicaid Buy-In Programs for the working disabled 2) Describe and apply analytical tools to assess the relative contribution of stakeholder involvement in shaping the policy implementation process.
Keywords: Access to Health Care, Disability Policy
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.