The Effects of State Policy Decisions on the Employment and Earnings of Medicaid Buy-In Participants in 2006

This article examines the Medicaid Buy-In program, so named because workers with disabilities “buy into” Medicaid coverage with monthly premiums. In 2006, 97,491 individuals were enrolled in 32 state Buy-In programs. States have taken different pathways toward the program’s dual objectives: expanding Medicaid coverage to vulnerable populations and promoting employment of working-age adults with disabilities. Analyses indicate that (a) some states appear to have accomplished both objectives, whereas other states have emphasized one over the other, and that (b) certain program features (e.g., higher earned income limits) contribute to both larger percentages of Buy-In participants who are employed and higher earnings of employed participants. The authors’ findings have implications for Buy-In design and the study of federalism in health care.