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Coming Someday: Medicaid Buy-In Programs for Workers with Disabilities

June 2001

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article is the first in a two-part series outlining how the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) is being instated. The goal of the legislation is to increase the choices of social security beneficiaries with disabilities for obtaining employment, vocational rehabilitation, or other support services from public and private providers. To ensure successful implementation, the programs are being phased in gradually over a period of three years and should be implemented nationwide by 2004. Eventually, most social security beneficiaries with disabilities will receive the benefits of these programs. Many believe that Georgia's implementation will begin in 2003 -- maybe.

The first part of this legislation that I will be exploring is the part that allows states to design Medicaid buy-in programs for people with disabilities who wish to return to work or earn a higher salary without losing their Medicaid benefits. The Medicaid buy-in allows working people with disabilities to "buy-in" to the state's Medicaid program by paying a premium or cost sharing. This creates an affordable option for individuals and employers. Keep in mind there are only 13 pilot states that have implemented these programs thus far, and Georgia is not one of them. As such, there are no systems in place to begin providing this service. The purpose of this article is merely to inform you of upcoming programs that are being created.

There are a few basic guidelines for the programs to follow. Medicaid buy-in plans must be state-wide and have the same comprehensive healthcare package as the state's regular Medicaid plan. The premiums cannot exceed 7.5% of gross income when the participant's gross income is between 250% and 450% of the Federal poverty level. States may impose premiums on individuals with income up to $75,000/year (with restrictions). States must impose 100% of cost of premiums for those with income over $75,000. There are no age restrictions to be eligible for the program. Applicants must meet or equal the Federal disability program criteria.

How the plans will look in each different state depends on how each individual state legislature decides how the plan will look and run. States have a lot of flexibility in how these programs are designed, financed, and administered. For this reason it will be extremely important for people affected by this important legislation to get involved in making sure the program covers the needs of all disabled individuals. For example, states can change the criteria so someone can access healthcare without getting on public assistance, they merely have to meet or equal the Federal disability program criteria. However, of the 13 states that have implemented the program, ten have used flexible measures for people to access healthcare. These states have seen impressive results in terms of people accessing the new services. The three states that made no changes in eligibility for the program are seeing little or no enrollment in the Medicaid buy-in program.

The state of Georgia has achieved transitional eligibility for the Medicaid buy-in program. The state's programs must meet benchmarks set up by the Healthcare Finance Administration before receiving additional funding. Georgia has received infrastructure grants to design, establish, and operate infrastructures that support working persons with disabilities. The funded organizations are working to conduct outreach programs to inform individuals about the newly created infrastructure. These new infrastructures will help provide personal assistance services to those looking to take advantage of the provisions of TWWIIA. The organization for the metro Atlanta area offering Benefits Planning Assistance and Outreach is the Shepherd Center. The contact persons at the center are Sally Atwell, M.S., C.R.C., L.P.C., and Curtis L. Rodgers, M.S., C.R.C., L.P.C. The contact information for the Shepherd Center can be found at the end of this article.

As you can see, there is very little definite information concerning how the Medicaid buy-in program will look in Georgia. However this offers us, as advocates, a tremendous opportunity to make sure the TWWIIA programs meet the needs of the people who will use the program. To make sure that Georgia sees the same success as ten of the 13 pilot states, there are many questions that we can help answer when the programs are being created.

Some of the important questions that need to be kept in mind when this legislation is being implemented are:

  • What exclusions and waivers will be put in place to make the Medicaid buy-in incentive viable?

  • What will be the role of employers paying Medicaid premiums?

  • What income level will be covered? 250% of the Federal poverty limit or higher?

  • How much of their assets can people keep to help promote self-sufficiency?

  • How much of their assets will be disregarded?

  • Are there particular assets that will be treated differently?

  • Will there be differentiation between assets accumulated while in the program versus before entering the program?

Some of the more successful Medicaid buy-in pilot states such as Minnesota, Wisconsin, and Iowa:

  • Boosted the asset spend-down level to between $10,000 and $20,000.

  • Created innovative home ownership programs where the dollar amount for down payments toward purchasing a house was excluded.

  • Completely disregarded retirement savings programs when determining eligibility.

  • Advocated for a revolving fund with buy-in premiums going toward paying back the Medicaid program. This helped the states track the new program and let them see the effect the new premiums made on the overall cost of the program.

  • Rewarded persons who earned more by lowering their Medicaid premiums, thus increasing the incentive to work more.

  • Allowed saving programs toward disability resources (impairment related work expenses such as personal care assistants and Braille computers) to be exempted as personal impairment savings and not held against their assets.

How can we help shape the program? Get involved in a state-wide disability coalition. Join a workgroup made up of individuals who are currently getting assistance and who would benefit from the new program. Consult the state Workforce Development agency or welfare and Medicaid agencies to find out how to get involved. Don't give up! If they say they don't have any of these programs in place, encourage them to create one, or help them create one so your voice can be heard. Call these numbers and check out the website information to find out how you can make these new programs work better for you.


Health Care Financing Administration (HCFA):
Region IV (Atlanta) -- Renard Murray (404) 562-7417

Other National Resources:

SSA Red Book on Work Incentives --

SSI Coalition Web site -- or contact your State Community Relations Bureaus or Ombudsman Programs

Atlanta, Georgia Resource:

The Shepherd Center
2020 Peachtree Road, NW
Atlanta, GA 30309
1-866-772-2726 or contact Sally Atwell, M.S., C.R.C., L.P.C. or Curtis L. Rodgers, M.S., C.R.C., L.P.C . at 1-866-SSA-BPAO, 404-350-7589, or 404-350-7598.
On the Web at or email at and

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
See Also
More on Returning to Work and Social Security