Since its inception, the Medicaid Buy-In program has offered state policymakers an important option for providing health care coverage to working adults with disabilities. More than 200,000 people have enrolled in the program at some point between 1997 and 2007, and as a result, have access to health services covered by their state Medicaid plans. Most Buy-In participants are also covered by Medicare because they receive Social Security Disability Insurance (SSDI) payments. Analyzing the Medicaid and Medicare expenditures of Buy-In participants offers useful information to policymakers and program administrators who are interested in monitoring spending trends for future budget and outreach planning. It can also foster a better understanding of how service needs vary among Buy-In participants. This information can help states to ensure their Buy-In programs will continue to meet the on-going needs of workers with disabilities.

In this report, we specifically examine the following questions:

• What were the annual and per member, per month (PMPM) expenditures of Buy-In participants enrolled between 2002 and 2005?

• How did expenditures and service use in 2005 vary by type of service and by participant characteristic - nationwide and by state?

• Among those first-time Buy-In participants who had prior Medicaid and/or Medicare coverage, how did their expenditures change around the time of Buy-In enrollment?