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Hanes, P., & Folkman, J. (2003). State Medicaid options that support the employment of people with disabilities. Portland, OR: Oregon Health and Science University, Center for Health and Disability Policy.
Abstract
This study of early Medicaid Buy-In program implementation in seven states addresses the relationship between program design and enrollment characteristics and workers' perceived benefits of participation in the program. Using data from self-administered surveys of working-age adults with disabilities, focus groups, meeting summaries, and administrative data gathered by states and submitted to CMS, the study examined barriers to employment, to what extent Buy-In participants increased their earnings, attitudinal and quality of life changes resulting from working and increased earnings, and the role of individual and societal attitudes in furthering return-to-work policies.
The study found that evidence from these early implementer states was mixed and inconclusive. Program design features such as income and resource limits and the availability of benefits counseling influence program participation rates and earnings profiles. Individual worker characteristics and societal attitudes about disability can influence these outcomes as well. The study concluded that the effectiveness of Buy-In programs seems to depend on whether it is integrated into a larger state initiative to boost employment and earnings among people with disabilities. Further, individual factors such as time spent in the labor market and ongoing fear of losing health insurance and income supports may moderate the effectiveness of Buy-In programs.
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