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Ireys, H., White, J., & Thornton, C. (2003). The Medicaid Buy-In Program: Quantitative measures of enrollment trends and participant characteristics in 2002. Washington, D.C.: Mathematica Policy Research, Inc.
Abstract
This report describes Medicaid Buy-In participants in 2002 for 21 states. It presents comprehensive data on the number and characteristics of individuals entering state Buy-In programs. In addition, the report identifies areas for future analysis, including the relationship between states’ expenditures for services and the earnings levels of program participants. This report was initiated by the Centers for Medicare and Medicaid Services (CMS) to begin building a longitudinal database that examines enrollment trends and participant characteristics in these state Buy-In programs. As a foundation for this database, this report looks at Buy-In participation in 21 states with both Medicaid Buy-In programs and Medicaid Infrastructure Grants (MIGs) in 2002.
The data in this report were compiled through each state’s Annual Buy-In Report to the CMS. These annual reports are themselves compiled from multiple and varying sources, such as state Medicaid Management Information System files, statewide or multi-agency eligibility systems, Social Security Administration files, state billing and collection records, and unemployment insurance data systems. There was extensive variation between the states in terms of the number of participants in their Buy-In programs, the amount of their monthly premiums, and the average monthly reported earnings and Medicaid expenditures of program participants.
From this data, three main themes emerged: enrollment in Buy-In programs increased substantially between 1999 and 2002; the majority of first-time enrollees in 2002 were already enrolled in public health insurance and disability-related programs; and about one-fifth of Buy-In participants had reported earnings over the substantial gainful activity level of $800 per month. The comparison of these state annual reports also raised some issues of data anomalies and variations, such as discrepancies between numbers of SSDI recipients and Medicare enrollees and the under-reporting of personal income, which are to be addressed in the compilation of 2003 data.
The report concludes with several critical policy questions to be addressed through continued collection and analysis of enrollment data. Among these questions are to what extent Buy-In programs promote increased employment among individuals with disabilities, the advantages of Buy-In programs over other Medicaid-related work incentive programs, and the relationship between health expenditure and earnings. The report also urges enhancing the state data on Buy-In programs with federal data sources from the Social Security Administration, Medicaid Statistical Information System files, and Medicare files.
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