Medicaid “Buy-in” Q&A

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Medicaid “buy-in” allows workers with disabilities access to Medicaid community-based 

services not available through other insurers. Nationally, workforce participation among people 

with disabilities is significantly lower than those without disabilities. Some individuals with 

disabilities who want to work face barriers achieving their employment and earnings potential 

because they need to choose between healthcare and work. Medicaid “buy-in” breaks down 

barriers to employment for people with disabilities. The Administration for Community Living 

(ACL), Centers for Medicare & Medicaid Services (CMS) and the Department of Labor’s Office of 

Disability Employment Policy (ODEP) are committed to policies and programs that promote and 

support successful employment outcomes for people with disabilities. 

What is the Medicaid “buy-in” program?

The Medicaid “buy-in” program is the nickname 

used to collectively refer to the Medicaid eligibility 

groups that serve workers with disabilities who are 

earning income and against whom states may 

charge premiums as a condition of Medicaid 

eligibility.1 The vast majority of states cover at least 

one of the “buy-in” groups. 

Is the Medicaid “buy-in” program new? 

No. The amendments to federal law that authorized 

these particular Medicaid eligibility groups were 

enacted in the late 1990s and early 2000s. These 

Medicaid eligibility groups promote and support 

employment for people with disabilities, and states 

often have a specific program name for their 

Medicaid coverage of these eligibility groups. 

Is the Medicaid “buy-in” the only way workers 

with disabilities can access Medicaid? 

There are multiple ways in which Medicaid 

beneficiaries with disabilities who work can 

preserve their Medicaid, some of which are 

independent of a state’s coverage of the “buy-in” 

eligibility groups. However, generally speaking, 

there is a limit on how much earned income an 

individual may have for purposes of his or her 

Medicaid eligibility for non-Medicaid “buy-in” 

eligibility groups. The “buy-in” Medicaid eligibility 

groups typically have the most generous income 

and financial eligibility standards. This document 

will focus only on the Medicaid “buy-in.”

What if a person with a disability is on Medicaid 

and they want to work? Could they move to the 

Medicaid “buy-in” if they get a job?

Medicaid beneficiaries who have disabilities and 

are interested in working and maintaining access to 

Medicaid should contact their Medicaid agency to 

learn about their state’s Medicaid options for 

workers with disabilities.

What if a state doesn’t have a Medicaid 

“buy-in”? Could a state add a Medicaid “buy-in” 

to their Medicaid program?

Yes. The few states that do not presently cover one 

of the “buy-in” eligibility groups may adopt one of 

them at any time. State Medicaid agencies can work 

with the CMS to add or make changes to their 

Medicaid program. 

1 Premiums are not mandatory. Not all states require Medicaid “buy-in” beneficiaries to pay premiums.

Last Updated: July 2019

ACL is an operating division of the 

U.S. Department of Health and Human Services.
What if an individual has private insurance 

or Medicare? Would they still need Medicaid 

“buy-in”?

Medicaid beneficiaries enrolled in the “buy-in” 

eligibility groups may still benefit significantly from 

their Medicaid coverage in spite of coverage they 

might have under Medicare or private insurance. 

Medicaid beneficiaries frequently are provided 

coverage for services that may not be available 

from private insurance or Medicare, such as 

personal care attendant services and other 

community-based long-term care services. Workers 

with disabilities may enroll in Medicaid to 

supplement Medicare and/or private insurance. 

How do workers with disabilities and others 

interested in learning more about Medicaid 

“buy-in” find more information?

Each state that covers one of the Medicaid “buy-in” 

groups has its own rules about income, assets, and 

premiums. Some states have no income or asset 

limits for its “buy-in” eligibility groups in order to 

promote employment and earnings for 

beneficiaries. Some states charge premiums. There 

is also general information on the CMS website: 

medicaid.gov/medicaid/ltss/employmment/index.html

What if my state has a lower income or asset 

limit? Could they change it to allow workers with 

disabilities to work and earn more?

Yes. States that presently cover one of the Medicaid 

“buy-in” eligibility groups can make changes to their 

income and asset rules2 by submitting a request to 

the CMS. Like other proposed Medicaid changes, 

CMS reviews state requests for approval.

What happens if a person enrolled in the 

Medicaid “buy-in” gets a job in another state and

wants to move there? Could they stay enrolled? 

Each state covering a Medicaid “buy-in” eligibility 

group has its own specific eligibility rules. 

Individuals who move should contact their new 

state to find out if their new state covers one of the 

Medicaid “buy-in” eligibility groups and obtain 

information about eligibility rules. If an individual 

wants to remain enrolled in Medicaid they would 

need to apply within their new home state. 

What if a worker enrolled in Medicaid “buy-in” is 

no longer employed but still needs Medicaid? 

Individuals who experience a change in their Medicaid

eligibility status must report their changes to their 

state Medicaid agency. The state Medicaid agency 

must determine if the change impacts the individual’s 

Medicaid eligibility, and if it adversely impacts such 

eligibility, determine whether there are other Medicaid 

eligibility groups covered under the state’s Medicaid 

plan that the individual might qualify under. An 

individual who loses eligibility under a Medicaid 

“buy-in” eligibility group due to the loss of earned 

income might still be eligible under a separate 

eligibility group covered under the state’s plan. 

How is the Medicaid “buy-in” good 

for employers?

When workers with disabilities don’t need to 

suppress their income to ensure access to critical 

healthcare services, employers are able to attract 

and retain more workers. Employers can support 

employee skill development and promote high 

performers with less concern that a person’s health 

care needs will impact their ongoing employment. 

This benefits the business community. 

This document was produced by the HHS Administration for Community Living (ACL) and DOL Office of Disability 

and Employment Policy (ODEP) with the support of the LEAD Center. The LEAD Center is a collaborative of 

disability, workforce, and economic empowerment organizations dedicated to improving employment and economic 

advancement outcomes for all people with disabilities. The LEAD Center was funded by the Office of Disability 

Employment Policy, U.S. Department of Labor, Grant #OD-23863-12-75-4-11.

For additional information you may contact Annette Shea at ACL at Annette.Shea@acl.hhs.gov. Special thanks to 

Gene Coffey at Centers for Medicare & Medicaid Services (CMS).

2 Income and asset rules cannot be below federal minimum standards.