UMMS Affiliation

Department of Psychiatry, Center for Mental Health Services Research; Center for Health Policy and Research

Publication Date


Document Type



Medicaid; Disabled Persons; Massachusetts


Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology


Summary: The Medicaid Buy-In program is a key component of the federal effort to make it easier for people with disabilities to work without losing health benefits. Authorized by the Balanced Budget Act of 1997 (“BBA”) and the Ticket to Work and Work Incentives Improvement Act of 1999 (“Ticket Act”), the Buy-In program allows states to expand Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid. To be eligible for the program, an individual must have a disability (as defined by the Social Security Administration) and earned income, and must meet other financial eligibility requirements established by states. States have some flexibility to customize their Buy-In programs to their specific needs, resources, and objectives. As of July 1, 2008, 33 states with a Medicaid Infrastructure Grant (MIG) reported covering 82,488 individuals in the Medicaid Buy-In program. The CommonHealth Working (CHW) program in Massachusetts is the oldest Buy-In program in the nation. It began in 1988 as a state-funded program and was folded into the state’s 1115 Medicaid research and demonstration project in 1996. This issue brief, the eighth in a series on workers with disabilities, compares the employment outcomes of newly enrolled CHW participants based on whether or not they were previously enrolled in MassHealth, Massachusetts’s Medicaid program, under another eligibility category. For those who had been enrolled in MassHealth, employment outcomes before and after CHW enrollment are contrasted.


Ellison, M.L., Samnaliev, M., Henry, A.D., Beauchamp, J.S., Shea, A., & Himmelstein, J. (2008). How Do Employment Outcomes of Medicaid Buy-In Participants Vary Based on Prior Medicaid Coverage? An Example from Massachusetts. Working with Disability: Work and Insurance in Brief, 8. Washington D.C., Mathematica Policy Research Institute. Link to report on publisher's website

Journal/Book/Conference Title

Working with Disability: Work and Insurance in Brief, 8