Public Policy Center, University of Nebraska


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Published by the University of Nebraska Public Policy Center.


Many persons with significant disabilities are unable to obtain health insurance in the private sector that provides coverage of the services that enable them to live independently and enter, remain in, or rejoin the workforce. For individuals with disabilities currently receiving health care under Medicaid, the fear of losing their health care and related services is one of the greatest barriers keeping such individuals from maximizing their employment, earnings potential, and independence. For many individual SSDI and SSI recipients, the risk of losing Medicare and Medicaid coverage that is linked to their cash benefits is a risk that is an equal or greater work disincentive than the loss of cash benefits associated with working.

To allow workers with income levels higher than SSI requirements to maintain their Medicaid coverage, the federal government has provided states with an optional “Medicaid Buy-In program.” The Buy-In allows qualifying people with disabilities whose income levels are too high for them to receive SSI, to purchase Medicaid coverage much like one would purchase any health insurance policy. The Medicaid Buy-In was first made a state option through the 1997 Balanced Budget Act (Section 4733). The 1999 passage of TWWIIA expanded the number and type of choices states can make if they decide to implement a Medicaid Buy-In program.

States primarily support working persons with disabilities through implementation of Buy-In programs. Twenty-nine states (Bicameral Briefing on Medicaid Buy-in Programs for Working Individuals with Disabilities, 2001) have adopted some form of a Medicaid Buy-In program that enables persons with disabilities to continue eligibility for Medicaid-financed services.

States with Buy-In programs implemented them following guidelines outlined in either the Balanced Budget Act (1997) or in TWWIIA (1999). Older programs tend to follow BBA guidelines and newer programs tend to follow TWWIIA guidelines. Nebraska’s Buy-In program currently follows the BBA guidelines.

This report provides projections of the number of qualified unmarried Nebraskans expected to enroll in the current Medicaid Buy-In program. (The current policy is summarized in the table presented below.) To gauge the effect of changes in specific policy parameters, we also estimate enrollment in the program under different policy scenarios. These projections are based on a number of underlying assumptions. We assume that all qualified Nebraskans have complete knowledge of the program, there is no perceived social stigma attached to participation in the program, and that enrollment for qualified individuals is costless.

The report is organized around the presentation of six tables of population projections. After I describe the data and the general methodology, I present the detailed model and assumptions used to calculate the estimates presented in the tables.

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