Affiliations: Center for Health Policy and Research, University of
Massachusetts Medical School, Shrewsbury, MA, USA
Note: [] Address for correspondence: Alexis D. Henry, Center for Health
Policy and Research, University of Massachusetts Medical School, 222 Maple
Avenue, Chang Building, Shrewsbury, MA 01545, USA. Tel.: +1 508 856 8833; Fax:
+1 508 856 8543; E-mail: [email protected]
Abstract: Working-age adults with severe disabilities face many barriers to
reaching their employment potential. One important barrier is the concern that
working will result in the loss of Medicaid benefits, which cover many needed
healthcare services for people with disabilities at little or no cost. Now
offered by over 30 states, Medicaid buy-in programs address this concern by
allowing people with disabilities to retain Medicaid while they work and
increase earnings. Prior reports of buy-in programs have not examined whether
work outcomes vary with characteristics of buy-in enrollees. Using data from a
statewide survey of Massachusetts buy-in program members, we found type of
disabling condition to predict three work outcomes: current work status of all
members; annual earnings over $10,000 among currently working members; and
future work intentions of currently non-working members. Members with
developmental or psychiatric disabilities were generally more likely to work
but had lower earnings than other members. Members with a physical disability
were generally less likely to work than other members, but when working tended
to have higher earnings. Those with co-occurring psychiatric and physical
disabilities had the poorest work outcomes. Across all conditions, few members
had earnings at levels consistent with economic self-sufficiency. Policy and
practice implications are discussed.
Keywords: Disability, employment, earnings, work barriers, health insurance
