Using Medicaid to Support Working Age Adults with Serious Mental Illnesses in the Community: A Handbook. Annotated Bibliography


Cinsavich, S. & Rado, G. (2002). Medicaid Buy-In: Concept and Implementation. Institute for Community Inclusion Policy Brief, 4(2).

This policy paper sheds light on the history leading up to the passage of TWWIIA in 1999 and describes the most important provisions of Medicaid buy-in policy. Current state policies and potential policy actions are also described. Available at

Hanes, P. & Folkman, J. (2003). State Medicaid Options that Support the Employment of Workers with Disabilities. Center for Health Care Strategies, Inc. (24 pages).

This paper describes the experiences of seven states in implementing Medicaid Buy-In for people with disabilities. The authors present a summary and history of the Medicaid Buy-In and then address several policy questions related to its implementation such as the intended scope of the Buy-In, its early signs of success/failure, and the role of both employers and employees in facilitating its implementation. Available at

Jensen, A., Silverstein, R., Folkemer, D., & Straw, T. (2002). Policy Frameworks for Designing Medicaid Buy-In Programs and Related State Work Incentive Initiatives. U.S. Department of Health and Human Services. (45 pages).

This publication provides information for state policymakers and administrators in the design and implementation of Medicaid Buy-In and other work incentive programs for individuals with disabilities. It focuses on the issues of cost, enrollment, and the relationship between cash assistance programs (SSI, SSDI, and state supplements) and health care entitlement programs (Medicaid and Medicare). The report details experiences in nine states that were among the first to implement Medicaid Buy-In programs and outlines decision pathways that states can use to guide them through the buy-in design process. Available at

Wiener, J. (2003). Medicaid and Work Incentives for People with Disabilities: Background and Issues. Washington, DC: The Urban Institute. (76 pages).

This paper explains in detail the relationship between SSI and Medicaid, as well as employment incentive programs, including the Balanced Budget Act of 1997, the Ticket to Work Act, and the 1619(b) provision of the Social Security Act. It offers examples of how states have implemented various employment incentives, and issues they have or may face, including horizontal equity, fiscal pressures and shortfalls, sufficient breadth and depth of coverages, and developing a reasonable and fair definition of disability. The paper includes several state-by-state charts with information about eligibility criteria, 1619(b) thresholds, and buy-in policies. Available at

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