Medicaid Buy-In Pathways

There are three primary Medicaid buy-in pathways:

  • Balanced Budget Act of 1997 eligibility group. States may use this option to cover individuals whose income does not exceed 250 percent of the federal poverty level (FPL).
  • Basic eligibility group. States may use this option to cover individuals above 250 percent FPL and whose income does not exceed a state-defined limit.
  • Medical improvement group. States may use this option to cover individuals who would be in the basic eligibility group, except for the fact that their disability no longer meets the Supplemental Security Income definition or that they work at least 40 hours per month.

There is a separate buy-in program for children with disabilities whose family income is too high to qualify for Medicaid. This option is referred to as the Family Opportunity Act pathway, although it functions similarly to Medicaid buy-in (Stone 2011).

State Medicaid Buy-In Programs

LTSS_medicaid_buy_in_program-01

Notes: Massachusetts offers a buy-in program under a Section 1115 waiver. In addition, other states that originally received authority through one of the above pathways may since have incorporated these programs into Section 1115 programs.

Source: MACPAC analysis of Kehn 2013.