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Medicaid Buy-In Doubles Enrollment, Expenditures

John Commins, for HealthLeaders Media, October 30, 2009

A new report from Mathematica found that combined inflation-adjusted Medicaid and Medicare expenditures for Buy-In participants more than doubled from $887 million to $1.9 billion between 2002 and 2005, as did program enrollment.

When compared with other working-age disabled Medicaid enrollees, the report, Analysis of Medical Expenditures and Service Use of Medicaid Buy-In Participants, 2002–2005, found that Buy-In participants in 2005 incurred lower annual Medicaid expenditures. The study added the difference suggests that Buy-In participants, who are working, may require fewer services or a less-expensive mix of services than other disabled Medicaid enrollees.

More than 200,000 people with disabilities enrolled in the Medicaid Buy-In program between 1997 and 2007. When workers with disabilities "buy into" Medicaid by paying monthly premiums or copayments, states can offer them Medicaid coverage when their income and assets would otherwise make them ineligible. Most Buy-In participants also receive Medicare coverage if they are eligible for Social Security Disability Insurance payments.

"Medicaid and Medicare expenditures will rise as enrollment in the Buy-In program continues to grow," says Gilbert Gimm, the report's lead author and a health researcher at Mathematica, a nonpartisan research firm based in Princeton, N.J. "However, much of this spending would not represent a new burden on state Medicaid budgets because most new Buy-In participants transfer from another Medicaid eligibility category.

"Since Buy-In participants overall are less expensive to Medicaid than other adult enrollees with disabilities, states without a Buy-In program might want to consider starting a new one. States with a Buy-In program might consider focusing outreach efforts toward younger workers with disabilities," he adds.

Although total Medicaid expenditures rose as enrollment increased between 2002 and 2005, the average monthly Medicaid cost remained relatively stable over this period, fluctuating between $1,287 and $1,161 depending on the year. However, the average monthly Medicare cost for Buy-In enrollees rose from $493 in 2002 to $597 in 2005, the study found.

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