Medicaid Buy-In
Several states have implemented Medicaid buy-in programs for low-income children or children with disabilities. For example, Ohio offers a state-sponsored Medicaid Buy in Program for children with high-cost medical care and no insurance, and whose families make above 300% of the Federal Poverty Level. Premiums are charged on a sliding fee scale and there are co-pays.
With the passage of the Family Opportunity Act (FOA) in 2006, Medicaid buy-in programs for children with disabilities are being implemented in a handful of states. The FOA Medicaid buy-in option allows states to expand eligibility to children under age 19 who meet the functional disability criteria for Supplemental Security Income (SSI) and whose families’ adjusted gross income is less than 300% of the Federal Poverty Level (FPL). Uninsured children who meet the disability and income criteria can access Medicaid as their only source of coverage, while those with existing private insurance can access wrap-around coverage for their deductibles, co-pays and other uncovered health care costs.
Because all of these various buy-in programs, including those implemented under the FOA, provide an important new insurance option for children and youth with special health care needs (CYSHCN) who are uninsured and are used by many families with private insurance to provide enhanced benefits for their underinsured CYSHCN, they are discussed more fully in the section on Closing Benefit Gaps: Medicaid Buy-In Programs.
