The 2016 Legislature is currently holding hearings on proposed Medicaid Buy-In Legislation. If you support a Medicaid Buy-In, you can submit testimony and view the measure status using the links below.

You can also show support by contacting the office of the Governor.

The Honorable David Ige
Governor, State of Hawai’i
Executive Chambers, State Capitol
Honolulu, Hawai’i  96813

Phone: 808-586-0034
Fax: 808-586-0006

Medicaid Buy-In Participation by State

Map Showing States that Support Medicaid Buy-In
Let’s Make Hawaii the 47th State with MBI!


Working-age adults with disabilities need adequate health insurance to enter or remain in the work force, but their options for insurance coverage are limited. Many who have full-time jobs may not be covered through their employer-sponsored health insurance because of a pre-existing condition. Those who work part-time or have jobs that do not offer health coverage may have to turn to government-sponsored programs, such as Medicaid. However, a person with a disability who earns more than the allowable amount will be ineligible for Medicaid coverage. That’s where the Medicaid Buy-In program comes in.

A Medicaid Buy-in enables people with disabilities to work and use Medicaid by “buying in” (i.e., by paying a premium and/or cost-share.) On July 6, 2012, Governor Abercrombie signed HB 2415 into law to establish a task force to implement a Medicaid Buy-in program in Hawai‘i.

The Medicaid Buy-In program allows adults with disabilities to earn more than would otherwise be possible and still have Medicaid coverage. In return, participants “buy into” the Medicaid program, typically by paying premiums based on income. As of June 2012, 45 states were operating a Medicaid Buy-In program to extend Medicaid coverage to working people with disabilities, with total nationwide enrollment of more than 100,000. (Mathematica Policy Research)

Why Hawaii needs a Medicaid Buy-In:

  • A Medicaid Buy-In Program in Hawaii can generate $240,000 fiscal benefit to the State in its first year of implementation.
  • $2.3 million fiscal benefit to the State over 5 years.
  • Medicaid Buy-In beneficiaries are more likely to have Medicare, (80% or more).
  • Savings on SNAP can reach over $70,000 in first year, and $700,000 over 5 years.
  • Governor Abercrombie sponsored Medicaid Buy-In program in US Congress under the Ticket to Work in 1999.
  • Less than 70% of Medicaid Buy In recipients are already known to Medicaid.
  • Generates revenue of $80,000 in General Excise Tax in its first year, and more than $750,000 over 5 years.
  • 45 States have Medicaid Buy-Ins.
  • State Medicaid officials may customize Buy-Ins to fit the state’s overall healthcare strategy
  • Medicaid Buy-In could generate $100,000 in premium in its first year and $900,000 over 5 years

Policy Brief



In Hawaii, there are approximately 22,000 adults receiving SSDI benefits as “disabled workers”; the average benefit for a disabled worker is about $1,097 per month. SSDI recipients get Medicare after a 2-year wait, but many need medications and other assistance not covered by Medicare.

(ALL AGE 18-64)
Total Population (18-64)
SSDI disabled workers (18-64)
SSI (18-64)
People with a disability (18-64)
Sources: American Community Survey, 2009; U.S. Census; Social Security Administration, State Statistics – Hawaii, 2010

More than 18,000 working age adults in Hawaii receive SSI benefits, with an average monthly SSI payment of $560. There are about 3,295 individuals who get both SSDI and SSI because their SSDI benefit is less than their monthly federal SSI payment. Their average monthly SSDI and SSI payments in the state of Hawaii are $552 and $142, respectively.
In Hawaii, adults with disabilities typically are covered by Medicaid only if they:
  • get Supplemental Security Income;
  • get Home and Community Based Services (HCBS) or facility care; or
  • have enough medical bills to spend their income down to qualify for short-term coverage through the state’s Medically Needy Program.
According to the 2009 American Community Survey conducted by the U.S. Census Bureau, approximately 7.4% of the civilian, non-institutionalized working population (18 to 64 years of age) is reported as “with a disability.”
In 2009, the employment rate of working-age people with disabilities in HI was half that of  those without disabilities, while the poverty rate of working-age people disabilities was triple that of those without disabilities.
To keep Medicaid, workers with disabilities often have to limit their income and assets to poverty levels, although Medicaid costs for SSI recipients who work are less than half of the costs for those who do not.
From a survey conducted in 2005 using Medicaid Infrastructure Grant funds, it was found that:
  • 69.6% of respondents would sign up for a premium sharing program that would allow for work without losing healthcare benefits;
  • 82.4% of respondents expressed interest in information about how to find and keep a job without losing healthcare benefits;
  • Lack of job supports, such as assistive technology and personal assistance, and the potential loss of benefits dissuade people with disabilities from working.
Through greater flexibility provided by the federal government, Hawaii can make adjustments to its Medicaid program to accommodate people with disabilities to encourage work, as 45 other states have already done.
  • reduce the number of uninsured or underinsured persons in Hawaii;
  • remove documented barriers to work, such as loss of benefits, lack of job supports and personal assistance services, and being told not to work by case workers;
  •  help working people with disabilities increase their economic independence and live above poverty by providing needed health care coverage and decreasing their reliance on SSDI or SSI benefits;
  • enable some SSDI recipients to work and get Medicaid as a supplement to private or Medicare insurance;
  • obtain federal funding for health care services for persons now served through state-funded mental health programs; and
  • allow persons with disabilities to work and pay state, federal and FICA taxes.
The most tangible benefit to the state would be from the increase in taxes paid by those employed. A recent study entitled Medicaid: Good Medicine for State Economies – 2004 Update by Families USA Foundation determined that:
  • for every $1.00 that the state spends on Medicaid, there is a business activity return of up $3.17;
  • in FY 2005, there were an estimated 11,000 jobs created due to Medicaid spending, with total spending on wages of $466 million; and
  • every $1 million spent on Medicaid results in $3.2 million in new business activity, 29.34 jobs created; and $1.2 million in new wages.
As an example of a program design for Hawaii’s QUEST WINS, a person must:
  • be employed;
  • be age 18 through 64;
  • be ‘disabled’ but for the earnings limit under SSA rules (Ticket Act, Title II, Section 201 (a)(1)(C));
  • have net countable income less than 250% FPL under the Social Security counting methodology. In 2011, this equals approximately $2,613/mo. of countable income, after Social Security disregards;
  • have countable assets less than $20,000;
  • − pay a premium.
It should be noted that three options have been developed based on other states’ buy-in plans, with different income and asset limits.
Five broad coverage groups have been identified in the preliminary formulation of QUEST WINS:
  1. Former 1619(b) Recipients and Others with earnings too high for Medicaid
  2. People with disabilities enrolled in Medicaid under a medically needy, spend down, or poverty level categories
  3. People with disabilities who lack other sources of health insurance, including SSDI beneficiaries in the 24-month waiting period before receiving Medicare, and working SSDI beneficiaries nearing the end of an extended period of Medicare coverage who will experience a loss of Medicare.
  4. People with disabilities whose premiums/cost sharing for other private or public insurance coverage (e.g., through private insurance, COBRA, spouses, or Medicare) exceed the cost of the QUEST WINS program.
  5. People with disabilities whose private and/or public (Medicare) coverage does not provide needed medical supports, but which are covered by the QUEST WINS program.
It should be noted that in most states with a Medicaid Buy-in, a vast majority of the participants are already known to the Medicaid program, and this is also expected to be the case for Hawaii. Based on the analysis already performed, the size of QUEST WINS could be anywhere from 200 to 2,000 participants.

Hawaii Research

Hawaii Testimony

Medicaid Buy In Impact on Other States