Ensuring Access to Medicaid Buy-in Programs Act of 2026
- Sponsor
- Sen. Blackburn, Marsha [R-TN]
- Committees
- Finance Committee (primary)
- Last action
- Jan 27, 2026
Bottom line
This bill expands Medicaid eligibility for working adults with disabilities by removing the current age limit, allowing more individuals to retain healthcare coverage while working.
What it actually does
This bill amends the Social Security Act to eliminate the age cap (currently under 65) for working adults with disabilities to qualify for Medicaid buy-in programs. It specifically defines a new group of individuals who, but for their earnings exceeding Supplemental Security Income (SSI) limits, would be considered SSI recipients, making them eligible for Medicaid if they are at least 16 years old. This expands access to Medicaid for older working individuals with disabilities.
Proponents argue
Supporters argue that the current age restriction creates a "cliff effect" where working adults with disabilities lose crucial Medicaid benefits once they reach a certain age, despite still needing healthcare coverage to maintain employment and independence. They contend this bill promotes workforce participation and reduces disincentives to work by ensuring continued access to essential medical assistance, thereby improving quality of life and economic self-sufficiency for this vulnerable population.
Opponents contend
Opponents might argue that expanding Medicaid eligibility could increase state and federal expenditures, placing additional strain on already stretched budgets. They may also raise concerns about the potential for increased administrative complexity for states, particularly those that need to adjust their existing buy-in programs to comply with the new federal requirements, even with the provided transition period.
The bill is short and its core changes are clear, making it accessible for a quick evaluation.
Section 2(a)(1)(A)(i) and Section 2(a)(3)
Eliminating the "Under 65" Age Restriction for Working Adults with Disabilities Medicaid Buy-In
This provision removes the phrase ", but less than 65," from existing law, specifically from the section of the Social Security Act that defines optional Medicaid buy-in groups for working individuals with disabilities. This change means that states can no longer impose an age limit of under 65 for these individuals to be eligible for Medicaid buy-in programs, effectively allowing older working adults with disabilities to continue or begin receiving Medicaid.
Supporters argue
Supporters argue this change addresses a critical gap in coverage, enabling older working adults with disabilities to avoid losing essential health benefits as they age, thereby supporting their continued employment and independent living.
Critics contend
Critics might express concern about the increased fiscal burden on federal and state Medicaid budgets due to the expansion of eligibility to an older demographic, potentially leading to higher healthcare costs.
Tradeoffs
The tension lies between supporting the independence and health of older working adults with disabilities and managing the potential increase in Medicaid program costs for states and the federal government.
Section 2(a)(2)(C)
Establishing a New Category for Medicaid Buy-In Eligibility
This provision adds a new clause (xviii) to Section 1905(a) of the Social Security Act, explicitly defining a group of individuals eligible for Medicaid. This group includes individuals who are at least 16 years old and would qualify for Supplemental Security Income (SSI) based on disability, but whose earnings exceed the SSI income limit. This formalizes and clarifies the eligibility criteria for the expanded Medicaid buy-in programs.
Section 2(b)
Transition Period for State Compliance
This section grants states that already offer Medicaid assistance to working adults with disabilities a grace period until January 1, 2028, to comply with the new requirements of this Act. This means states have nearly two years from the bill's enactment date to adjust their existing programs and administrative processes to accommodate the removal of age restrictions and the new eligibility definitions.