Document Type

Research Report

Publication Date



The role that employment has played for persons with disabilities over the past several decades has moved from one of no engagement in the workforce to a realization that persons with disabilities can work and are interested in working. The shrinking workforce has increased employers' interest in looking at the full range of potential workers, including those previously considered unemployable. The growing economy—coupled with the declining birth rate, the increase in technology and supports for a diverse workforce, and the increasing expectation that all persons should be provided with the opportunity to work—has led to a new view of individuals with disabilities. Many persons with disabilities perceived as not able to seek employment were not included in the unemployment statistics of the U.S. Department of Labor and thus were not counted as part of the available workforce. Labor force participation rates of persons with disabilities are less than one-third of those without disabilities.

Legislative and administrative initiatives in the past ten years have stressed equality of opportunity and workforce participation of persons with disabilities as a high priority. As in the case of welfare reform, the focus has moved to employment as a realistic and preferred goal for many persons with disabilities. In response to these initiatives, the Centers of Medicare and Medicaid Services (CMS), the primary health care resource for many persons with disabilities, has sought to support states in their effort to assist persons with disabilities interested in working to gain employment. The expansion of the Medicaid Buy-In and the passage of the Ticket to Work legislation (TTWWIIA) have both been directed at addressing some of the major barriers to employment for persons with disabilities. The Medicaid Infrastructure Grants (MIGs) encourage states to review and revise their health coverage practices to support persons with disabilities to enter and remain in employment. Through the expansion of the MIG initiative, CMS has encouraged states to develop supports and services that will enhance employment access and job retention for persons with disabilities.


This report summarizes the findings of a panel of experts convened by Centers for Medicare and Medicaid Services (CMS) and charged with identifying key strategies that would support increased workforce participation by persons with disabilities served and supported through state-based Medicaid Buy-In programs.



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