Medicaid Buy-In Expansion Removes Age 65 Ceiling for Working Adults with Disabilities by 2028

The Ensuring Access to Medicaid Buy-in Programs Act of 2026 removes the 'age-out' cliff for working people with disabilities. Under current rules, many states offer Medicaid 'buy-in' programs that allow people with disabilities to work and earn more than the standard poverty limits while keeping their health coverage. However, these programs often cut off once a person turns 65. This bill amends the Social Security Act to strike the phrase 'but less than 65' from the definition of a working individual with a disability in Section 1905(v), effectively allowing states to extend this coverage to seniors who are still in the workforce.

Breaking the Retirement Trap

For many, turning 65 means an automatic transition to Medicare, but Medicare doesn't always cover the specific long-term supports—like home health aides or specialized medical equipment—that Medicaid does. Imagine a 64-year-old graphic designer with a physical disability who relies on a Medicaid buy-in program to afford the daily assistance they need to get to their desk. Under current law, their 65th birthday could mean losing the very coverage that makes their employment possible. By removing the age limit in Section 2, the bill allows this designer to keep working and keep their specific healthcare benefits as long as they stay employed, regardless of their age.

State Flexibility and Deadlines

The bill doesn't just change the definitions; it gives states the green light to expand their optional Medicaid groups. This includes people who would qualify for Supplemental Security Income (SSI) if not for their paychecks. Because this is a significant shift for state bureaucracies, the legislation includes a built-in buffer. According to the 'Compliance Timeline' provision, states that already have these buy-in programs in place have until January 1, 2028, to get their systems and regulations in line with the new age-inclusive standards. This ensures that the transition for older workers happens without a sudden lapse in their existing coverage.

Career Longevity for the Disability Community

This policy shift recognizes a modern reality: people are working longer, and a disability shouldn't force an early retirement just to maintain health insurance. By allowing states to cover working individuals with disabilities at age 66, 70, or beyond, the bill aligns Medicaid with a workforce that is increasingly staying active later in life. For a small business owner with a disability, this means they can continue to grow their company into their senior years without the fear that their success—or their age—will disqualify them from the medical support they need to function daily.