A bill to amend title XIX of the Social Security Act to remove certain age restrictions on Medicaid eligibility for working adults with disabilities.
- Bill Number
- S. 3690
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Status
- Introduced
- Latest Action
- 2026-01-27: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-01-28T11:56:21Z
AI-Generated Summary
Purpose
The Ensuring Access to Medicaid Buy-in Programs Act of 2026 aims to expand access to Medicaid for working adults with disabilities by eliminating certain age-based restrictions on eligibility. This allows more individuals to buy into Medicaid coverage without losing benefits due to employment income, promoting financial independence and health security.
Key Provisions
- Amendments to Medicaid Eligibility Rules: The bill modifies Section 1902(a)(10)(A)(ii) of the Social Security Act to remove the upper age limit of 65 for two optional "buy-in" groups (subclauses XV and XVI). These groups allow states to offer Medicaid to working individuals with disabilities who exceed income limits for standard programs.
- New Eligibility Category: Adds a new clause (xviii) to Section 1905(a), defining eligible individuals as those who would qualify for Supplemental Security Income (SSI—a federal cash assistance program for low-income people with disabilities) except for earnings above the SSI limit, and who are at least 16 years old. This explicitly includes working disabled adults without an upper age cap.
- Updated Definitions: Revises Section 1905(v)(1)(A) to eliminate the "less than 65" age restriction in the definition of "working individuals with a medically improved disability."
- Transition for Existing State Programs: States already providing buy-in coverage to the affected groups as of the enactment date have until January 1, 2028, to fully comply with the changes, ensuring no immediate penalties for non-compliance.
Significant Changes to Existing Law
- Removal of Age Caps: Previously, Medicaid buy-in programs under subclauses (XV) and (XVI) limited eligibility to individuals under 65. The bill extends these programs to adults 65 and older, aligning them with broader disability support without age barriers.
- Expansion of Buy-In Options: Introduces a new mandatory inclusion of the working disabled group (now clause xviii) in state buy-in programs, making it easier for states to cover individuals whose work earnings disqualify them from SSI but who still need health coverage.
- No Changes to Core Medicaid Structure: The amendments build on existing optional state programs rather than mandating them nationwide, preserving state flexibility while encouraging broader adoption.
Potential Impacts
- On Citizens: Working adults with disabilities, especially those 65 and older, gain easier access to affordable Medicaid coverage, reducing the risk of losing health insurance due to employment. This could encourage more disabled individuals to work without fear of benefit cliffs (sudden loss of aid when income rises).
- On Government Agencies: State Medicaid programs may see increased enrollment and administrative costs but could benefit from federal matching funds (typically 50-75% of costs). The federal Department of Health and Human Services (HHS) would oversee implementation, potentially leading to updated guidance and reporting requirements.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. citizens and residents.
Main Stakeholders Affected
- Individuals with Disabilities: Primary beneficiaries, particularly working adults aged 16 and older who exceed SSI income thresholds but need subsidized health coverage.
- State Governments and Medicaid Agencies: Responsible for implementing and funding expanded programs; they gain flexibility but face potential budget pressures.
- Federal Government (HHS and Social Security Administration): Provides oversight, funding matches, and coordination with SSI rules.
- Advocacy Groups and Healthcare Providers: Disability rights organizations (e.g., those supporting employment for disabled people) and medical providers may see increased patient access, improving care continuity.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: Strengthens anti-discrimination aspects of the Americans with Disabilities Act by removing barriers to employment-linked health coverage. No conflicts with existing Medicaid waivers or SSI rules are introduced, but states must align their programs to avoid federal compliance issues post-2028.
- Constitutional Implications: Aligns with equal protection principles under the 14th Amendment by reducing age-based disparities in disability benefits, without raising federalism concerns since states retain opt-in flexibility.
- Political Implications: Supports bipartisan goals of disability inclusion and workforce participation, potentially reducing long-term reliance on public assistance. It may spark debates on federal spending amid Medicaid's large budget, but the optional nature limits mandates on states.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-01-27: Read twice and referred to the Committee on Finance.
- 2026-01-27: Introduced in Senate
Bill Versions
- Ensuring Access to Medicaid Buy-in Programs Act of 2026 — issued 2026-01-27 — PDF (3 pages)