| As one of the most recent work-incentive programs for people with impairments, the Medicaid Buy-in offers those working individuals with disabilities who would not qualify for Medicaid under existing income and asset rules the option to keep their health insurance coverage. Depending on the rules in the state, they may be required to pay a premium and participate in cost-sharing.;This dissertation uses pooled, cross-sectional, time-series data to examine models of program adoption, eventual program revision, and program generosity. It employs event history analysis to model state innovations and Heckman two-step techniques to estimate program maintenance and enrollment. Selection bias seems to play an important role in the generosity equation. Both internal determinant models accounting for state political, economic and social characteristics as well as state tradition to innovate, and diffusion models accounting for spatial effects and emulation of similar states are included.;This research finds some evidence for the interdependence of behavior across states as well as for the complementary and counter-cyclical nature of the program. In general, policy makers in traditionally more expansive states in terms of healthcare coverage of vulnerable populations and in conservative states with relatively small disability populations are more willing to innovate. Further, wealthier states having the financial capacity establish more relaxed eligibility requirements.;Using the governance framework of Heinrich et al. (2004) and the existing relevant implementation literature, this research further analyzes five sets of factors that are likely to affect the incentives for some individuals with disabilities to enroll in the Buy-in: (1) economic, ideological, and social support environment, (2) client characteristics, (3) administrative strategies, (4) policy structures, and (5) policy tools serving as client treatments.;According to the results from the enrollment model and principal factor analysis of policy tools, adverse economic conditions, state wealth, more liberal political culture, a denser social support system, the tendency of the state to innovate and expand health coverage, the number of people who are SSI and SSDI beneficiaries, stricter Medicaid standards as well as the two measures of the expansiveness of program policy tools produce positive impacts on enrollment.;Keywords. Medicaid Buy-in, Policy Innovation and Diffusion, Policy Maintenance, Program Enrollment, Comparative State Health Policy... |
