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The federal Ticket to Work and Work Incentives Improvement Act of 1999 is intended to increase employment opportunities for persons with disabilities, focusing on individuals participating in the two federal income assistance programs: Social Security Disability Insurance and Supplemental Security Income. A key provision of the Ticket to Work law gives states the option of expanding Medicaid coverage to employed persons with severe disabilities. The Medicaid expansion, often referred to as a “buy-in,” represents a major change in access to health care for persons with severe disabilities by greatly increasing the income and asset thresholds for Medicaid eligibility. This report, undertaken at legislative request, examines the impacts of implementing the optional Medicaid buy-in provision of the Ticket to Work law.