S. 3690: Ensuring Access to Medicaid Buy-in Programs Act of 2026

This bill is called the "Ensuring Access to Medicaid Buy-in Programs Act of 2026" and aims to modify certain eligibility criteria for Medicaid, specifically for working adults with disabilities. Here are the key components of what the bill proposes:

Removal of Age Restrictions

The bill seeks to eliminate age limitations that currently restrict the eligibility of working adults with disabilities for Medicaid buy-in programs. This means that adults who are disabled and are working can gain access to Medicaid services regardless of age, including those over the currently enforced age cap of 65.

Modification of Medicaid Buy-In Programs

The legislation proposes amendments to the Social Security Act that will allow states to establish Medicaid buy-in options for working individuals with disabilities. This access will now include:

• Individuals who are at least 16 years old.
• Individuals who do not qualify for Medicaid only because their earnings exceed the set limit for Supplemental Security Income (SSI).

State Compliance and Implementation

The bill includes a provision that states already providing Medicaid benefits to the populations mentioned will not be penalized for failing to fully comply with the new amendments until January 1, 2028. This gives states time to adjust their programs to meet the new requirements.

Summary of Changes to Legislation

The bill aims to:

• Remove the age cap limiting eligibility for Medicaid buy-in programs.
• Adjust definitions within the Social Security Act to include a broader range of individuals with disabilities.
• Provide states with a grace period to adapt to the new eligibility requirements.

Overall Impact

By making these changes, the bill seeks to improve access to healthcare services under Medicaid for working adults with disabilities, helping them maintain their employment without losing critical health coverage.

Relevant Companies

• UNH (UnitedHealth Group Inc.): This company provides health insurance and may see changes in enrollments and service demands due to the expanded Medicaid eligibility.
• ANTM (Anthem, Inc.): As a major health insurer, Anthem could be affected by shifts in Medicaid enrollment as more working adults with disabilities seek coverage.