Medicaid Infrastructure Grants To Support the Competitive Employment of People with Disabilities

To support State efforts to enhance employment options for people with disabilities by building Medicaid infrastructure.

Funding may be used to develop a Medicaid buy-in, increase availability of Personal Assistance Services, or for State-to-State technical assistance.

In addition, States
may use funding to develop a comprehensive approach to bridge Medicaid services with other key supports and programs used by employed people with disabilities.
Related Programs

Examples of Funded Projects

For a description of State specific projects funded under this grant program.

Please see our website at

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - Contact the appropriate CMS Regional Administrator.

(See Appendix IV for Regional Offices.)

Program Accomplishments

Through FY 2007, a total of 50 entities (49 States and the District of Columbia) have been approved for funding from the Infrastructure Grant Program section 203 since its inception. There are 33 States with Medicaid buy-ins and one additional State has a plan amendment under review. As of September 30, 2006, there were just over 78,402 workers receiving Medicaid benefits under the buy-in options. A total of 26 States and the District of Columbia have applied for and will receive continuation grant awards in FY 2007. Nine States received new competitive grant awards in FY 2006. In addition, five States, South Carolina, Missouri, Iowa, Indiana and Arkansas will continue to carry out employment goals for the working disabled population by spending previous grant awards in FY 2007 through a no-cost extension of funding. Of the $42.8 million (FY 2007) that has been appropriated for the upcoming grant year, $34.7 million was granted to the States. The reason for the large discrepancy in the FY 2007 appropriation, and the funding amount is that States are enrolling fewer participants in Medicaid buy-in programs than Congress originally anticipated. Higher levels of funding are legislatively related to the yearly amount of Medicaid buy-in service costs expended by a State.

Uses and Use Restrictions

While the proposals submitted by the States may vary, States participating in this grant program will use the funds to remove the barriers to employment of persons with disabilities, by creating health systems change through the Medicaid program.

The development or enhancement of certain core Medicaid components in each State would enable people with disabilities not only to work, but to sustain adequate health coverage if they find they need to relocate to another State for employment purposes.

An adequate personal assistance services benefit and a Medicaid buy-in for employed people with disabilities are significant components of the Ticket to Work and Work Incentives Improvement Act.

The infrastructure grants program provides money to the States to develop these core elements.

In addition, States may use funding to develop a comprehensive approach to bridge Medicaid services with other key supports and programs used by employed people with disabilities.

Funds may not be used for the direct provision of services to people with disabilities except on a one-time, last resort, emergency basis for the purpose of sustaining the individual's competitive employment.

Eligibility Requirements

Applicant Eligibility

Either of the following may apply: (a) the single state medicaid agency; or (b) any other agency or instrumentality of a state(as determined under State law) in partnership, agreement and active participation with the single state medicaid agency, the State Legislature, or the office of the Governor.

Beneficiary Eligibility

There are two groups of potentially eligible beneficiaries, as defined by the Ticket to Work and Work Incentives Improvement Act of 1999. The first group consists of persons with disabilities between the ages of 16 and 65 years old, employed, and who meet income, asset, and resource standards established by the State. The second group of potential beneficiaries consists of persons between the ages of 16 and 65 years old, employed, and who cease to be eligible for Medical Assistance because of medical improvements determined at the time of a regularly scheduled disability review, but who also continue to have a severe medically determinable impairment.


Federal funds must go to a designated State Medicaid Agency or its partner agencies or instrumentality's. Individuals must meet State requirements. Administrative cost will be determined in accordance with OMB Circular No. A-87, "Cost Principles for State and Local Governments."

Aplication and Award Process

Preapplication Coordination

No preapplications are required.

This program is excluded from coverage under E.O.


Application Procedures

The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. Application forms are submitted to the Acquisition and Grants Group, CMS, C2-21-15 Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. This program is subject to the provisions of OMB Circular No. A-102.

Award Procedures

Official notice of approved applications is made through the issuance of a grant award.


Established when program announcements are published in the Federal Register or transmitted to States.


Ticket to Work and Work Incentives Improvement Act of 1999, Section 203, Public Law 106-170.

Range of Approval/Disapproval Time

The range is from 100 to 150 days.


There are no formal appeals procedures. If an application is disapproved, the reasons for disapproval will be fully stated.


Extensions and continuations of projects are available if formally applied for and approved. If a grant application is recommended for approval for 2 or more years, the awardee must annually submit a formal request for continuation accompanied by a progress report that will be evaluated prior to a recommendation of continuation.

Assistance Considerations

Formula and Matching Requirements

No State or local matching funds are required for the infrastructure grants.

Length and Time Phasing of Assistance

CMS announced the first round of infrastructure grant awards in October 2000. This grant program is authorized for 11 years beginning in fiscal year 2001.

Post Assistance Requirements


Progress and expenditure reports are required on all projects.


All fiscal transactions identifiable to Federal financial assistance are subject to audit by the DHHS audit agency.


Proper accounting records, identifiable by project number and including all receipts and expenditures, must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.

Financial Information

Account Identification



(Grants) FY 07 $37,074,935; FY 08 $40,200,000; and FY 09 est $45,500,000.

Range and Average of Financial Assistance

$500,000 to $2,750,000; $500,000.

Regulations, Guidelines, and Literature

Grants Administration policies (45 CFR 74 and 92) and application kits may be obtained from the Office of Acquisition and Grants Group, Centers for Medicare and Medicaid Services, Room C2-21-15, Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. Grant applications forms are also available on the CMS website at

Information Contacts

Regional or Local Office

Contact the appropriate CMS Regional Administrator. (See Appendix IV for Regional Offices.)

Headquarters Office

Dennis Smith, Director, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, Department of Health and Human Services, Room C5-21-17, Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-3870.

Criteria for Selecting Proposals

The major elements in evaluating proposals include: understanding the barriers that impede competitive employment of people with disabilities; the extent to which the proposed infrastructure development will offer enduring and significant improvement in the ability of the system to provide adequate health coverage for people with disabilities and are competitively employed; providing needed personal assistance and other supports, and/or removing other significant employment barriers; the appropriateness of the methods, work plan, budget, and timetable; the qualifications of key staff; and the State's plan for using its grant experiences to identify different or better ways to improve its buy-in or Medicaid services that support the competitive employment efforts of people with disabilities.

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