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Medicaid Buy-In - At a Glance
Who is Covered?
- Basic Coverage Group: Workers who are at least 16 but under age of 65, who meet the SSI definition of disability
- Medical Improvement Group: Workers who received coverage in the Basic Coverage Group and, on a continuing disability review, lost eligibility for that group as a direct and specific result of medical improvement but retain a severe medical impairment.
Basic Coverage Group: Who Is Eligible?
Individuals who
- Have certification of disability as defined by the Social Security Administration; and
- Are at least 16 but not yet 65 years of age;
- Are engaged in paid work (includes part-time and full-time work);
- Have a gross income that may be as high as $ 53,028 for an individual, $71,028 for a disabled couple (as of January 1, 2008);
- Have non-exempt resources that do not exceed $10,000;
Note: There is no substantial gainful activity rule (i.e., an individual can earn more than $940 per month in 2008 and still be eligible for the buy-in)
Medical Improvement Group: Who Is Eligible?
Medical Improvement Group: Who Is Eligible?
Individuals who are
- Members of the Basic Coverage Group, who lose eligibility for the Basic Coverage Group due to medical improvement but retain a severe medical impairment, and
- Are engaged in paid work (40 hours per month and earn at least the federal minimum wage)
Grace Periods Or What If I Lose My Job?
- Change in Medical Condition: A grace period of up to six months will be allowed if, for medical reasons, the Medicaid Buy-In recipient is unable to continue working. Medical verification will be required.
- Job Loss (through no fault of recipient): A grace period of up to six months will be allowed if, through no fault of the recipient, job loss occurs (layoff, etc.). Verification will be required that the recipient is reasonably expected to return to work as it is a temporary layoff, or that the recipient is actively seeking new employment
Note: The eligibility figures used in this document are based on federal poverty level figures released by the U.S. Department of Health and Human Services in early 2008.
Income Limits
- Individuals with countable income up to 250% of federal poverty levels (FPL) (i.e., gross wages as high as $53,028 in a household of 1 for the year 2008)
- Monthly countable income for a household of 1 must be $2,167 or less in 2008 (i.e., up to 250% of FPL). If monthly countable income is $1,300 or less in 2008 (i.e., up to 150% of FPL), no premiums will be due.
- Individuals with income above 250% of FPL may not purchase Medicaid coverage.
Determining Countable Income
- Will follow the same SSI budgeting rules as used in the regular Medicaid spend down program.
- Typical deductions from income: first $20 of unearned income excluded; first $65 (or $85 if no unearned income), plus 50% of remaining earned income excluded; impairment related work expenses are a deduction from earned income; money set aside in an approved Plan for Achieving Self Support (PASS) can be excluded from unearned or earned income.
- Example: An individual has $3,885 in gross monthly wages and no other income. This individual will have $1,900 in countable monthly income ($3,885 – 20 – 65 = 3,800 – 1,900 = $1,900). Since this is less than 250% of the FPL for 2008, this individual will be eligible for the buy-in.
Asset Limits
- $10,000 is allowed in countable resources (i.e., bank accounts and other liquid resources)
- Exempt resources include: a house, a vehicle, certain life insurance policies, a limited burial reserve, and several other items
Premiums
- A moratorium exists on premium collection until the Department of Health completes the automated payment system
- Premiums range from $0 to approximately $780 yearly (assuming all income is earned) in a household of 1
- Premiums apply to all net income
- Below 150% of FPL – NO PREMIUM
- 150% - 250% of FPL – Premium of 3% of net earned income plus 7.5% of net unearned income.
- Thus, a single individual with a disability could return to work and earn $53,028 annually by paying a Medicaid premium of approximately $65 per month (at the top level)
- Example: Using the example above, with $3,885 in gross monthly income and $1,900 in countable income, the individual’s monthly buy-in premium would be $57 (i.e., .03 x $1,900.) Applying For The Medicaid Buy-In Program
- Applying For The Medicaid Buy-In Program: Application for the Medicaid Buy-In Program for Working People with Disabilities must be made at the Local Department of Social Services or the Human Resources Agency in New York City.
Prepared by Neighborhood Legal Services, Inc.- Updated February, 2008
(716) 847-0650 • Work Incentives Hotline: 1-888-224-3272 • www.nls.org
