The Medicaid Buy-In program is a worthwhile resource for working individuals with disabilities. This plan allows you to keep Medicaid coverage even if your earnings exceed the standard limits. This means you can work and earn more without risking access to necessary healthcare services.
Medicaid Buy-In is the nickname for the Medicaid eligibility groups that serve workers with disabilities who are earning income and against whom states may charge premiums as a condition of Medicaid eligibility.
The primary eligibility groups include:
These programs allows workers with disabilities access to Medicaid community-based services not available through other insurers. Nationally, workforce participation among people with disabilities is significantly lower than those without disabilities. Some individuals with disabilities who want to work face barriers achieving their employment and earnings potential because they need to choose between healthcare and work. Medicaid Buy-In breaks down barriers to employment for people with disabilities.
This initiative specifically addresses the needs of adults with disabilities so participants can access mental health care and hospital care, empowering them to be self-sufficient. This Medicaid Buy-In program promotes community-based services and simplifies the eligibility determination process so everyone in the community gets medical benefits.
The Administration for Community Living (ACL), Centers for Medicare & Medicaid Services (CMS), and the Department of Labor’s Office of Disability Employment Policy (ODEP) are committed to policies and programs that promote and support successful employment outcomes for people with disabilities.
Not everyone meets the criteria for the Medicaid Buy-In program. Here’s what you need to qualify:
By meeting these requirements, individuals can benefit from Medicaid coverage while pursuing employment, providing a critical support system for financial and health stability.
The Medicaid Buy-In program has different rules about income for enrollees depending on where they live. States use different methods to calculate premiums, often based on income status, family size, and whether the income is earned or unearned.
The Medicaid Buy-In program limits premiums, so Americans with incomes can access medical services while staying within their family's maximum premium limits.
In some states, beneficiaries must pay a monthly premium based on income. Lower-income Americans often pay a modest premium, while others fall into different premium tiers.
It can be challenging for some to pay this amount, especially if they face barriers to employment. There are also rules about payment, like grace periods and programs that help those with countable resources.
You might have to pay extra healthcare costs, such as copayments for different services. These expenses include deductibles, coinsurance, and payments for prescriptions or specialist visits. There are also charges for hospital services and emergency room visits.
The Medicaid Buy-In program offers benefits similar to traditional Medicaid. These benefits include doctor visits, hospital stays, prescription medications, mental health services, and long-term care support.
Long-term services include home health care and personal care services. The plan pays for durable medical equipment, assistive technology, and case management services.
The Medicaid buy-in program offers transportation assistance and language interpretation to help people navigate healthcare needs. Other services include care coordination, health education, and wellness programs.
The application process changes by state but generally involves the following steps. First, contact your state's Medicaid agency for an application. Ask about specific eligibility requirements and procedures.
Fill out the application form accurately and submit it to your state's Medicaid agency. If your income changes, notify the agency promptly. This could impact your premium amount or eligibility.
Be aware of work incentives available through the Social Security Administration's Ticket to Work program. These incentives help you maintain your Medicaid benefits while working.
The Ticket to Work program provides several services, including the Medicaid Buy-In program, to help Americans with disabilities prepare for, find, and retain employment.
Medicaid benefits, including those from the Buy-In program, often require renewal. Follow renewal deadlines to keep your coverage. Renewal involves updating your income, work activity, and disability status. Failure to do so could result in a loss of benefits.
Each state that covers one of the Medicaid Buy-In groups has its own rules about income, assets, and premiums. Some states have no income or asset limits for its Buy-In eligibility groups in order to promote employment and earnings for beneficiaries, while other states charge premiums.
States that do not currently cover one of the buy-in eligibility groups can adopt one of them at any time. State Medicaid agencies can work with the CMS to add or make changes to their Medicaid program.
The AHCCCS Freedom to Work program allows individuals to earn up to 250% of the Federal Poverty Level (FPL) with no resource limit. Participants pay monthly premiums ranging from $0 to $35 based on countable income and can save for retirement without penalty.
The Working Disabled Program (WDP) serves individuals earning up to 250% FPL, with resource limits of $2,000 for individuals and $3,000 for couples. Participants pay premiums between 2% and 7% of their income, with retirement accounts exempt from resource calculations.
MED-Connect is notable for its high-income threshold of up to $75,000 annually and generous resource limits of $10,000 for individuals and $15,000 for couples. The program includes spousal coverage and uses a sliding premium scale from $0 to $150 monthly based on income.
The Health Benefits for Workers with Disabilities (HBWD) program accepts individuals earning up to 350% FPL and allows substantial assets ($25,000 individual/$35,000 couple). Participants pay monthly premiums of 2-7% of their income, making it one of the more generous programs nationwide.
Medicaid for Employed People with Disabilities (MEPD) serves individuals up to 250% FPL with resource limits of $12,000 for individuals and $13,000 for couples. The program offers premium-free coverage for those below 150% FPL, with income-based premiums above that threshold.
The Working Healthy program covers individuals earning up to 300% FPL with a $15,000 resource limit. The program includes comprehensive benefits, including dental and vision coverage, with premiums determined on a sliding scale based on income.
CommonHealth Working stands out for having no upper income or asset limits, making it one of the most accessible programs nationwide. Premiums are determined on a sliding scale based on income and family size, allowing participants to earn and save while maintaining healthcare coverage.
Medical Assistance for Employed Persons with Disabilities (MA-EPD) has no income limit and a $20,000 resource limit. The program's premium structure is based on income and household size, offering significant flexibility for working individuals with disabilities.
The Ticket to Work Health Assurance program serves those earning up to 300% FPL, with modest resource limits of $999.99 for individuals and $2,000 for couples. Monthly premiums range from $0 to $204 based on income, and the program offers retroactive coverage when needed.
Medicaid Insurance for Workers with Disabilities accepts individuals earning up to 250% FPL with resource limits of $4,000 for individuals and $6,000 for couples. The program allows PASS income exclusions and bases premiums on countable income.
Medicaid for Employed Adults with Disabilities (MEAD) offers coverage up to 450% FPL with generous resource limits of $27,000 for individuals and $40,000 for couples. The program determines premiums based on income and family size, making it one of the more comprehensive programs available.
The Working Disabled Individuals program serves those earning up to 250% FPL with a $10,000 resource limit. The program includes dental benefits and determines premiums based on countable income.
Medical Assistance for Workers with Disabilities (MAWD) covers individuals earning up to 250% FPL with a $10,000 resource limit. Participants pay 5% of their monthly income as a premium and receive comprehensive prescription coverage.
Medicaid for Working People with Disabilities accepts individuals earning up to 250% FPL with resource limits of $5,000 for individuals and $6,000 for couples. The program includes long-term care services and determines premiums based on income.
Healthcare for Workers with Disabilities (HWD) serves those earning up to 220% FPL with no resource limit and premiums ranging from $0 to $150. The program stands out for having no asset test requirement, making it more accessible for working individuals with disabilities.
The Medicaid Purchase Plan (MAPP) covers individuals earning up to 250% FPL with a $15,000 resource limit. The program determines premiums based on income and allows retirement account exclusions from resource calculations.
