This federally authorized program exists in more than 40 states.
- It can provide Medicaid to working people with disabilities who are not eligible for 1619(b) Medicaid.
- A few states created MBI programs authorized though 1997 legislation. The majority of MBI programs have been enacted under the authority of Section 201 of the 1999 Ticket to Work and Work Incentives Improvement Act.
- Since most SSI recipients who work for substantial wages and lose an SSI payment are protected by 1619(b), the MBI programs often provide a work incentive to individuals who receive Social Security Disability benefits (or another form of income), with no SSI.
This program is known by different names in different states.
- Sometimes the words Medicaid Buy-In are in the state program’s name; sometimes the name does not reference it being a Buy-In program.
- The federal design of the program assumes that states will charge monthly premiums to obtain Medicaid coverage
We will focus on key components of MBI programs created through the 1999 Ticket to Work legislation:
- States can establish their own income and resource limits for the program.
- Individuals must have earned income.
- Individuals must meet the medical criteria to establish disability in the SSI program, but earnings above a substantial gainful activity level are not relevant to eligibility.
- States use the SSI rules for determining countable income and resources.
- States can charge premiums to participate in the program, with premium amounts established on a sliding scale.
- MBI enrollees must be at least 18 and less than age 65 (no age limits if program authorized by 1997 legislation)
Countable income and resource limits for MBI program vary from state to state.
- The majority of states have established monthly countable income limits at 250 percent of the federal poverty level ($2,530 per month).
- Several programs have established much higher income limits.
- Some programs have no income limits.
Medicaid Buy-In Example: JP receives monthly Social Security disability payments of $950 and no SSI. Prior to starting work he received Medicaid with a spend-down of $200 per month. JP starts a job earning $1,500 per month ($18,000) per year.
JP will be eligible for his state’s Medicaid Buy-In program:
- His total countable income will be $930 from Social Security ($950 – 20) and $717.50 from earnings ($1,500 – 65 = 1,435/2 = $717.50).
- With his total monthly countable income of $1,647.50 less than the $2,530 monthly limit for the MBI program in his state, he will be eligible for the program if his resources are within the program limits.
VR counselors should check with their state Medicaid agency to see if there is an MBI program operating in their state. If so, the Medicaid agency should be able to direct them to a website for information about how that program operates and eligibility criteria.