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Medicaid Buy In Program High Quality

A. Many people with disabilities are interested in working. Health insurance coverage can have an important relationship to employment for people with disabilities. For example, persons with disabilities on Medicaid may be concerned that they will lose their Medicaid coverage if they enter or return to the workforce. Commercial or employer-based health insurance might not provide coverage for services and supports that enable people with disabilities to work and live independently such as personal assistance services. The purpose of the Medicaid Buy-In program is to allow persons with disabilities to purchase Medicaid coverage that helps enable them to work.

medicaid buy in program


The Medicaid Buy-In program offers health care coverage to people with disabilities who are working, and whose earnings and resources might otherwise make them ineligible for Medicaid. The Medicaid Buy-In program is an optional Medicaid program that states may choose to provide. Most states, but not all, have a program (as of April 2014, states without a Medicaid Buy-In are FL, TN, HI, AL and DC).

States have some latitude in the design of their Medicaid Buy-In program so eligibility criteria for the program vary by state, but eligibility determination considers factors such as employment, disability, income and resources.

A. Disability determination for the Medicaid Buy-In program uses the same medical definition for having a disability or blindness that the Social Security Administration (SSA) uses for its disability benefits programs (the Social Security Disability Insurance and Supplemental Security Income programs). This means that you will need to have a physical or mental impairment that causes significant functional limitations and that has or is expected to last for at least 12 consecutive months, or result in death. However, because the Medicaid Buy-In program is intended to provide health coverage to working individuals with disabilities, disability determination for this Medicaid program does not consider your employment. In other words, you can have a disability, work and have earnings, and participate in this health coverage program.

A. Yes, you may enroll in a Medicaid Buy-In program if your state has such a program, even if you have Medicare and/or employer-based health insurance coverage. Medicaid Buy-In programs are based on different rules and differ from the new Medicaid adult expansion group, such as if you are eligible for Medicare then you are not eligible for the adult expansion group. If you have significant health care costs, the Medicaid Buy-In program would help by providing wrap-around to your Medicare or employer coverage. Additionally, this program may be able help you with Medicare and/or employer insurance costs. Medicaid can also cover some services and supports, such as personal assistance services, that other health insurance either does not cover at all or covers with restrictions.

A. Generally Medicaid Buy-In programs do not require a minimum number of hours of work to be eligible. Individuals may work part-time or be self- employed. However, unpaid activities such as volunteer work do not count as employment. States generally require some verification of earnings and/or proof of employment.

A. States may require persons eligible for the Medicaid Buy-In to pay a monthly premium or other cost sharing charges typically set on a sliding fee scale based on income. Many, but not all, programs charge a state-specific premium. Several programs have co-payments higher than typical Medicaid.

A. You would apply for a Medicaid Buy-In program just as you would apply for any other Medicaid program in your state. See Process for Medicaid Eligibility Fact Sheet for additional information.

A. Individuals may be concerned about what would happen to Medicaid Buy-In coverage if they lost their job or were unable to continue working. Many state Medicaid Buy-In programs, though not all, may allow participants to temporarily stay on the program following an interruption or loss of employment. The length of time that an individual can stay on the program varies by state. States also vary in their policies for granting an extension of coverage during periods of unemployment. For individuals who become ineligible for the program, states will determine if you are eligible for any other benefit category.

If you enroll in a Medicaid Buy-In program, it is important that you report changes to your employment status such as loss of employment or change in earnings. How you report such changes will depend on your state. For example, you might report changes to an eligibility or case worker, or you might report changes through an online system.

A. You should consider a range of issues when assessing your health coverage options, including your health needs, service and benefit package differences, whether you need long-term services and supports, provider networks, costs and premiums associated with different coverage options, income and asset limits, and your employment status. You should take into account your unique needs and circumstances, and the options available to you in your state. Click here for a chart with an illustrative comparison of three health insurance options: the Medicaid Buy-In program, the Medicaid expansion program (i.e., new adult Medicaid) and qualified health plans (QHPs) purchased through a Health Insurance Marketplace.

A. While your primary role as a navigator or assister is to help consumers obtain health insurance coverage, you might also refer individuals to resources and organizations that help people with disabilities on employment issues. This will be especially true if you are informing consumers about the Medicaid Buy-In program as most require employment as part of the eligibility criteria.

There are a number of national employment services, which help both people with and without a disability. A one-stop location to find many resources is The Department of Labor and American Job Centers offer a range of employment-related services and resources. American Job Centers (AJCs) are located in communities across the country. The Department of Labor and AJCs offer resources to assess career interests and transferrable skills, and provide job leads. Some states have websites which provide resource information about employment, including their state Medicaid Buy-In program.

Agencies or organizations tailored to disability-specific assistance include State Vocational Rehabilitation Services (SVR), the Employer Assistance and Resource Network (EARN), and the Job Accommodation Network (JAN). The Federal government funds programs to help individuals with disabilities reenter and start employment. These programs include services from counseling and guidance to job development and placement. You can access state specific information here.

EARN is tailored to employers looking to hire people with disabilities. Additionally, EARN operates the Workforce Recruitment Program, a recruitment and referral program to increase employment of people with disabilities. To access the website for EARN click here. For consumers looking for help with job accommodations or their rights as employees with a disability, the Job Accommodation Network or JAN can be found here.

Lastly, most people receiving Social Security Disability Benefits (SSDB) between the ages of 18 to 64 have a Ticket to Work, which gives consumers more choices on seeking assistance with employment. The consumer can access information about Employment Networks here, which are agencies that assist Ticket Holders who want to work. In addition, SSA has contracts in all states for Work Incentive Planning and Assistance (WIPA) programs. These programs assist individuals with employment referrals and work incentives counseling to help consumers understand how work and benefits interact. The list of WIPAs can be found at the same website.

The Medicaid Buy-In program is an optional state Medicaid benefit group for workers with disabilities who have earnings in excess of traditional Medicaid rules. Individuals with disabilities who would be ineligible for Medicaid because of earnings can work and access the services and supports they need. Ideally, it means workers with disabilities do not need to choose between healthcare and work.

CMS partners with Department of Labor (DOL)/Office of Disability Policy (ODEP) to provide resources and outreach for Leveraging State Employment First (E1st) Policy Alignment Efforts to Support Employment Outcomes of Individuals benefiting from Money Follows the Person (MFP) grant program.

Note: The Health First Colorado (Medicaid) Buy-In Program for Children with Disabilities (or the "Children's Buy-In" for short) is a different program for people who are 18 years old or younger. Learn about it in DB101's Benefits for Young People article.

Subject to federal authorization and funding, the act authorizes working adults with disabilities who are 65 years of age or older to continue participating in the existing medicaid buy-in program (program).

As Sharon Lewis, deputy administrator for the Administration for Community Living (ACL), noted in her Disability Employment Awareness Month blog post earlier this month, working is about more than earning a paycheck. It gives purpose and structure to our lives. In the late 1990s, the Medicaid Buy-In program launched historic changes for workers with disabilities. For individuals suppressing their income to gain or maintain access to critical community-based supports, it was life changing.

Today the Medicaid Buy-In program continues to provide workers with disabilities an opportunity to improve their economic well-being and achieve a better life. Inspired through the independent living movement, the Medicaid Buy-In program is an optional State Medicaid benefit group for workers with disabilities who have earnings in excess of traditional Medicaid rules. So people with disabilities who would be ineligible for Medicaid because of earnings can work and access the services and supports they need. Ideally, it means workers with disabilities do not need to choose between healthcare and work. 041b061a72


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