What is Medicaid Buy-In? (Spanish, Chinese)
The Medicaid Buy-in allows people with disabilities who work and earn more than Medicaid allows as income to keep the comprehensive benefits offered by Medicaid if they meet certain eligibility requirements.
Who is eligible?
To be eligible you must:
- Be a New York State resident;
- Be at least 16 years old and under 65;
- Meet Social Security’s definition of disability;
- Only people with disabilities are covered. Non-disabled family members are not eligible.
- You receive Social Security Disability Income (SSDI), or
- You lost your SSDI because you went back to work, or
- You have a disability that qualifies for Supplemental Security Income (SSI) but never received SSI, or
- You received SSI in the past but were disqualified because your resources are too high.
- Earn an income on a part-time or full-time basis;
- Earn no more than $55,188 for an individual or $73,884 for a couple;
- Have non-exempt resources (assets that are counted toward your total income for Medicaid) that do not exceed the Medicaid resource level of $13,800 for an individual or $20,100 for a couple.
Non-exempt resources, or resources that count for eligibility, may include:
- Salary (see below);
- spouse’s income;
- alimony & child support;
- any income from investments such as stocks, IRAs, and bonds;
- workers compensation;
- legal settlement; and
- a second home
Exempt resources or those that will not affect your eligibility include:
- If your only income is from benefits like SSI or SSDI, eighty five dollars of your income will not be counted for your eligibility.
- If you get benefits and you have a job; the first twenty dollars of unearned income (benefits income, like SSI or SSDI); the first sixty-five dollars of earned income (from a job) will not be counted for your eligibility;
- If you have to pay for any equipment required by your disability in order to work, that cost will be deducted from your total income for this purpose;
- After the above considerations, half of your total income (job and/or benefits income) will not be counted for your Medicaid Buy-In eligibility.
Other things that are not counted are:
- student loans;
- disaster and/or emergency assistance payments;
- blindness-related work expenses;
- PASS plan funds (funds set aside to help someone achieve work-related goals);
- primary home;
- life-insurance policies up to $1,500, as long as they cannot be borrowed against;
- burial funds, as long as they cannot be borrowed against;
- equity value of a business; and
- Native American payments.
Will it cost me anything?
There may be a premium based upon your income. A decision about the premium will be
made when you apply. There is also a yearly deductible, which is the amount you must pay before the plan pays. Your plan’s deductible is decided by each health care program. If you have a deductible, you must pay the full amount of your medical costs until you have met the deductible. You may also have a co-pay, which is the amount you pay for your service (for example, a doctor visit or prescription) when you are in an HMO or Medicaid Managed Care program.
What if I was receiving SSI but I earn too much money after I go to work?
There is a special federal work incentive program known as 1619(b) that allows you to
earn more than $43,421 in income before losing your Medicaid benefits. To qualify for
higher earnings (known as a higher threshold) the Social Security Administration will look at the following:
- Impairment-related work expenses;
- Work expenses for people who are blind;
- A Plan to Achieve Self-Support (PASS):
- Publicly-funded attendant or personal care; or
- Medical expenses above the State per capita amount
What is PASS?
PASS is an SSI program to help people with disabilities return to work. The program lets people with disabilities set aside money and/or things they own to pay for items or services they need to reach a specific work goal.
How does PASS work?
An applicant finds out what training, items or services they need to reach his/her work goal and how much they cost. PASS can include supplies to start a business, school expenses, equipment and tools, transportation and uniform requests. PASS can help people save to pay the cost of these items and services by allowing them to set aside money for installment payments or down payments for those things.
How do I apply for the Medicaid Buy-In Program?
If you are not considered disabled under Social Security, a disability review can be done by the New York State Disability Review Team. If you are found disabled by the Review Team then you can apply for the Medicaid Buy-In program by contacting your local social services office. In New York City you can contact the Human Resources Administration, 180 Water Street, 25th floor, NY, NY 10038, or call 877-472-8411. You can also call CIDNY at 646-442-4186 and ask for a benefits counselor for more information.
Is the Buy-in retroactive?
If you are approved for the Medicaid Buy-in Program, you will be entitled to up to
three months retroactive benefits.
What if I am denied?
You have 60 days from the date of the denial notice to file for a fair hearing. To request a
fair hearing you can contact:
- New York State Office of Temporary and Disability Assistance, Office of Administrative Hearings at (212) 417-6550 or (800) 342-3334;
- You can also print out the form for appeal from www.otda.state.ny.us/oah/forms.asp or complete an E-Request form (NOTE: the E-Request form must be completed within 15 minutes);
- Printed forms can be faxed to (518) 473-6735 or mailed to NYS Office of Temporary
- Disability Assistance, P.O. Box 1930, Albany, NY 12202; or the Local Department of Social Services, Human Resources Administration, (718) 557-1399 or 1(877) 472-8411 (toll free within the five boroughs of New York City).
NOTE: Remember to request Aid Continuing. That will allow you to keep your current benefits while a fair hearing is being scheduled and held.