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Buy-In to Medicaid

The Buy-in to Medicaid program is a form of work incentive that was initiated to provide Medicaid to disabled individuals who, because of the amount of their earned income, would not qualify for Medicaid. Individual states may, but are not required, to provide this incentive by creating a new eligibility group. Currently, just over half the states offer this program with many more planning to do so. Individuals “buy-in” to the program by paying a premium or other fee. However, participating states are not required to seek such payments.

The maximum amount of income that an individual can have varies between the participating states. Though the specifics are not exactly the same from state to state, the eligibility criteria for this program generally requires that the individual be in a family with a net income of less than 250 percent of what the national poverty level would be for such family. The definition of “family” is prescribed by each state. Further, except for the earnings amount, the individual must otherwise be eligible for Supplemental Security Income (SSI) benefits. If the individual was not already receiving SSI benefits, a disability determination must take place though it is not made under color of the “substantial gainful activity” benchmark.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.