The Medicaid Buy-in Program for
Working People with Disabilities
The Medicaid Buy-in Program offers Medicaid coverage to people with disabilities who are working and whose net income is more than the allowable limit for regular Medicaid. It allows them to earn more income without the risk of losing vital health care coverage.
Who is eligible?
To qualify for the Medicaid Buy-in Program for Working People with Disabilities you must:
- Be a resident of New York State
- Be at least 16 years of age (coverage up to 65 years of age)
- Have a disability as defined by the Social Security Administration
- Be engaged in paid work (includes part-time and full-time work)
- Have a gross income that may be as high as $46,170 for an individual and $61,870 for a couple (net income not to exceed 250% of the Federal Poverty Level); and
- Have non-exempt resources that do not exceed $10,000
Who will determine if I have a disability?
The Disability Review Team at the local Social Security Administration (SSA) office determines disability for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits. A determination of disability by SSA will be accepted as proof of disability for the Medicaid Buy-in Program for Working People with Disabilities. If you have not been certified disabled through SSA, you will need to have a disability review done by New York State Disability Review Team. Your Westchester County social services worker is available to advise you of the process.
What if I already work, meet the Social Security Administration's definition of being disabled, and receive Medicaid coverage with a monthly spend down?
If you are already working and receive Medicaid coverage with a monthly spend down, and meet the SSA's definition of disabled, you still have the option of participating in the Medicaid Buy-in Program for Working People with Disabilities.
Will I have to pay a premium for coverage?
Depending on how much income you have, there may be a modest premium. This determination will be made when you apply for the program. At the present time, there is a moratorium on premiums.
What if I already have health insurance through my employer?
If you have health insurance coverage through your employer, you should keep the insurance and talk with your Westchester County social services worker. Medicaid may cover the cost of the premium for that coverage. If you have family coverage through your employer, you may wish to keep that coverage as the Medicaid Buy-in Program for Working People with Disabilities does not offer family coverage.
If I enroll in the Medicaid Buy-in Program for Working People with Disabilities, will my family also be covered?
Disabled single people and married couples are covered under this program. Spouses without a disability and children may be covered through other comprehensive State insurance programs such as Child Health Plus, Family Health Plus, and/or the Healthy New York Program.
Will I be given the option to choose Managed Care?
Participants in the Medicaid Buy-in Program for Working People with Disabilities will be given the option to choose managed care if their income is below 150% of the federal poverty level and there is no other reason for exclusion.
Where can I apply for the Medicaid Buy-in Program for Working People with Disabilities?
Applications must be completed and submitted to your local Westchester County Department of Social Services office.
If I am getting SSI checks along with Medicaid coverage and I begin working and earning enough money to stop the SSI checks, will I also lose my Medicaid coverage?
Currently, if you receive SSI payments and
begin earning enough money to stop SSI cash payments, you may still be able to
keep Medicaid coverage under a federal work incentive program known as
1619(b). A working person with a disability in New York State in 2003 may
have up to $34,136 in income before losing Medicaid coverage.
Under 1619(b), if your gross earnings are higher than $34,136, you may qualify
for a higher threshold. An Individual Threshold can be calculated for you
by the Social Security Administration office if you have:
- Impairment-related work expenses
- Blind work expenses
- A plan to achieve self-support (PASS)
- Publicly funded attendant or personal care or
- Medical expenses above the State per capita amount
If you lose eligibility for Medicaid under 1619(b), you should contact your local Westchester County Department of Social Services office immediately to see if you qualify for the Medicaid Buy-in Program for Working People with Disabilities.
Who can tell me if I am eligible?
The Westchester County Department of Social Services will review your application and tell you if you are eligible for the program. Please make sure you bring the information required to complete the application.
New York State Department of Health
Westchester County Department of Health
Westchester County Department of Senior Programs and Services