Medicaid Buy-In for Working Disabled Individuals in New York State

by David Goldfarb Goldfarb Abrandt Salzman & Kutzin LLP

Medicaid coverage is expanded as of July 1, 2003, to working disabled individuals with incomes up to 250 percent of the Federal Poverty Level. Congress enacted the Medicaid Buy-In option for states in the Balanced Budget Act of 1997 (§ 4733) and enhanced the option in the Ticket to Work and Work Incentive Improvement Act of 1999. In 2002 New York opted into the program. 2002 N.Y. Laws chapter 1; N.Y; Soc. Serv. Law §§ 366(1)(a)(12)-(13) and 367-a. Implementation was delayed until July 1, 2003.

The Medicaid Buy-In program extends Medicaid coverage to disabled individuals who are working but have net income below 250 percent of the federal poverty level and non-exempt resource at or below $10,000. 250 percent of the FPL for 2003 is $22,152 per year ($23,275 in 2004). However, with SSI related earned income exclusions, an individual could be eligible with income as high as approximately $46,170.

Medicaid since 1987 had provided for disabled individuals to retain Medicaid benefits if they lost SSI due to an increase in their wages. (However, no similar provision had existed for disabled individuals who were not on SSI).

In New York, to be eligible for Medicaid Buy-In Program a person must:

Be between the ages of 16 and 65;

Meet the SSI criteria for disability except there is no “substantial gainful activity” test;

Be working part-time or full time;

Have gross income below 250% of the poverty level after taking into consideration all income disregards; and

Have non-exempt resources of $10,000 or less.

If an individual meets the criteria and is receiving coverage, but becomes non-disabled under SSI criteria, coverage may continue if the individual has a severe medically determined impairment and is employed at least 40 hours per month and earns at least the federal minimum wage.

There is a moratorium on the collection of any Medicaid Buy-In premium. However, beginning some time in 2004 there will be a premium of 3% of net earned income plus 7.5% of net unearned income for persons above 150% of the FPL.