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Medicaid Buy-In

Case Study 1: Corrine’s new job and the cost of Medicaid

Person using a laptop at workCorinne, who has a mental health disability, qualified for $1,080 in monthly SSDI. In 2023, she begins work for the first time since becoming SSDI eligible. She has gross earnings of $1,565 per month (all countable for SGA purposes)—more than the 2023 SGA level of $1,470 per month.

Facing a very significant Medicaid spend down, Corrine is worried about keeping her Medicaid.

Think about it. What needs to happen?

Corrine should apply to her state’s MBI program, which was established under the Ticket legislation. Corinne’s state has set countable income limits at 250% of the Federal Poverty Level, i.e., $3,037 in 2023. Her state’s resource limit is much higher than Corrine’s total savings.

Because her total countable income when she starts working is $1,810 per month, she will be within the MBI program’s countable monthly income limit of $3,037:

  • Her countable unearned income is $1,060. This is $1,080 SSDI - $20 General Income Exclusion.
  • Her countable earned income is $750. This is half of $1,565 - $65 Earned Income Exclusion).
The takeaway

Because Corrine meets her state’s unique MBI countable income limit, it is reasonable to expect that she will meet the financial standard for MBI.

Case Study 2: Corrine’s medical Continuing Disability Review

Person talking on the phone at workIn 2024, Corinne from the previous case study goes through an SSDI medical Continuing Disability Review (CDR). Although she continued to be in active mental health counseling, the review found that she had medically improved and was no longer eligible for SSDI benefits. This medical improvement meant that she no longer qualified for the MBI program through the Basic Coverage Group.

Corrine is worried about losing her Medicaid coverage because she needs continued mental health treatment to work.

Think about it. What needs to happen?

Corinne does some research and learns that her state offers the potential for continued coverage through the Medical Improvement Group. She calls her state Medicaid agency to learn how to switch her group so that her coverage can continue.

The takeaway

Because Corrine continues to have a severe mental health disability and continues to work at least 40 hours per month at more than the federal minimum wage, she will continue to qualify for her state’s MBI program in the Medical Improvement Group.