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Medicaid Buy-In

Is there a Medicaid Buy-In (MBI) program in my state?

  • A Medicaid Buy-In (MBI) program exists in 40 states.
  • Check your state’s Medicaid agency website to see if they have created this optional program.
  • The name of your state’s MBI program may not include “Medicaid” and/or “Buy-In.”

MBI eligibility

  • States set their own eligibility criteria within federal guidelines.
  • In all states, people who are eligible for MBI must meet the Supplemental Security Income (SSI) disability definition without reference to work or earnings.
  • If a person is already receiving SSI or SSDI payments, they meet the disability criteria.
  • If a person is not getting SSI or SSDI, the state Medicaid agency will make a disability determination. The applicant is not required to have ever received SSI or SSDI.
  • Countable monthly earnings over the Substantial Gainful Activity (SGA) level are not considered when making the MBI disability determination, as SGA is not a factor for MBI program eligibility.

MBI income limits

  • A state may set its own unique income limits.
  • If the MBI program was established under Section 4733 of the Balanced Budget Act (BBA) of 1997, the countable income limit must be less than 250% of the Federal Poverty Level ($3,037 in 2024).
  • If the program was established under the Ticket to Work legislation of 1999, the state can establish whatever income limit it chooses, or it can have no income limit.
  • To determine countable income, states must use SSI income exclusions (including the $65 Earned Income Exclusion and half the remaining earned income, as well as Impairment-Related Work Expenses (IRWEs), Blind Work Expenses (BWEs), and PASS deductions).

MBI resource limits

  • A state may set its own unique resource limits.
  • If a state established its MBI program under BBA, the countable resource limit can be as high as $14,000.
  • If a state established its MBI program under the Ticket legislation, the countable resource limit can be any amount or the state can have no resource limit.

MBI premiums

  • In most states, premiums increase as countable income increases.
  • A state may decide to not collect MBI premiums.

MBI Medical Improvement Group

  • An MBI program established under Ticket to Work legislation has a Medical Improvement Group.
  • To be eligible for the Medical Improvement Group, a person must first have been eligible for the Basic Eligibility Group.
  • If a person is found to be medically improved following a medical Continuing Disability Review, their MBI eligibility can be retained if they continue to have a severe medical impairment and they work at least 40 hours per months while earning at least the federal minimum hourly wage.

What if a person using MBI can’t work?

  • A state may offer work stoppage protection.
  • This option allows a person’s MBI eligibility to continue if they are laid off or if they must stop work for disability-related reasons.
  • States that offer this protection typically provide a grace period. The length of this period varies by state. For example, it may be as short as 2 months or as long as 12 months.

Look for these optional MBI features in your state program

  • How is unearned income treated? (Some states limit unearned income to the SSI Federal Benefit Rate.)
  • How is spousal income treated? (Some states do not count spousal income.)
  • How is savings in retirement accounts treated? (For example, New York ignores retirement savings when looking at resources.)