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.)