The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) is a special program for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income limit is 250% of the Federal Poverty Line, after more than half of gross earned income is disregarded. This allows them to earn more income without the risk of losing health coverage.
The official State website on this program has basic information, including the current income and resource limits which change every year with the Federal Poverty Line. Current levels are in Box 3 in the Medicaid Income and Resource Levels Chart.
Applications for MBI-WPD should include the usual components of a Medicaid application, as well as proof of disability, proof of employment, and two additional forms:
LAW: NY Social Services Law § 366(1)(a)(14 - 15), § 367-a(15). State directives include:
GIS 15 MA/013 - MBI-WPD Disability Certification and Exception Trusts PDF - This GIS implicitly states that a person whose earned income is too high for MBI-WPD can use a pooled trust or an individual supplemental needs trust (both are types of "exception trusts") to bring their income down to the MBI-WPD level -- until they reach the age of 65 and can no longer be in MBI-WPD. The GIS says that if an individual is certified as disabled for purposes of MBI-WPD, that same certification also establishes disability for use of a pooled or individual trust. This clarification was needed to avoid a catch-22: A working person cannot generally qualify as "disabled" under Social Security disability insurance rules, with some exceptions. Yet in order to qualify for MBI-WPD, one must be "disabled" and be working. Plus - one must be "disabled" under the Social Security rules to enroll in a pooled/individual supplemental needs trust. This GIS clarifies that a certification of disability meets the disability criteria for both MBI-WPD and for a supplemental needs trust.
GIS 14 MA/013 - Establishing Medicaid Buy-In Program for Working People with Disabilities Eligibility at Application PDF - emphasizes the importance of identifying applicants who would be eligible for MBI-WPD, including any individual who is certified disabled and working, prior to sending the application to the New York State of Health (NYSOH) for processing because of "excess" income. If applying specifically for the MBI-WPD program, the application should be processed by the district. A disability determination will be needed if the individual does not have certification of disability or blindness.
Further, any referrals to the local district from the NYSOH for a Medicaid eligibility determination because of having income over the MAGI limits should be checked for eligibility under the MBI-WPD program if the individual is certified or potentially disabled and working. These referrals may include people who indicate the need for waiver services, home care or personal care services, or who request eligibility in the spenddown (Excess Income) program.
The MBI-WPD program allows an eligible individual to have higher Medicaid income (up to 250% FPL) and resource limits ($20,000 for a household of one, and $30,000 for a household of two) without having to pay a spenddown. "The program also allows for the medical improvement of an individual without the loss of Medicaid coverage. There continues to be a moratorium on premium collection."
10 ADM -02 10ADM-02 - Medicaid Buy-In Program for Working People with Disabilities Medical Improvement Group (Mar. 3, 2010)(attachments available here )(concerns continuing eligibility for people no longer eligible for disability under the "basic coverage" group because of medical improvement, but who still have a severe impairment)
09MA015 - Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) Work Requirement: Documentation Change (local districts may no longer require that an individual document payment of applicable taxes in order to demonstrate work activity. (May 15, 2009)
DOH GIS 08 MA/004 (February 2, 2008). Among other things, clarifies that Substantial Gainful Activity (SGA) "... is a factor in determining disability for the Aid to Disabled (AD) program and is not considered for the MBI-WPD program because recipients in that program are expected to work."
This training reviews Medicaid disability budgeting and the MBI-WPD program (by The Legal Aid Society Health Law Unit)
NYS DIsability Manual - Page 13 says to refer to MBI-WPD if over SGA limits. Page 16 shows a chart that shows that in the first step of the sequential process if the answer is person is over SGA then refer to MBI-WPD.
Through the NY Makes Work Pay project -- www.nymakesworkpay.org --Neighborhood Legal Services in Buffalo, funded by a subgrant from Cornell University, has extensive resources to encourage enrollment in MBI-WPD, including:
Statewide Work Incentives Hotline (toll-free 1-888.224-3272). Answer any questions about the range of Social Security, SSI, Medicaid and Medicare work incentives, including questions on the MBI-WPD.
Direct links to some key policy-to-practice briefs:
Self Help Guides
This article was authored by the Empire Justice Center.