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Medicaid Buy-In


Medicaid Buy-In Coming Soon to a County Near You!!! What is Medicaid Buy-In? New form of Medicaid for individuals with disabilities who work Will eliminate Spend ... – PowerPoint PPT presentation

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Title: Medicaid Buy-In

Medicaid Buy-In
  • Coming Soon to a County Near You!!!

What is Medicaid Buy-In?
  • New form of Medicaid for individuals with
    disabilities who work
  • Will eliminate Spend-downs
  • Will eliminate Patient Liability
  • Provide Medicaid coverage to individual who
    receive Social Security Disability Insurance

Who is Eligible?
  • All Individuals with Disabilities
  • Meet MOST of the Medicaid eligibility standards

Basic Medicaid Eligibility ForAged, Blind,
  • To qualify for Medicaid, a person must meet basic
  • be a U.S. citizen or meet Medicaid citizenship
  • be an Ohio resident
  • have or get a social security number and
  • Individuals ages 14 to 64
  • Determined Disabled By Social Security
  • Meet Resource Limitations and Income Restrictions

Income Resource Limitations
  • Individual
  • Countable Monthly Income Under 556
  • Resources Under 1,500 per Month
  • Couples
  • Countable Monthly Income Under 956
  • Combined Resources Under 2250

What is Considered Income and Resources
  • Income
  • Supplemental Security Income (SSI)
  • Social Security Disability Insurance (SSDI)
  • Unemployment
  • Workers Comp
  • Earned Income
  • Resources
  • Checking Account
  • Savings Account
  • Stocks, Bonds, CDs
  • Burial Plots over 1500
  • Additional Houses, Cars, Boats

Medicaid Buy-In Work Requirement
  • Individual Must be working Part-Time OR Full-Time
  • Community Based Employment
  • Self-Employment
  • Vocational Assessment (Paid)
  • Continued coverage for individuals who lose
    their job while participating in program

New Income Resource Criteria
  • Individual Only !!!
  • Must be working and earning income
  • Meet the income eligibility criteria 2,167
  • Excludes 20,000 of earned income for the
    individual, then allows total individual income
    up to 250 of the federal poverty level
  • Have a maximum resources of 10,000

Medicaid Spend-Down
  • A spend-down is a specified amount that an
    individual would have to pay each month before
    they would be eligible for Medicaid coverage.
  • Individual income limits for Medicaid id 556.
    Anything over is considered a spend-down
  • Individual receiving 637 SSDI has a 81
  • Individual receiving 637 of SSDI and 606 of
    earned income has a gross income of 1243 and a a
    spend-down of 687

Patient Liability for Medicaid Waiver
  • Total earned and unearned income under 1179 per
    month limitation
  • Income of 2,100 per month consumer has to pay
    921 per month

Free Medicaid
  • Individuals earning under 15,000 receive
    Medicaid for free
  • Ex 7.00 x 20 hr/wk 606 gross per/mo
  • 606 x 12 months 7,272
  • Social Security Benefit of 637 per month x 12
    months 7,644
  • SSDI Work 14,916 FREE MEDICAID
  • OR
  • 35,000 per year - 20,000 (exclusion) 15000

Free Medicaid Cont
  • Social Security Work Incentives
  • Impairment Related Work Expenses (IRWE)
  • Subsidies Special Conditions
  • Work Expenses (Self-Employed)
  • Consult Social Security or a Benefit Specialist

Medicaid Buy-In over 15,000
  • Premiums
  • Individuals must pay a premium in order to
    participate in the Medicaid Buy-In program when
    their total family income exceeds 150 of the
    federal poverty level (15K). The premium charged
    is 7.5 of the difference between 150 FPL and
    total income.
  • 18,000 (after exclusions) 112 per month
  • Enrollees who do not pay their premiums for two
    months in a row will be subject to termination.
    If they are terminated, they may reapply for
    MBIWD but they must pay all MBIWD delinquent
    premiums for the months of coverage before they
    can be re-enrolled

Stopped Working
  • Grace Period
  • Program participants will be allowed a six-month
    grace period if they lose a job or if their
    disability improves. This allows individuals time
    to either find another job, plan for a transition
    back to regular Medicaid, or in the case of
    medical improvement plan for a transition off of

How to Apply
  • Call the local Jobs and Family Service Office
  • Fill out form JFS 07211 available 4/1/2008
  • Provide all documentation
  • Pay stubs, checking, savings, address, Social
    Security info, ect
  • 440-813-2783