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The concern expressed most frequently by people with disabilities who want to work is the fear of losing coverage for health care should their employment cause them to lose eligibility for benefits such as Medicare and Medicaid. Often these individuals are unable to get private health insurance that will cover all their medical needs. The loss of Medicare and Medicaid leaves them without a way to pay for medical expenses and for basic supports they require to live. Therefore, many do not work, as it would result in the loss of their Medicare or Medicaid coverage. Others may be employed, but are careful to limit their earnings to the very low levels that will not jeopardize such coverage. The Medicaid Buy-In program is designed to provide access to comprehensive health care for working people with disabilities who may have a difficult time finding affordable comprehensive health care coverage in the private market.

Q: What is the Medicaid Buy-In program for the Working Disabled?

A: The Medicaid Buy-In program for the Working Disabled offers individuals with disabilities, who are working or are interested in working, the opportunity to continue their health care coverage through Medicaid. The Medicaid Buy-In program for the Working Disabled allows the working disabled to earn more income without the risk of losing Medicaid coverage.

Q: When will the program begin?

A: The Medicaid Buy-In program for the Working Disabled is scheduled to begin on April 1, 2003.

Q: Who is eligible?

A: To qualify for the Medicaid Buy-In program for the Working Disabled you must: 1) Be between 16 and 64 years of age 2) Be a resident of New York State 3) Be determined disabled by the Social Security Administration (SSA), the New York State Disability Review Team or the Local District Disability Review Team 4) Be working 5) Have a gross annual income that does not exceed 250% of the Federal Poverty Level (FPL)-$45,320 for individual, $60,720 for a couple 6) Have no more than $10,000 in countable assets

Q: Who will determine if I am eligible?

A: Your local district social services worker will review your application and decide if you are eligible to participate in the Medicaid Buy-In program for the Working Disabled. Specific documents may be required for the application process, including certification of disability.

Q: How is work defined? Must I work for a specified number of hours at a specified salary in order to qualify?

A: If you are severely disabled based on SSI disability criteria, there are no requirements governing the number of hours you must work or your salary. If you are a Buy-In participant who experiences improvement in your disability, you are required to work at least 40 hours monthly and earn at least minimum wage to retain your Buy-In eligibility.

Q: Will I have to pay a premium?

A: Not everyone will. If your monthly income is less than 150% of the FPL ($27,192 for individuals, $36,432 for couples), you will not have to pay a premium. The amount of your monthly premium will be based on the amount of your earned (wages) and unearned income (SSI, SSDI, pensions, etc). If your net available income is more than 150%, but less than 250% of the FPL, your premium will be 3% of your earned income plus 7.5% of your unearned income. SSI budgeting methodology is used to calculate net available income.

Q: What if I already have health insurance through my employer?

A: If the cost of your employer's health plan is less than that of Medicaid, the Medicaid By-In program for the Working Disabled may pay all or part of your insurance premium through your employer.

Q: Where can I apply for the Medicaid Buy-In program?

A: After April 1, 2003, contact your Local District Social Services office where a worker will review your application. Specific documents may be required for the application process, including certification of your disability.