Working Disabled Medicaid Buy-In

Is the Working Disabled Medicaid Buy-In Right for You?

Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Medicaid.
• Have low income, low resources, and either have a disability or are 65 years old or older. (If you get Adult Public Assistance (APA) benefits, you automatically qualify.) Learn more about APA-related Medicaid.
• Have a disability and work, even if your income is higher. The Working Disabled Medicaid Buy-In program is explained on this page.

Answer the questions on this page to see if you might qualify for the Working Disabled Medicaid Buy-In. If so, it’s a good option to consider because it lets you earn a lot more money and pay a low monthly premium, low copayments and no deductible to get Medicaid’s comprehensive coverage.

Note: If you qualify for APA or for SSI’s 1619(b) rule, you automatically get APA-related Medicaid and don’t need to worry about the rules discussed here. Learn more about them in DB101’s SSI and APA article.

Do You Meet the Working Disabled Medicaid Buy-In Program’s Basic Requirements?

To qualify for the Working Disabled Medicaid Buy-In, you must:

• Be 18 years old or older
• Be working and earning too much money to get APA-related Medicaid
• Be a U.S. citizen or meet specific noncitizen requirements

If you are working and are either a U.S. citizen or a non-citizen who qualifies, the Working Disabled Medicaid Buy-In might be an option for you.

Medicaid’s rules for immigrants:

• Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
• Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

Note: You can get Working Disabled Medicaid Buy-In coverage if you are a Native American born in Canada or Mexico who has rights to cross the border.

Do You Have a Disability That Meets Social Security’s Standards?

To qualify for the Working Disabled Medicaid Buy-In, you must have a disability that meets Social Security’s definition of disability. For adults, Social Security says you have a disability if:

• You have a physical or mental impairment or combination of impairments
• Your condition has lasted or is expected to last for at least 12 months

Note: For the Working Disabled Medicaid Buy-In, Social Security’s disability rules related to earned income do not apply.

If you currently get a disability benefit like SSI or Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards.

If not, Social Security, in collaboration with Alaska Disability Determination Services (DDS), will check to see if your disability qualifies. Learn more about the disability determination process in DB101's SSI and APA article.

If you already have a disability determination from Social Security or think that your disability will meet Social Security’s standards, the Working Disabled Medicaid Buy-In might be an option for you.

Do You Have Low Resources?

Resources are money and property you own. For the Working Disabled Medicaid Buy-In, you must have less than $10,000 in resources ($15,000 for couples). Some resources don’t count towards the Working Disabled Medicaid Buy-In’s resource limit, like the home you live in and one car.

If your resources are below the limit, the Working Disabled Medicaid Buy-In might be an option for you.

Is Your Income Below the Working Disabled Medicaid Buy-In’s Income Limit?

The Working Disabled Medicaid Buy-In program is designed so that if you have a disability, you can work without worrying that you’ll lose your Medicaid health coverage. That’s why its income limit is a lot higher.

For the Working Disabled Medicaid Buy-In, you must:

• Have $1,751 per month or less in unearned income, such as SSDI. If you are married, the limit is $2,593 and your spouse's deemed unearned income is also counted.
  
• Have household countable income that is at or below at or below 250% of the Federal Poverty Guidelines (FPG), including other members of your family you live with. That’s $3,919 per month if you live alone.
  • Almost all of your unearned income is counted, but less than half of your earned income is counted. For the Working Disabled Medicaid Buy-In , your income is counted using SSI’s countable income calculation.

Tip: If you live alone and have no unearned income, you could actually have up to $7,923 per month in gross earnings and still qualify for the Working Disabled Medicaid Buy-In. (That's as much as $95,070 per year!)

If your income is low enough and you meet all other requirements, you should sign up for the Working Disabled Medicaid Buy-In, after making sure it is better than any employer-sponsored coverage you could get.

How to Sign Up

You can apply for the Working Disabled Medicaid Buy-In:

• Online, using HealthCare.gov or myAlaska.
• By filling out the DPA Application for Services or DPA Medicaid Application for Adults and Children with Long Term Care Needs and submitting it:
  • In person or by mail to any Division of Public Assistance (DPA) office
    
  • By email to hss.dpa.offices@alaska.gov, or
    
  • By fax to 1-888-269-6520.
• By phone at 1-800-478-7778.

If you use an application form, you can also apply for other benefits at the same time, such as Adult Public Assistance (APA), SNAP (formerly Food Stamps), and Alaska Temporary Assistance Program (ATAP). If you apply for the Working Disabled Medicaid Buy-In online, you have to apply for other benefits separately.

Keeping Working Disabled Medicaid Buy-In Coverage

Usually, once you are approved for the Working Disabled Medicaid Buy-In, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, you need to report within 10 days of when you know about the change. You can report these changes to the Division of Public Assistance (DPA) by calling 1-800-478-7778, by fax to 1-888-269-6520, by email to hss.dpa.offices@alaska.gov, or in person at any Division of Public Assistance (DPA) office.

When you report your changes, the DPA will tell you whether you will continue getting Working Disabled Medicaid Buy-In coverage and if your premium will change.