In July 1999, the Division of Medicaid began a new program to offer Medicaid coverage for disabled individuals who are:
- working but have no health insurance or not enough insurance, or
- want to return to work and need health insurance.
This group is sometimes referred to as a “Buy-In” program because workers who earn over a certain amount must pay a monthly premium to purchase their Medicaid benefits.
Who is Eligible for Working Disabled?
The basic eligibility requirements for the Working Disabled (WD) Program are as follows:
- Working: means that the disabled person works at least 40 hours each month at some type of paid activity.
- Disabled: means that the disabled person meets the Social Security definition of disability except for the provision of Substantial Gainful Activity (SGA). The fact that the disabled individual is working is not considered in making the disability decision.
* There is no requirement for someone to apply for disability benefits (such as Social Security benefits) during the application process for Working Disabled coverage.
Income and Resources
- Income: a person who is working and disabled must meet two separate income tests. One is an earnings test and the other is for all other income other than earnings (unearned income).
- Earnings: the earnings limit is set at 250% of the federal poverty level.
- Unearned: if the disabled worker (or spouse) receives income that is not “earned,” it is treated as unearned income with an income limit set at 135% of the poverty level. This includes income such as disability benefits, pensions, workers’ compensation benefits, interest/dividends, etc.
These are assets or what a person owns. The resource limit for the Working Disabled Program is higher than for other Medicaid groups; $24,000 per individual and $26,000 per couple. Certain types of resources are not counted toward the resource limit:
- Home property,
- Certain property that produces income,
- Up to two vehicles,
- Household goods,
- Personal property up to $5,000,
- Life insurance up to $10,000 in face value,
- Burial funds up to $6,000 if kept in a revocable form.
Resources that count include money in the bank; the value of stocks, bonds or other investment accounts; the value of non- home property that does not produce in come.
Working Disabled individuals earning less than 150% of the poverty level for an individual or couple do not pay a monthly premium. For Working Disabled individuals/couples who earn more, the premium is equal to 5% of the amount Medicaid considers to be “countable” earnings. Countable earnings are less than ½ of the gross earned income amount x 5%.
How Do I Apply?
Apply by calling or visiting your local Medicaid regional office. You will need to provide proof of wages and hours worked and also provide verification of your resources (things you own). Your worker will advise of any additional information that may be needed.