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NYS Medicaid Buy-In Option: Do You Qualify?By Rick Fitzgerald As the opportunities for work improve for people with disabilities, concerns have been raised about maintaining comprehensive medical coverage. Under the Medicaid program, attendant services, adaptive equipment and mobility devices are 100% covered. Conventional insurance offered by employers, however, may not cover those items. As an incentive to those who become employed, the option of “buying” Medicaid is offered. Medicaid eligibility varies by state. In New York, for example, there are five requirements. First you must be employed. It doesn’t matter if you are working full or part time, you can work as much as you are able. Second, you must be ineligible for any Supplemental Security Income (SSI)-based Medicaid programs. SSI Medicaid programs include being an SSI recipient or 1619(b) eligible. According to Section 1619(b) of the Social Security Act, if you are deemed disabled under federal standards, your work income has been discontinued, you have assets less than $2,000 and you have used Medicaid in the past 12 months, you are still eligible to receive Medicaid until your income exceeds $41,771. Third, your countable assets cannot exceed $10,000. Countable assets include bank accounts, IRAs, 401(k) plans, stocks, bonds and other investments. The home that you live in and the car that you drive are not considered countable assets. Fourth, your countable annual income cannot exceed $25,536 for an individual. Countable income is income that is reduced based on a formula that takes into account extra work-related expenses that can be incurred by people with disabilities. Some of these costs can be purchasing and maintaining adaptive equipment needed to work, excessive transportation costs and staff costs if the staff assists you in getting to work. Last, you must be at least 16 years old but not older than 64. Those who meet the above-listed criteria can begin the application process with a call to the local Department of Social Services. If you are currently receiving Medicaid you can speak with your worker (also known as an eligibility specialist) and ask to be transferred to the Medicaid Buy-In for Working People with Disabilities (MBI-WPD) program. Staff there will assist you with the transition. If you have never received Medicaid, you can contact the Medicaid Unit of the Department of Social Services (DSS) in your county. A Medicaid application and supple-mental packet are required. The supplemental packet includes documentation that allows the state to certify the disability under their regulations. Tina Fitzgerald, a former benefits specialist with the Benefits Planning and Outreach Program at the ARISE Center for Independent Living in Syracuse, said that “these state regulations mirror closely those of Social Security, and if you can show that you receive a Social Security Disability (SSD) check now or have received an SSD or SSI check in the last 12 months you won’t have any problem with the certification-of-disability process.” If not, there will be a medical form to send to the state officials. All applicants to the MBI-WPD program will also have to verify income and assets. “In the future, this verification will be used by New York state to determine what the premium, if any, you will pay,” Fitzgerald said. The premium will be income-based and charged to those with incomes between 150% and 250% of the federal poverty level (FPL) for the family size of the applicant. Be aware that although the income reflects family size, Medicaid will only be granted to the individual with a disability. Other family members may be eligible under other programs offered by DSS. How has MBI-WPD helped people maintain or participate in work activities? People who had limited their work hours to remain eligible for Medicaid will now have the option to increase their work hours. People who have large spend-downs can work to decrease their out-of-pocket expenses for Medicaid. According to Fitzgerald, none of the individuals she has assisted in the MBI-WPD program have ever failed to recertify annually. The most common comment by consumers, she said, is, “I can work and still receive all the services I need to do that.” The MBI-WPD is a valuable program that is not only an incentive to seek employment, but a tool to maintain access to services and continued employment. Becoming eligible is a simple process, if you are found ineligible for all other disability-related Medicaid programs. When you apply, your local DSS will determine your countable income and resources to be sure you are within the restrictions. To begin the process, contact your DSS Medicaid worker or the Medicaid unit at your local DSS. If you need further assistance, call the Social Security Administration at 1-800-772-1213 or go to: www.ssa.gov for a referral to your local work incentives counselor. These counselors are trained to assist individuals in accessing all the available Social Security work incentives and related state programs. ***************************** Rick Fitzgerald is a writer. He has worked for many papers in central New York and is currently a team leader with the Self-Advocacy Association of New York State AmeriCorps project. |
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