Customized Employment Webcasts
Welcome to the webcast on Medicaid Buy-in. Today, Mike Keffer, a benefit specialist with COVA, the Center of Vocation Alternatives, will answer questions about the Medicaid Buy-In program.
WHAT IS MEDICAID BUY-IN?
Most folks do refer to Medicaid Buy-In for Workers with Disabilities as Medicaid Buy-In. As the name implies, it really is a way to buy into Medicaid for little or no cost, if you are working. Prior to Medicaid Buy-In many people who worked had increased costs for Medicaid or were ineligible due to assets. Medicaid Buy-In actually reverses this situation. It increases the asset limit and now earnings decreases the costs for Medicaid, which is rather hard to believe. In effect, Medicaid Buy-In has served more to encourage work than any other work incentive that I know about. In my line of work financial encouragement to work is so important and I believe that work is one of the most important components in recovery.
Medicaid Buy-In was part of the federal "Ticket to Work" and "Work Incentives Improvement Act of 1999", which in the world of benefits was a gigantic and far reaching piece of legislation. However, each state had to adopt this part of the law - this happened in Ohio on June 30, 2007 and enrollment began April 1, 2008.
WHO IS ELIGIBLE?
A person who has been found disabled by Social Security or Medicaid, age 16 through 64 and is wage or self-employed and meets the income and resources limits is eligible for Medicaid Buy-In. One of the great things about this work incentive is that the amount of work does not matter. For example, I have a client who works at a fast food restaurant for five hours per week - he receives a paystub and taxes are taken out and he qualifies! Another example is someone who actually walks around and collects coins laying on the ground, she pays quarterly taxes to the IRS and by doing so meets the definition of work and also unbelievably qualifies for Medicaid Buy-In!
WHAT IS THIS FINANCIAL ELIGIBILITY YOU JUST SPOKE OF?
Medicaid for the aged, blind and disabled, known as Medicaid ABD, and Medicaid Waiver programs are both "needs based' or another term used is "means tested'. This translates into the fact that Jobs & Families Services looks at all income and assets that relate to the individual applying. An asset is defined as basically any item that can be converted to cash; some things are not counted as assets and are excluded, such as the car you drive and the house you live in. So it is that Medicaid Buy-In is also a needs based program. The great thing about this program is that financial eligibility is far greater than Medicaid ABD. The asset limit was $1500 for Medicaid ABD, now it is $10,580 for Medicaid Buy-In and this figure may be adjusted annually if there is a Cost of Living Increase for Social Security.
One of the key elements of Medicaid Buy-In is that financial eligibility is based on the individual's income and resources. As long as income is below 250% of the Federal Poverty Level (FPL) and assets are less than the $10580, then financial eligibility is met. There are even other income deductions of more than $20,000 per year. We figured that a person can be earning over $70,000 per year and still meet the financial eligibility. So basically, if someone is working and disabled they will be eligible for Medicaid Buy-In.
YOU JUST SPOKE OF ALL THIS INCOME A PERSON CAN HAVE; I HEARD THAT MEDICAID HAS A MONTHLY SPENDDOWN IF YOU HAD TOO MUCH INCOME - WHAT IS GOING ON HERE?
One of the fantastic things about Medicaid Buy-In is that Spenddown is eliminated!!! Yes, that is worth repeating - Medicaid Spenddown is eliminated!! Well, in the first place what is this Spenddown that has been eliminated? Medicaid ABD monthly Spenddown occurs when an individual has countable income over the Medicaid Needs Standard - for an individual this is only $589 per month. Now unearned income, for example SSDI, counts basically dollar for dollar toward this limit (after the first $20 is excluded) and wages count at around half of this toward the limit (after the first $65 is excluded). For example, if an adult client has $820 in SSDI and $665 in wages per month, then the monthly Spenddown is calculated to be a whopping $511 for each month. Another Spenddown example is a child living at home (age 16 or 17) on SSI/Medicaid, this individual would have a Spenddown if parental income is above $533 per month - this is referred to as deeming. A more likely scenario for this example however would be that the child would receive Medicaid Healthy Start and the income limit for this program is 200% of the federal poverty level, for a family of three this is $37,060!! This means the client would have to meet or incur (or pay out of pocket) this expense in a month to have Medicaid health care coverage for the month - in other words it may be very unlikely that they will receive Medicaid coverage under the Spenddown program.
SO MEDICAID BUY-IN ELIMINATES SPENDDOWN, WHAT'S THE CATCH?
Well, there really is no catch. Now it is true that someone on Medicaid Buy-In does have a premium. But the calculation of the premium is tons more generous than the Spenddown calculation. In fact, if an individual has total gross income less than 150% of the federal poverty level, which for an individual is $16,335 per year, there will be no premium calculation whatsoever!! However, if the individual's gross income is more than 150% of the federal poverty level, then there will be a premium calculation. Now an important aspect of the premium calculation is that it includes the income of everyone in the family, this could be the individual, the individual's spouse, the individual's dependent children; and if it's a child, then parental income is also included in the gross income calculation. The calculation is as follows: total gross family income minus 150% of federal poverty level for the family and then you multiply this figure by .1 (10%) and now that is the amount of the monthly premium. If the family pays other health insurance premiums there is a dollar for dollar deduction from the premium calculation.
IF I HAVE A MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER, CAN I TRANSITION TO MBIWD?
Yes you can! In some cases an individual on Medicaid Waiver can have a Patient Liability if income is greater than $1380 per month and that patient liability can be a dollar for dollar liability over that $1380. So get a job and eliminate any possible patient liability! Also, an individual may want to increase wealth with an increased asset limit of $10,580, where it was only $1500, and the great thing is there is no change in Waiver services.
WHAT ARE SOME OTHER IMPORTANT THINGS I SHOULD KNOW ABOUT MEDICAID BUY-IN?
Once eligible for Medicaid Buy-In and you lose your disability status through medical improvement, you can maintain Medical Buy-In coverage if you work at least forty hours per month at least at minimum wage.
Also once eligible for Medicaid Buy-In and you lose your job, you have a 6-month grace period to get another job before you lose your Medicaid buy-In coverage.
OKAY, LET'S GET SPECIFIC: HOW CAN MBIWD BENEFIT A YOUNG PERSON WITH A DISABILITY WHO BEGINS EMPLOYMENT AFTER GRADUATION (ASSUMING THE AGE RANGE IS 18 TO 22)?
If they are not on Social Security Disability, and If they can meet the Social Security or Medicaid definition of disability, they can take their paystubs to Jobs and Family Services along with the appropriate application, and get Medicaid Buy-In that will be based on their income level and does not include their parent's income in this calculation - since now they're an adult! If they work full-time they can choose their work health insurance and keep Medicaid Buy-In as secondary insurance, or they can choose their work health insurance at a later date without penalty since they have credible health coverage under Medicaid Buy-In.
Now if they're on SSDI or SSI, then they automatically meet the definition of disability. They simply take their paystubs with the appropriate application to Jobs and Family Services and eliminate any Spenddown due to individual income.
LET'S GET SPECIFIC AGAIN: HOW CAN MBIWD BENEFIT A TRANSITION YOUTH WITH A DISABILITY WHO IS EMPLOYED AND RECEIVES SSI?
Let's assume this is for age group age 16 to 17, a working child. Any Spenddown due to parental deeming of income will be eliminated or if the family income is over the Medicaid Healthy Start limit, which for a family of three is $37,060; then Medicaid Buy-In is an excellent option, since will allow individual to get Medicaid health coverage. Even with the family income, the premium may still be relatively low.
HOW IS THE BEST WAY TO APPLY FOR MBIWD?:
You may contact me directly at my Ohio toll free number, 877-521-2682 or my direct number in Columbus, 614-291-0435. My address is, Mike Keffer, at COVA, 3770 North High St., Columbus, Ohio, 43214, OR you may go directly to Jobs and Family Services if you are an existing Medicaid consumer, contact your caseworker or call the Medicaid Consumer Hotline at 1-800-324-8680.
Another option is to take Medicaid Buy-In Addendum, JFS 07211 form, with paystubs to Jobs and Family Services, have them scan it in and/or get a receipt that the application was dropped off.
If not an existing Medicaid consumer: Complete the appropriate paperwork (JFS 07200 and JFS 07211) and take paystubs into local Jobs and Family Services office and get it scanned in.
Applications and additional information is available at www.jfs.ohio.gov/ohp/consumers.