Did you know that you can keep your Medicaid benefits and work a full-time job? A lot of people don’t. Colorado has a program that will let you do just that – The Colorado Medicaid Buy-In for Working Adults with Disabilities. Are you ready to learn more? Keep on reading!
The expectation for most adults is to be a member of the American workforce. However, a significant barrier to people with disabilities integrating into the workforce is the impact increased income has on benefit eligibility. Knowing that traditional employer-provided health insurance will not work, the choice for an individual was to work and lose benefits or not work and keep benefits. The Medicaid Buy-in program removes the need to make such a decision.
Medicaid Buy-in is the realization of a program sought by the disability community for decades and has become one of the most successful work programs we have ever seen.
Medicaid Buy-in works by having employed individuals pay a monthly premium from $25 to $200, based on their income. The significant difference between Medicaid Buy-in and regular Medicaid is that Buy-in does not care about assets. This is the only disability program in Medicaid that allows you to save money, have life-insurance, etc.
This program allows you to access regular Medicaid services and certain HCBS (Home and Community Based Service) waivers. Not all HCBS waivers are implemented under this program yet but are in the process of being considered for inclusion.
Eligibility Requirements
General requirements:
You must be:
- Between the ages of 16 and 64
- Employed
- Disabled
- Within income guidelines
Employment
The employment requirement is very lenient. You can have any job, full-time or part-time; self-employed or working for someone else. As long as you are paid for real work, you will meet the eligibility requirements.
Disability
Disability status for Medicaid Buy-in uses the same criteria as Medicaid – Social Security Administration (SSA) state disability determination process.
Income Guidelines
For example, if you earn $1500 per month from a part-time job, you would subtract $65 and divide the rest in half.
$1500 – $65 = $1435 $1435 / 2 = $717.50 counted income per month.
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For unearned income like SSDI or a pension, subtract $20. The rest is then considered counted income.
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All clients in the buy-in program are considered a household of one. Therefore, family income is not relevant.
¹Federal Poverty Level Information
Participation
How do you participate in the Medicaid Buy-in Program?
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If you are already on Medicaid, merely report any employment or other change that would make you eligible. The system should push you into the program.
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To apply for the program, we recommend that you use
PEAK – the online system.
For more information directly from the Colorado Department of Healthcare Policy & Financing, go to Health First Colorado Buy-In Program For Working Adults With Disabilities
There is also a Medicaid Buy-In Program for Children with Disabilities. That program has some different rules but is a way for children with disabilities to have Medicaid with higher parental income.
For more information directly from the Colorado Department of Healthcare Policy & Financing, go to Health First Colorado Buy-In for Children with Disabilities.
Regulation and Oversite
The Department of Health Care Policy and Financing is the department responsible for the Medicaid Buy-In Program for Working Adults with Disabilities.
Governing Body
Stakeholder Participation
There are no committees dedicated to buy-in but those of us working on employment issues in general, focus on addressing buy-in issues when appropriate. We are working with members of the Colorado Congressional delegation to discuss systems issues and with the Department of Health Care Policy and Financing as needed to address application issues.
If you are interested in receiving notification of action on this matter, please subscribe to the CCDC alerts via our membership Become a Member of CCDC and check “Employment” and “Medicaid” as issues that interest you.
Known Issues for Individuals & Possible Solutions
Many individual’s problems are successfully resolved by HCPF. However, there is still the need for education of county workers on the rules regarding the Medicaid Buy-in Program.
A few common themes include:
Clients or applicants told that they cannot have Buy-In with HCBS.
This is not accurate. Buy-in is available now in EBD (Elderly, Blind, and Disabled), BI (Brain Injury), SCI (Spinal Cord Injury), and CMHS (Community Mental Health Supports) waivers and they are working on implementing it in the SLS (Supported Living Services) waiver program. There was a state Medicaid Director letter in 2013 informing counties that Buy-In is available with HCBS.
Clients using HCBS receive a letter from the county telling them to submit information about assets, such as bank statements.
While this is a program that does not have an asset test, the state has to see if you are eligible for a free program first. Regular HCBS has no premium but has an asset limit of $2000.
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You can choose to fill it out –it will not hurt you.
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If you do not fill it out, HCPF will proceed as if your assets are over $2000 (the limit for HCBS). What should happen is that the system should process the application and assign you to the Buy-In.
You get a notice saying you are not eligible because you have too many assets.
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There is no asset test.
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If this is a termination, you should appeal. In the case of a termination, you should always appeal. (See the link below for appeal information.) If you are told you have too many assets, contact the program Administer in the Important Contacts section below.
You get a notice saying your income is too high.
Assuming your income is not too high, and this is a termination, you should appeal. In the case of a termination, you should always appeal. (See the link below for appeal information.) If you are told you have too many assets, contact the program Administer in the Important Contacts section below.
You are told you are no longer disabled.
If an SSDI beneficiary goes through their nine-month trial work period, and they are making above Substantial Gainful Activity (SGA) they will lose the SSDI cash benefit. If you leave SSDI to begin working, you may need to have a State Level Disability Determination done again.
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You cannot be removed from the program while you are waiting for the form.
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If you know, you are getting close to this ask SSA for a diary date and alert your county technician and Beverly that this is happening.
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In some cases, depending on your SSA records, they may just give you a new diary date.
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As always, if there is a termination notice you need to appeal to keep your benefits going.
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People leaving SSDI for work are not having any problems getting the state determination if they need it.
Resources for Individuals
The CCDC Individual Advocacy Program takes all Medicaid Buy-in cases. Contact the Individual Advocacy team by calling 303-839-1775 extension 2. Leave your name, number, when you called, and a brief explanation of your issue. We will return your call within 24 to 48 hours during regular business hours.
Known Systemic Issues
Known systems issues: There are two major systemic issues that we are working on resolving, but the resolution will likely require help from Congress.
The federal authority for this program says that the program must end at age 65.
This is based on the theory that people are eligible for Medicare at age 65. There are three problems with this.
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The age of retirement and Medicare eligibility has gone up.
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No one retires at age 65 anymore.
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Even if one gets Medicare, this does not address long-term care, which includes HCBS waivers.
The reason there are asset limits in long-term care programs is to address the public policy decision that Medicaid should not be an inheritance protection program, especially for middle or upper-middle-class seniors that have had a lifetime to save for long-term care needs. This focuses on elders, not people with disabilities who age.
CCDC is working to change the law to allow people who have been continuously working to keep their Medicaid Buy-In status, not be required to reduce their income, and will enable them to maintain their assets such as retirement savings before they are ready and able to retire fully. People should not have to get rid of hard-earned assets accumulated while on the program only because they have turned 65. The legislative focus is to allow individuals to continue on the Medicaid Buy-in program.
This program is the only option for people with disabilities to get out of poverty by engaging in gainful employment. This is not an inheritance protection issue. Additionally, this population has NOT had a lifetime to prepare for long-term care needs.
The federal authority for this program says that the state can only allow an individual to remain unemployed for ten days.
According to the Bureau of Labor Statistics, the average number of weeks an individual was unemployed in August 2017 was 24.4². Therefore the 10-day requirement is ludicrous and unacceptable requiring a more stringent standard for enrollment in this program. CCDC is working to change this condition to the state instead that “as long as an individual is on unemployment (available to work and looking for a job) they will remain eligible for the Medicaid Buy-in program.”
Currently, to remain in compliance with this requirement, it is recommended that a second job be available. CCDC can assist with this option.
²Table A-12. Unemployed persons by duration of unemployment
