The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) expands eligibility for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income limit is 250% of the Federal Poverty Line, after more than half of gross earned income is disregarded. This allows them to earn more income without the risk of losing health coverage. See how earned income is calculated for anyone with a disability or who is age 65+ here.
The official State website on this program has basic information, including the current income and resource limits which change every year with the Federal Poverty Line.
Current INCOME and ASSET levels are in Box 5 in the Medicaid Income and Resource Levels Chart.
Use this NYLAG Medicaid Budget template to calulate income budgeting.
Heads up - Expansion of Eligibility May be Coming in 2025!
The NYS Legislature and Governor agreed to expand eligibility in 2025 - increasing income and asset limits and removing the age limit of 65. People with incomes above the current limit of 250% FPL also will be required to pay a monthly premium, with the amount increasing on a sliding scale.
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See this document for more infomation on the premium and these changes, and some recommendations for implementation.
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In late 2024, the State published information about the proposed changes with an opportunity for public comments - see this webpage. NYLAG testified at the hearing and its comments can be downloaded here. NYLAG strongly supports encouraging people with disabilities to work at all ages, including after they reach age 65, and expanding the income and asset limits for this program. The comments make some recommendations for how the law is implemented.
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WARNING: The expansion must be approved by the federal Medicaid agency -- CMS -- in a "waiver." New York State did not submit the waiver until late 2024, so it will be reviewed by CMS in the incoming Trump administration rather than under the Biden administration. Stay tuned for opportunities to submit comments to CMS. At the very least, implementation of this expanded eligibility will be delayed past its expected start date of January 2025 to an unknown date.
Applications
Applications for MBI-WPD should include the usual components of a Medicaid application, as well as proof of disability, proof of employment, and two additional forms:
Law, Regulations, and NYS Guidance
LAW: NY Social Services Law § 366(1)(a)(14 - 15), § 367-a(15). State directives include:
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GIS 15 MA/013 - MBI-WPD Disability Certification and Exception Trusts PDF - This GIS implicitly states that a person whose earned income is too high for MBI-WPD can use a pooled trust or an individual supplemental needs trust (both are types of "exception trusts") to bring their income down to the MBI-WPD level -- until they reach the age of 65 and can no longer be in MBI-WPD. The GIS says that if an individual is certified as disabled for purposes of MBI-WPD, that same certification also establishes disability for use of a pooled or individual trust. This clarification was needed to avoid a catch-22: A working person cannot generally qualify as "disabled" under Social Security disability insurance rules, with some exceptions. Yet in order to qualify for MBI-WPD, one must be "disabled" and be working. Plus - one must be "disabled" under the Social Security rules to enroll in a pooled/individual supplemental needs trust. This GIS clarifies that a certification of disability meets the disability criteria for both MBI-WPD and for a supplemental needs trust.
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GIS 14 MA/013 - Establishing Medicaid Buy-In Program for Working People with Disabilities Eligibility at Application PDF - emphasizes the importance of identifying applicants who would be eligible for MBI-WPD, including any individual who is certified disabled and working, prior to sending the application to the New York State of Health (NYSOH) for processing because of "excess" income. If applying specifically for the MBI-WPD program, the application should be processed by the district. A disability determination will be needed if the individual does not have certification of disability or blindness.
Further, any referrals to the local district from the NYSOH for a Medicaid eligibility determination because of having income over the MAGI limits should be checked for eligibility under the MBI-WPD program if the individual is certified or potentially disabled and working. These referrals may include people who indicate the need for waiver services, home care or personal care services, or who request eligibility in the spenddown (Excess Income) program.
The MBI-WPD program allows an eligible individual to have higher Medicaid income (up to 250% FPL) and resource limits ($20,000 for a household of one, and $30,000 for a household of two) without having to pay a spenddown. "The program also allows for the medical improvement of an individual without the loss of Medicaid coverage. There continues to be a moratorium on premium collection."
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Oct. 2011 - 11ADM-07 - Medicaid Buy-In Program for Working People with Disabilities: Disregard Retirement Accounts in Determining Resource Eligibility and Increased Resource Standards
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Announced effective 10/1/2011, individual resource limit increased to $20,000 and couples to $30,000 - however, effective Jan. 2023 this has been further increased. See above.
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IRAs and other retirement funds are excluded from resource limits for this program, even if not in distribution status.
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10 ADM -02 10ADM-02 - Medicaid Buy-In Program for Working People with Disabilities Medical Improvement Group (Mar. 3, 2010)(attachments available here )(concerns continuing eligibility for people no longer eligible for disability under the "basic coverage" group because of medical improvement, but who still have a severe impairment)
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09MA015 - Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) Work Requirement: Documentation Change (local districts may no longer require that an individual document payment of applicable taxes in order to demonstrate work activity. (May 15, 2009)
- GIS 08 MA 027 - Medicaid Buy-In Program for Working People with Disabilities: Work Requirement (9/23/2008) - "There is no minimum number of hours that an individual in the MBI-WPD Basic Coverage group must work per month nor is there a minimum wage requirement... Seasonal work may be considered work for the MBI-WPD program for the duration of the employment. If the work ends, a grace period of up to 6 months in a twelve-month period may be granted if the individual continues to look for employment. If the recipient has not secured employment by the end of the grace period, his or her eligibility for MBI-WPD ends and continued eligibility under other Medicaid programs must be considered."
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DOH GIS 08 MA/004 (February 2, 2008). Among other things, clarifies that Substantial Gainful Activity (SGA) "... is a factor in determining disability for the Aid to Disabled (AD) program and is not considered for the MBI-WPD program because recipients in that program are expected to work."
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04ADM-05 - Medicaid Buy-In Program for Working People With Disabilities (MBI-WPD): Transition of the MBI-WPD Program to Local District Staff (July 20, 2004),
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03ADM-04 - Interim Implementation of the Medicaid Buy-In Program for Working People with Disabilities (replaced by 04-ADM-05 above)
Advocacy Information and Training Materials
This article was authored by the Empire Justice Center.
