Medicaid Buy-In Program for Working People with Disabilities
Online Guide

Medicaid Buy-In Program for Working People with Disabilities
(MBI-WPD) Online Guide

Welcome to the NY Makes Work Pay Medicaid Buy-In for Working People with Disabilities (MBI-WPD) website.

In it, you will find information to prepare to apply for the program and to apply for the program.

The MBI-WPD program that started on July 1, 2003 allows New Yorkers with disabilities to continue working or return to work without fear of losing their essential health care coverage through Medicaid.

Traditionally, New Yorkers with disabilities have had to limit their wages, or pay high "spenddowns" in order to retain or access Medicaid. Through New York State's MBI-WPD program, they will no longer have to do either.

What this means for thousands of New Yorkers with disabilities is independence, recovery, and support in achieving goals. In the past, if you had a disability and worked, it was easy to earn too much and lose your health benefits. Now, the rules have changed.

If you complete the steps in this website, your application will be ready before you step foot in a Department of Social Services office or in New York City, the Human Resources Administration (HRA)/Medicaid office.

The information on this website is based in large part on the Medicaid Buy-in For Working People with Disabilities Toolkit developed by the New York State Department of Health and found at www.health.state.ny.us

Frequently Asked Questions


Why is the Medicaid Buy-In program for Working People with Disabilities important?

According to a national survey, the #1 reason that people with disabilities gave for not working was fear of losing their essential medical benefits. This program allows people to keep their benefits, meet their medical needs and to continue working. Medicaid coverage is more comprehensive than many other programs including private health insurance. Medicaid covers the medical costs of prescriptions, long-term care, and ongoing medical supplies. Medicare and some private health insurance companies do not cover all of these costs.

Why is it called the Medicaid Buy-In program for Working People with Disabilities?

The term "Buy-In" is used because you are buying in (paying a premium) to the Medicaid program. If your net available income is below 150% of the Federal Poverty Level (FPL), you will not have to pay any premium to get Medicaid through the MBI-WPD program. If your net available income is at least 150% but at or below 250% of the FPL, you will have to pay a premium to obtain your Medicaid through the MBI-WPD program. However, New York State is not collecting premiums at the present time.

What is the difference between the Basic Group and the Medical Improvement Group?

For both groups you must meet the age, work, citizenship or satisfactory immigration status, residency, income and resource requirements. Additionally, for the Basic Group you must have certification of a disability. To be eligible for the Medical Improvement Group, you must have lost eligibility under the Basic Group due to medical improvement. In the Medical Improvement Group, you must be working a minimum of 40 hours per month at no less than federal minimum wage.

What is considered work?

Work is any activity for which you receive payment. This can be full time or part time. You can even be self-employed.

How much money do I have to make in order to apply?

Under the Basic Group of the MBI-WPD program, there are no requirements on how many hours you work, or how much you are being paid. Under the Medical Improvement Group, you must work a minimum of 40 hours per month earning at least the federal minimum wage.

Can I get Medicaid through the Medicaid Buy-In program for Working People with Disabilities if I get Social Security Disability Insurance (SSDI) benefits?

If you are working, and meet all of the other eligibility requirements, yes, you can get the Medicaid Buy-In program for Working People with Disabilities.

How come 250% of the Federal Poverty Level is approximately $27,225*, yet I can earn up to $55,476*?

When you apply for the MBI-WPD program, your income is put through a budgeting methodology used by the Social Security Administration. In that test, there are deductions from both your earned and unearned income. During this process, much more of your earned income is deducted in order to attain your net available income, while very little is deducted from your unearned income. This allows people to work more, and still keep their benefits. If all of your income comes from earned income, you can earn up to $55,188* gross. If most of your income is unearned, then you would only be able to make $27,225* per year to qualify.

*The dollar amounts quoted are the Federal Poverty Levels for 2011; these amounts change annually.

Will I have to pay Medicaid co-pays and deductibles?

All of the standard Medicaid co-pays and deductibles apply with the Medicaid Buy-In program for Working People with Disabilities.

Is this the same as the Medicare "Buy-In" Program (Medicare Savings Program)?

No. The Medicaid Buy-In program for Working People with Disabilities (MBI-WPD) is a program that launched July 1, 2003. The MBI-WPD program provides Medicaid health care coverage for working people with disabilities. The Medicare Savings Program (MSP) assists people who are on Medicare through age or disability by paying their monthly Medicare premiums. See the comparison chart included in this toolkit for more information.

How do I go about getting the MBI-WPD program?

You can apply for the MBI-WPD at your Local Department of Social Services (LDSS). This online guide will help you in the process of preparing to apply for the Medicaid Buy-In program for Working People with Disabilities.

Are there any services available to help me decide if I would like to apply for the Medicaid Buy-In program for Working People with Disabilities?

Your local Work Incentive Planning and Assistance (WIPA) can provide you with information about the MBI-WPD, and help you decide if you should apply. It is especially important if you are in receipt of Social Security Disability Insurance (SSDI) to seek advice prior to applying for the MBI-WPD program. Lists of local WIPAs for your area are enclosed in this toolkit. Help Support

What if I am working and have not been on any benefits for some time?

It is not a requirement that you be on any kind of assistance or receive any kind of benefits in order to qualify for the MBI-WPD. As long as you are working and meet the Social Security guidelines for disability, you may qualify for the MBI-WPD.

What if I am working, have a disability, and have never received SSI or SSDI?

You can still qualify for the MBI-WPD program if you are determined disabled by the Local or State Disability Review Team and you meet all the other eligibility requirements.

How much can I have in resources?

You can have countable resources up to the Medicaid resource level — this figure is increased January 1 each year. As of October 1, 2011 the Medicaid resource level is $20,000 for an individual and $30,000 for a couple. This does NOT include your home or vehicle. Additionally, as of October 1, 2011, retirement accounts are exempt. Your Local Department of Social Services can tell you what other resources are exempt. See the Resources Worksheet on this website for further information about resources.

What if I am already getting Medicaid through spenddown?

If you are on the spenddown program and working, you should talk with your Social Services caseworker about the MBI-WPD program. In most cases, you will save money by enrolling in the MBI-WPD program. If you apply for the MBI-WPD program, you should keep meeting your spenddown while you are waiting for a decision on your MBI-WPD application.

What application can I use to apply for the Medicaid Buy-In program for Working People with Disabilities?

The following application forms will be accepted for the MBI-WPD program provided the application form is completed and signed by the applicant

It is recommended that you write "MBI-WPD" on the top right hand corner of the application to help route your application.

Is there follow-up I need to do after handing in my application to a specific worker at social services?

If you receive a request for missing information, you need to get all requested information to the LDSS office as quickly as possible (within 10 days) in order for your application to be processed. You can call your eligibility worker at the LDSS and make sure your application is complete.

How long does the application process take?

You should receive your notification within 90 days.

What should I bring when I go to LDSS to apply for the MBI-WPD program?

Please refer to the "Medicaid Documentation Checklist" enclosed in this website. It will be a guide to exactly what you should bring when applying for the MBI-WPD program.

Does the MBI-WPD cover my children or other family members?

No. The MBI-WPD program is only for individuals or couples who are disabled and working. There are other programs offered by the Local Department of Social Services that cover children and other family members.

© 2010 Cornell University. All rights reserved.