GIS 14 MA/013: Establishing Medicaid Buy-In Program for Working People with Disabilities Eligibility at Application

The purpose of this General Information System (GIS) message is to emphasize the importance of identifying applicants who would be eligible for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD). When screening applications, the district should consider for the MBI-WPD program, any individual who is certified disabled and working, prior to sending the application to the New York State of Health (NYSOH) for processing. 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 under the medically needy category of assistance, should be checked for eligibility under the MBI-WPD program if the individual is certified or potentially disabled and working. These referrals may be for individuals who are ineligible for Medicaid under a MAGI category of eligibility and who indicated the need for waiver services, home care or personal care services, or who requested that eligibility be determined under a different basis, including 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.