Hi R,
Things have ben busy for me between travel and work, but here is an idea of what NY State is doing.
I haven't encountered anyone who is working with this program (I'll update this thread if I hear anything), and I don't know their formulary, but TBarrett wrote about it last year - she may be able to share:
http://ihatedialysis.com/forum/index.php?topic=22287.0This is what NY State has to say about it:
http://www.health.ny.gov/health_care/medicaid/program/buy_in/Medicaid Buy-in Program
•What is the Medicaid Buy-In Program for Working People with Disabilities?
The Medicaid Buy-In program offers Medicaid coverage to people with disabilities who are working, and earning more than the allowable limits for regular Medicaid, the opportunity to retain their health care coverage through Medicaid. This program allows working people with disabilities to earn more income without the risk of losing vital health care coverage.
•Who is eligible?
To qualify for the Medicaid Buy-In program for Working People with Disabilities you must:
■Be a resident of New York State;
■Be at least 16 years of age (coverage up to 65 years of age);
■Have a disability as defined by the Social Security Administration;
■Be engaged in paid work (includes part-time and full-time work);
■Have a gross income that may be as high as $55,476 for an individual and $74,580 for a couple; and
■Have non-exempt resources that do not exceed the Medicaid resource level of $20,000 for a one-person household and $30,000 for a two-person household.
NOTE: Effective October 1, 2011, retirement accounts that previously would have been counted as a resource will be disregarded in determining eligibility for this program. Countable retirement accounts are annuities or work-related plans for providing income when employment ends. They include but are not limited to: pensions; Individual Retirement Accounts (IRAs); 401(k) plans and Keogh plans.
•Who will determine if I have a disability?
The Disability Review Team at the local Social Security Administration (SSA) office determines disability for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits. A determination of disability by SSA will be accepted as proof of disability for the Medicaid Buy-In program for Working People with Disabilities. If you have not been certified disabled through SSA, you will need to have a disability review done by New York State Disability Review Team. Your local social services district worker (county social services worker) is available to advise you of the process.
•What if I already work, meet the Social Security Administration's definition of being disabled, and receive Medicaid coverage with a monthly spenddown?
If you are already working and receive Medicaid coverage with a monthly spenddown and meet the Social Security Administration's definition of disabled, you still have the option of participating in the Medicaid Buy-In Program for Working People with Disabilities.
•Will I have to pay a premium for coverage?
It depends on how much income you have. There may be a modest premium based on your income. This determination will be made when you apply for the program. At the present time, there is a moratorium on premiums.
•What are Community Work Incentive Coordinators (CWICs)?
Community Work Incentive Coordinators (CWICs) work under a project called Work Incentive Planning and Assistance (WIPA) that is sponsored by the Social Security Administration. CWICs are individuals who help people with disabilities make the most of programs that are offered. CWICs know about programs such as Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Medicaid and Medicare. They can help you make choices about employment options that are best for you. To find a CWIC in your area:
■Call your local Social Security Administration office or
■Call the Statewide Technical Assistance Line toll-free at (888) 224-3272 TDD (716) 847-1322 or
■Visit the SSA website at
https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate•What if I already have health insurance through my employer?
If you have health insurance coverage through your employer, you should keep the insurance and talk with your local social services district worker. Medicaid may cover the cost of the premium for that insurance coverage. If you have family coverage through your employer you may wish to keep that coverage as the Medicaid Buy-In program for Working People with Disabilities does not offer family coverage.
•If I enroll in the Medicaid Buy-In program for Working People with Disabilities, will my family also be covered?
Single people and married couples, if both individuals are working and disabled, are covered under this program. Spouses without a disability and children may be covered through other comprehensive State insurance programs such as Child Health Plus, Family Health Plus, and/or the Healthy New York Program.
•Will I be given the option to choose Managed Care?
Participants in the Medicaid Buy-In program for Working People with Disabilities will be given the option to choose managed care if their income is below 150% of the Federal Poverty Level.
•Where can I apply for the Medicaid Buy-In Program for Working People with Disabilities?
Applications must be completed and submitted to your Local Department of Social Services office.
•If I am getting SSI checks along with Medicaid coverage and I begin working and earning enough money to stop the SSI checks, will I also lose my Medicaid coverage?
Currently, if you receive SSI payments and begin earning enough money to stop SSI cash payments, you may still be able to keep Medicaid coverage under a federal work incentive program known as 1619(b). A working person with a disability in New York State in 2011 may have up to $45,454 in income before losing Medicaid coverage.
Under 1619(b), if your gross earnings are higher than $45,454 you may qualify for a higher threshold. An Individual Threshold can be calculated for you by the Social Security Administration office if you have:
■Impairment-related work expenses
■Blind work expenses
■A Plan to Achieve Self-Support (PASS)
■Publicly funded attendant or personal care; or
■Medical expenses above the State per capita amount
If you lose eligibility for Medicaid under 1619(b), you should contact your Local Department of Social Services office immediately to see if you qualify for the Medicaid Buy-in program for Working People with Disabilities.
•Who can tell me if I am eligible?
Your Local Department of Social Services will review your application and tell you if you are eligible for the program.
Other Helpful Resources
Medicaid Buy-In program for Working People with Disabilities Toolkit
•Medicaid Buy-In program for Working People with Disabilities Toolkit! (PDF, 97KB, 21pg.)
For information regarding this and other Medicaid programs
•Call the Medicaid Help line at 1-800-541-2831 or TDD 1-800-662-1220
•Contact your Local Department of Social Services Office
For more information about the Social Security Administration's (SSA) work incentives programs, such as 1619(a) and 1619(b).
•Call toll free 1-800-772-1213
•Contact your local Social Security office
•Visit the SSA web site at
http://www.socialsecurity.gov/redbook/eng/guide-employment-supports.htm#13 and
http://www.socialsecurity.gov/redbook/eng/guide-employment-supports.htm#19.
To locate a Community Work Incentive Coordinator (CWIC) near you or to find out more information about how work will affect your benefits:
•Call the Statewide Technical Assistance Line toll-free (888) 224-3272 or TDD (716) 847-1322
•Visit the SSA website at
https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate•Call an Independent Living Center in your area (LINK to ILC directory:
http://www.nysilc.org/directory.htm)
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