Substantial gainful activity isn’t an eligibility consideration. A person could be eligible at time of application for the buy-in despite earnings in excess of the substantial gainful activity amount. Most states require proof of earned income. States could effectively increase the Medicaid resource limits by disregarding resources above the $2,000 SSI resource standard both at time of application as well as post-enrollment. States could charge premiums or other cost-sharing charges with no federal limit on the amount they charge. There is no age limit per se (e.g., the person must be under age 65) with a BBA-authorized MBI. Section 201 of the Ticket to Work and Work Incentives Improvement Act of 1999 (Ticket Act) created a second MBI program with several key provisions to make the buy-in program more attractive: It allows states to offer a buy-in to individuals at any income or resource level the state elects to establish. Individuals must have earned income to qualify for this Medicaid option in all states. CMS now allows states to require cost sharing and affordable premiums, based on income on a sliding scale. A state could require some individuals to pay the full premium as long as the premiums don’t exceed 7.5 percent of the individual’s total monthly income. The state must require payment of 100 percent of the premium for individuals with incomes over approximately 450 percent of the federal poverty level. MBI enrollees authorized by the Ticket Act must be at least 18 but below 65 years of age. CMS provides an overview of the Medicaid Buy-In option at the following website at: Optional Group #2: Medically Needy
Substantial gainful activity isn’t an eligibility consideration. A person could be eligible at time of application for the buy-in despite earnings in excess of the substantial gainful activity amount. Most states require proof of earned income. States could effectively increase the Medicaid resource limits by disregarding resources above the $2,000 SSI resource standard both at time of application as well as post-enrollment. States could charge premiums or other cost-sharing charges with no federal limit on the amount they charge. There is no age limit per se (e.g., the person must be under age 65) with a BBA-authorized MBI. Section 201 of the Ticket to Work and Work Incentives Improvement Act of 1999 (Ticket Act) created a second MBI program with several key provisions to make the buy-in program more attractive: It allows states to offer a buy-in to individuals at any income or resource level the state elects to establish. Individuals must have earned income to qualify for this Medicaid option in all states. CMS now allows states to require cost sharing and affordable premiums, based on income on a sliding scale. A state could require some individuals to pay the full premium as long as the premiums don’t exceed 7.5 percent of the individual’s total monthly income. The state must require payment of 100 percent of the premium for individuals with incomes over approximately 450 percent of the federal poverty level. MBI enrollees authorized by the Ticket Act must be at least 18 but below 65 years of age. CMS provides an overview of the Medicaid Buy-In option at the following website at: Optional Group #2: Medically Needy