Benefits for workers with disabilities under Medicaid
The Medicaid buy-in program allows people with disabilities who are working to enroll in Medicaid, or stay in Medicaid without a spenddown, by paying a monthly premium. The program is designed for people who receive SSDI benefits and want to return to work, but won’t be able to get health insurance on the job.
People who receive SSI or both SSI and SSDI before they return to work can already keep their Medicaid without a spenddown under the Section 1619 programs. They are better off sticking with those programs because they do not require any premiums and have higher income limits.
In order to qualify for the Medicaid buy-in program, you must be:
- A U.S. citizen or lawful immigrant in a category eligible for Medicaid;
- Disabled (as defined by Social Security);
- An Illinois resident age 16 to 64; and
- Employed by an employer that makes FICA contributions
Also, your property or assets must not be worth more than $25,000 (usual exemptions apply, including your home and a car you need to get to the doctor). Your income must be equal to or less than 350% of the federal poverty level. Income includes:
- Social Security or other income
- Spouse’s income
Deductions from income include taxes, transportation, day care expenses, union dues, life insurance or retirement plan withholding, special work expenses, and the small lunch allowance ($9 per month).
How to apply
To apply for the program, fill out an application and mail it with the required documentation to:
Health Benefits for Workers with Disabilities
P.O. Box 19145
Springfield, IL 62794-9145
No interview is required for the program.
When benefits start
Benefits do not start until premiums are paid. If the first premium is paid before the 20th of the month, benefits will start the 1st of the next month. If the first premium is paid after the 20th of the month, benefits will start one month later.
Like other Medicaid programs, benefits can be retroactive 3 months before the month of applications. For example, if you apply in March, you can get benefits for the past December, January and February. But you will have to pay premiums for the retroactive months.
When benefits end
Benefits can end because of the following reasons:
- Failure to pay premiums
- Failure to provide proof of employment
- Stopping employment for medical reasons for more than 90 days
- Stopping work for any other reason for more than 30 days
Updated: February 2017