Background

HISTORY

The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) program is a federal and state effort that grants states the ability to extend Medicaid coverage to working people with disabilities. Although some individuals with disabilities who work are eligible for Medicaid, many others have historically risked losing coverage because of additional earnings. Loss of Medicaid means lost coverage for valuable health services essential to their success in the workplace – services typically not covered by private insurance. The MBI-WPD program is a response to these concerns.

The Balanced Budget Act of 1997 allowed states to establish the MBI-WPD. The Federal Ticket to Work and Work Incentives Improvement Act of 1999 extended the MBI -WPD program to include those who lose disability status under the Social Security Administration. Both acts give states great flexibility in designing income and asset limits, as well as cost sharing requirements for their MBI-WPD program. This flexibility, combined with state-specific variation in the traditional Medicaid program, means that MBI-WPD programs vary greatly state to state.

New York State, in January 2002, passed the NYS Health Workforce Recruitment and Retention Act, which implemented the MBI-WPD in NYS in July 2003. With the implementation of the MBI-WPD working New Yorkers with disabilities can earn more income without the risk of losing their Medicaid coverage.

WHO ADMINISTERS THE PROGRAM

The overall responsibility for the administration of the Medicaid program, including the MBI-WPD program, on the federal level lies with the Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services. CMS has primary responsibility for the formulation of policy and guidelines, maintenance and review of utilization records, and general financing.

In New York State the NYS Department of Health has overall administrative responsibility for the MBI-WPD and oversees the implementation of MBI-WPD. In NYC, the Medical Assistance Program (MAP) of the Medicaid Insurance and Community Services Administration (MICSA) within the Human Resource

Administration (HRA) has responsibility for the administration of the MBI-WPD. MAP oversees the determination of eligibility, application and renewal process of the MBI-WPD program. Outside of NYC, the MBI-WPD is administered by the County Departments of Social Services.

FUNDING

Costs shares of the MBI-WPD participants will be at the regular cost share rate of 50% federal, 25% state and 25% local.

Summary of the Medicaid Buy-In Program

The MBI-WPD program allows individuals with disabilities to maintain their Medicaid benefits when they work or return to work and their total income would otherwise make them ineligible for Medicaid. The MBI-WPD program offers the same Medicaid benefits that are covered through regular community-based Medicaid benefits and community based long term care benefits, but not institutional long-term care services in a skilled nursing facility. Individuals who have other health insurance are eligible for the MBI-WPD program, although Medicaid will be the secondary payer. Most MBI-WPD recipients must enroll in a managed care plan to receive Medicaid services.

An individual must be disabled, between the ages of 16 through 64, engaged in work, and meet the MBI-WPD program’s residency, citizenship/immigration status, income and resource guidelines.

Applicants for the MBI-WPD program may apply at a local community Medicaid office. The MBI-WPD application is the DOH-4220, Access NY Health Care.

A determination of eligibility is generally made within 45 days of the date of application when an applicant has certification of disability. When an applicant does not have a certification of disability, they can request a disability review by the NYS Disability Review team, which is generally made within 90 days.