How to Get or Keep Medicaid While Working (For People with Disabilities)

Art: Robin Mead

“I am bedridden and cannot work outside the home. However, when I am able I enjoy making jewelry and crafts in bed. I started selling them on Etsy. Then a friend told me that I would be considered self-employed and I could apply for Medicaid for Working Disabled. So I applied and it got approved! Now Medicaid pays 100% of all my doctors bills and prescriptions, but the best thing is it also provides me with a personal care attendant 20 hours per week in my home.”  – Juniper

“People aren’t aware of Medicaid programs for working adults while disabled. People think Medicaid is only for really poor people. One of the ADAPT protestors who was arrested in Colorado is a full-time attorney. She has Medicaid, which provides services so she can live at home, get assistance getting in and out of her wheelchair, take care of her kids, and work.” – Pansy

“My sister had $300 per month in medicaid spend down expenses. She started tutoring a neighbor’s child, and we helped her apply for Medicaid for Working Adults with Disabilities. Now she tutors a one afternoon each week (which she likes doing) and she pays $20 per month for Medicaid. All her medical expenses and surgeries are covered.” – Sweet Pea

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MEDICAID FOR WORKING PEOPLE WITH DISABILITIES

Good news about Medicaid and working while disabled. If you start working, you may be able to keep Medicaid, even if you would not normally qualify.

While rules vary by state, many states have no work minimums and people with small at-home businesses often qualify for this program,

OPTION ONE: MEDICAID BUY INS

💮 Most states have a program called Medicaid Buy In for Working Adults with Disabilities (available in about 45 states. Please check your state as Medicaid programs constantly change)

💮 You do not need to be on Social Security disability to qualify for this program, but if you are not on disability you will need to go through a process of being determined disabled by the state.

💮 You will pay a small monthly fee. Usually $20-$100, depending on your income level.

💮 Many people with disabilities in this program are not able to work outside the home, but run small at-home businesses, (babysitting, pet sitting, tutoring, jewelry making, etc.)

💮 “Medicaid buy ins” are not the same as “Medicaid spend downs”. Spend downs are evil. You do not want them.

💮 In some states they will not count your assets. You can qualify even if you have too much money in the bank.

💮 In some states you can earn $75,000 per year and still keep Medicaid

💮 In many states they will not count any of your spouse’s income.

💮 Do not get scared off if you see an income limit for unearned income. In some states they do not count your disability payments in this income.

💮 Many states have no minimum work requirement. For example, the state Medicaid website in California: “There are no minimum hours or amount you must earn in order to be eligible. For example, your work activity could be regularly picking up recyclable items to earn income.”

💮 If your disability benefits stop because you’ve earned too much, you can still be considered disabled for the purposes of this program. You may still need ongoing medical records showing that you continue to be disabled. They will use all the same criteria to decide if you are still disabled, except they will disregard the amount you earn.

💮 You won’t get automatically enrolled in this program. You need to contact your Medicaid office and ask how to apply for Medicaid Buy-In For Working People with Disabilities. It may have a different name in your state. The people who answer the phone may or may not know what this program is.

💮 In many states, it is possible to find this program by googling the name of your state and the words: medicaid working disabilities.

💮 Pro tip: In states with minimum requirements for hours, there is often no minimum requirements for earnings. This is especially important for people who are self-employed. From Mass Legal Services “Advocates report that the MECs apply a flexible standard in recognizing employment, sometimes using a $1 per hour rule of thumb to identify employment.”

💮 Pansy got Medicaid through this program and it covered her $40,000 hospital bill. Here’s how she did it: How Pansy Got on Medicaid By Being Smart, Scrappy & Persistent

💮 Reader’s Tip: “Some states require earning income every so often, even if it is a dollar. In my state of New Jersey, I think it is every 6 or 8 weeks. They might terminate if it has been a while. Minimum requirement is $400 a year here.”

OPTION TWO: SECTION 1619B

💮 This program is for people on SSI (not SSDI). If you are on SSI and already have medicaid, this program will allow you to keep your Medicaid when you go back to work.

💮 If you are on Medicaid, you may be able to keep your Medicaid even if you go back to work and earn too much money too continue disability benefits.

💮 This is called Continued Medicaid. Learn more about the policy here: Section 1619b

💮 In some states you can earn $55,000 per year and still keep Medicaid!

💮 In the ideal world, the Medicaid office should continue your Medicaid automatically. If you run into a problem, or they don’t know the rules, show them the Section 1619b policy for your state.

OTHER OPTIONS

💮 There are several other Medicaid programs you might be eligible for. These programs are not specific for working people with disabilities. Check out: How to Get Medicaided

💮 If you are on Medicare, you may wish to start by looking into the programs above as most will pay all your co-pays and often cover premiums as well. If those don’t work out, you can also look into Qualified Disabled and Working Individuals (QDWI) Program in your state. This does not provide full Medicaid but will cover the cost of your Medicare Part A premium.

IF SOMEONE AT THE MEDICAID OFFICE SAYS YOU DON’T QUALIFY

💮 Don’t listen

💮 Learn the rules yourself.

💮 If you read this whole page, you may already know more than the person you are talking to.

💮 Reader’s Stories: How to Respond When You Are Told You Can’t Get Medicaid

GET HELP

💮 If you want help figuring out your benefits, you can try contacting a Centers for Independent Living in your area and ask if they can connect you with someone who can advise you on working and benefits.

💮 You can also get benefits counseling through Work Incentives Planning Assistance programs. Note: Some work incentive programs are designed to help you go back to work full time and transition off benefits.

💮 Disability Benefits 101 – Great information on working while receiving disability benefits in Alaska, Arizona, California, Kentucky, Michigan, Minnesota, Missouri, New Jersey, and Ohio

💮 In Nevada: Work Program in Nevada

💮 In Massachusetts: Work Program in MA

💮 In Nebraska: Medicaid for Working

💮 Learn a whole bunch more here: How to Work While on Disability

What Do You Think? 

Updated January 2019. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. 

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