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


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,


💮 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.”


💮 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.


💮 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.


💮 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


💮 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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20 thoughts on “How to Get or Keep Medicaid While Working (For People with Disabilities)”

  1. I’m trying to get the Medicaid Buy In for Working People with Disabilities in New York, but I have too much in savings. Is there some other way to get coverage or a loophole? I really need insurance and home care asap, and the NY state of health marketplace plans are terrible.

    Liked by 1 person

    1. You could meet with a lawyer who specializes in special needs trusts. If your savings go into a trust, they will not count.

      Or, If you were first disabled before age 26, you could open an ABLE account and put the savings there. You can contribute 15k per year.

      Liked by 1 person

  2. Do we know if Medicaid for Working People with Disabilities covers the cost-sharing of Medicare? Premiums, co-pays, etc? For instance: I am currently eligible for Specified Low Income Beneficiary (SLMB) on SSDI alone, but if I make even $2 of income in a month to qualify for MWPD, I will be over the income limit. That shouldn’t be an issue if MWPD covers part-b premium, but I can’t find any information on it.

    Liked by 1 person

      1. I live in Louisiana. I am 67. Have Medicare. Medicaid. Disability. Also have custody of my 11 yr old granddaughter. Will I lose any of these if I work n can’t figure out how much I can


  3. Wow, this is a lot of useful information but very difficult for me to absorb (TBI). Been turned down by MA office because my spouse makes too much money, but we are struggling. Where should I start?


    1. I am trying to get ihss for my grandma in California. She is 92, severe hearing, vision, ambulatory impairment, among other health conditions. She has Medicare, which doesn’t cover ihss. Medical covers ihss, and my grandma qualifies but her share of cost is 1400. She recieves survivor benefits from my grandathers fed gov pension and social security. She was a homemaker and didn’t work much on the books.
      I tried to enroll her for the 250 % working disabled but the worker said she doesn’t qualify because she is not receiving, nor is eligible to receive Disability.
      Is this true? If so, is there any way around it?


      1. I don’t know the specific rules for this program, but in most programs there is another way to qualify as disabled. There is probably a form that her doctor can fill out. The worker may not be familiar with the procedure. You might try asking supervisors. Also, asked to see a written copy of the policy of how they determine disability.

        There was another reader here who was not on Social Security disability and did successfully get in this program. I believe they went through a medical review process in order to qualify.


  4. As far as 1619B goes, if you are working full time and are offered insurance through your work, do you have to take it and lose Medicaid? I know a few people with kids who otherwise would qualify for Medicaid but since their job offers them insurance they are required to take it instead.

    Or is that possibly a state by state thing? I live in Indiana if that’s any help in answering this.


    1. I’m sorry I don’t know the answer to this, but it’s possible to have both medicaid and private insurance. Some people have private insurance through work, and then medicaid acts as a secondary insurance. I don’t know the specifics.


      1. So, my dad who had a stroke, legally blind, on dialysis, and hemiplegia. He is on SSDI and gets about $1550 a month. Medical has him paying supplemental insurance of $300 as monthly spend down in order to qualify for IHSS. Its causing a severe financial hardship. don’t know where to go for help. We live in California.


        1. Hi Rocio,

          Sorry I don’t have a great solution. Many people find it worth it to buy the supplemental insurance.

          The only other option I know would be for him to look into medi-cal for working disabled, I’m not sure what the age limit is. The program is very flexible and some people who are working small at home jobs a few hours per month qualify (i.e. babysitting, pet care, making and selling crafts, etc). There is no spend down for that and they do not count his disability income at all.

          Hope this helps.


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