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  Thanks to AB from Madison, WI.  Here is his comment posted on April 30.  Since most people won’t see this, I decided to include it as part of our daily post.  The website he referenced is reproduced below his comment.  I just took it from the Social Security Website.  Thanks AB for your clarification. 

This is part of a larger federal mandate intended to stop making people with disabilities choose between working and having health coverage. It looks like Florida is either finally getting around to implementing this federal change or is modifying the way state rules apply. Here’s a quick link for more info: http://www.ssa.gov/disabilityresearch/wi/buyin.htmHave a great day!
-AB in Madison WI

 

States can extend Medicaid coverage to certain disabled people who work. Under Section 4733 of the Balanced Budget Act of 1997, States have the option to provide Medicaid to working people with disabilities whose earnings are too high for them to qualify for Medicaid under existing rules. A person may qualify if he or she:

  • Is in a family whose net income is less than 250 percent of the national poverty level for its size (i.e., the poverty limit for a family of three is $16,090 in 2005, so the limit for this program is $40,225).
  • Meets the definition of “disabled” under the Social Security Act and would be eligible for Supplemental Security Income (SSI) payments if it were not for his or her earnings.

A person is not required to be receiving SSI in order to be eligible under the Medicaid provision. However, if not an SSI recipient, the State decides if he or she is disabled.

The fact that the individual is working will not be considered when making the disability decision for this law.

EXAMPLE

Here is an example of how this provision could work.

The Federal poverty level for an individual is $9,570 in 2005. The net income test for help under this provision is income of less than 250 percent of the Federal poverty level, ($23,925). Joe Green’s gross annual earnings are $42,765. After the SSI earned income exclusions, he meets the net income test for Medicaid and is eligible under this provision, as follows:

 
$42,765.00
  annual earnings
÷
12
   
 
$3,563.75
  monthly earnings
$85.00
  general and earned income exclusions
 
$3,478.75
   
$1,739.37
  exclusion of half remaining earned income
 
$1,739.37
  monthly countable earnings
x
12
   
 
$20,872.44
  yearly countable income

In this example, Mr. Green’s net income of $20,872.44 is below $23,925 limit for an individual.

The Ticket to Work and Self-Sufficiency Program is the centerpiece of new legislation (signed into law by President Clinton in December 1999) under the Ticket to Work and Work Incentives Improvement Act of 1999. This law includes several important opportunities for people who receive Social Security disability benefits who want to go to work.

Effective October 1, 2000, one of the provisions of this new law expands States’ options under Medicaid.

  • States can cover working individuals with disabilities who are at least age 16, but less than 65 years of age using income and resource limits set by the State, and       

  • States can provide Medicaid to employed individuals covered under the group described above, who lose that coverage due to medical improvement, but who still have a medically determinable severe impairment.

The Social Security Administration and the Center for Medicare and Medicaid Studies (CMS) are encouraging States to participate in this new program and has information on the State Medicaid Buy-In program. (This link will open in a new window.)

 

How to Apply

To apply for assistance under this new rule, you should first contact the State Medicaid office in your area to find out if your State participates or plans to participate.

 About the time I’m convinced that this blog should be mostly, if not all devotional, I get something like this in my e-mail box.  It is a bill that gives people the ability to buy into the Medicaid program, even if they become ineligible because they go to work and have a higher income.  The law reads as though there is currently a buy-in program, but no one seems to know about it, if it exists.  There are still lots of questions that don’t seem to be answered.  Is the Medicaid buy in program part of a larger federal program?  How much do you need to make before you must opt out?  What is the cost?  Can those who never had medicare because they worked but never had insurance either buy in? 

    

HB 1311 2008

CODING: Words stricken are deletions; words underlined are additions.

hb1311-00

Page 1 of 2

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S

1 A bill to be entitled

2 An act relating to optional payments for medical

3 assistance; amending s. 409.904, F.S.; providing for

4 Medicaid eligibility for certain persons with disabilities

5 under a Medicaid buy-in program, subject to specific

6 federal authorization; requiring the Agency for Health

7 Care Administration to seek amendments to specified

8 Medicaid waivers for certain persons with disabilities;

9 providing an effective date.

10

11 Be It Enacted by the Legislature of the State of Florida:

12

13 Section 1. Subsection (10) is added to section 409.904,

14 Florida Statutes, to read:

15 409.904 Optional payments for eligible persons.–The

16 agency may make payments for medical assistance and related

17 services on behalf of the following persons who are determined

18 to be eligible subject to the income, assets, and categorical

19 eligibility tests set forth in federal and state law. Payment on

20 behalf of these Medicaid eligible persons is subject to the

21 availability of moneys and any limitations established by the

22 General Appropriations Act or chapter 216.

23 (10) Subject to specific federal authorization, a person

24 who is determined to be disabled and who, but for earnings,

25 would be considered for receiving supplemental security income;

26 whose countable earnings, taking into account supplemental

27 security income earned income disregards, do not exceed 250

28 percent of the federal poverty level and whose unearned income

HB 1311 2008

CODING: Words stricken are deletions; words underlined are additions.

hb1311-00

Page 2 of 2

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S

29 does not exceed 88 percent of the most current federal poverty

30 level; who has attained 16 years of age but who is less than 65

31 years of age may be eligible for Medicaid services as part of a

32 Medicaid buy-in program established under s. 409.914(2)

33 specifically designed to accommodate those persons made eligible

34 for such a buy-in by Title II of Pub. L. No. 106-170. A

35 participant in the Medicaid buy-in program must be charged a

36 premium based on a sliding scale once the participant’s earned

37 income exceeds 100 percent of the federal poverty level.

38 Additional assets excluded under the supplemental security

39 income program are as follows: cash assets in the amount of

40 $8,000 for a single individual and $9,000 for a couple; any

41 retirement account recognized by the Internal Revenue Service;

42 and a second vehicle for a couple.

43 Section 2. The Agency for Health Care Administration shall

44 seek amendments to Medicaid waivers serving persons with

45 disabilities to provide that persons who are eligible for

46 Medicaid under a Medicaid buy-in program authorized under s.

47 409.904(10), Florida Statutes, may be eligible for services

48 under waivers if they otherwise meet the level of care

49 qualifications for services under such a waiver.

50 Section 3. This act shall take effect July 1, 2008.