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VA Medicaid Buy-In

The Appropriations Act of 2006 authorized an amendment to the Virginia State Plan for Medical Assistance that allows certain individuals with disabilities (including blindness) to retain Medicaid coverage by cost-sharing through the payment of a premium as long as they remain employed and their earned income does not exceed twice the Federal Poverty Level.

This type of cost-sharing arrangement is known as a Medicaid Buy-In (MBI) program. MEDICAID WORKS is Virginia's MBI program.

See the Medicaid WORKS topics for current Medicaid Buy-In information.

NOTE: See the MEDICAID WORKS topics for current Medicaid Buy-In information as actually implemented.

All information below is presented for archival purposes only, and summarizes the multi-year planning stages of the program.

The 2002 Virginia General Assembly passed HJ 219/SJ 128, requesting the Department of Medical Assistance Services (DMAS), in collaboration with the Department of Rehabilitative Services (DRS) and the Virginia Office for Protection and Advocacy, to proceed with the development of a Medicaid "Buy-In."

A Medicaid Buy-In program would allow working people with disabilities to pay a premium to participate in the State's Medicaid health care program, as though they were purchasing private health care coverage. This historic program change promises to remove major disincentives for people with disabilities who are willing to work, but cannot because they risk loss of health care coverage (Medicaid) if they earn too much income.

NOTE: See the DMAS website pages for the latest news about the Medicaid Buy-In Waiver proposal and CMS action on it. An index of available information may be found at:
http://www.dmas.virginia.gov/mb-home.htm

Proposed Model Design Summary

It is hoped that this program design will create the appropriate infrastructure for a Buy-In that effectively encourages a significant employment effort, while controlling the participation level and costs. This proposal describes a Medicaid Buy-In (MBI) waiver option to enable Medicaid coverage for approximately 200 individuals with disabilities, based on an appropriation of $430,000 for the second half of FY 2004, with the following features:

Income Limits

·             Maximum unearned income requirement per month of 80% of the Federal Poverty Level (about $621/month in 2004).

·             Minimum gross earned income requirement per month of $400 (roughly equivalent to 80 hours per month at the current current minimum wage level of $5.15 per hour).

·             Total income limit of 175% FPL based on Supplemental Security Income (SSI) methodology for countable income.

·             Spousal income is not considered in determining the individual's eligibility for the MBI program.

Resources Limits-$7,500

·             Maximum allowable resources of $7,500, excluding earnings from the MBI participant that are placed in IRS approved retirement accounts and medical savings accounts which are initiated after Buy-In enrollment (Retirement accounts and medical savings accounts existing before Buy-In enrollment are counted toward the maximum allowable resources of $7,500).

Cost-sharing - Premiums at 5% of income

·             Premium requirements begin with the first month of MBI enrollment and are charged at 5% of countable income, with a minimum premium charge of $25.00.

·             Spousal income is considered in determining the premium responsibility for the individual to participate in the MBI program (Spousal income of up to 175% FPL will be disregarded in determining premium requirements; however, 5% of amounts above 175% FPL will be assessed as part of the participant's premium).

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Department of Medical Assistance Services (DMAS) communication.

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