a/k/a Illinois Medicaid Buy-In

Questions and Answers

What is the Medicaid Buy-in program?

The Medicaid Buy-in program allows people with disabilities who are working to enroll in Medicaid, or stay in Medicaid without a spenddown, by paying a monthly premium.

Who is it for?

The program is designed for people who receive SSDI benefits and want to return to work, but won't be able to get health insurance on the job.

What about people who receive SSI or both SSDI and SSI?

People who receive SSI or both SSI and SSDI before they return to work can already keep their Medicaid without a spenddown under the Section 1619 programs. They are better off sticking with those programs because those programs do not require any premiums and have higher income limits.

What are the eligibility requirements?

U.S. citizen or lawful immigrant in a category eligible for Medicaid
Disabled as defined by Social Security
Illinois Resident age16 to 64
Employed (someone is making FICA contributions)

What are the income and asset rules?

Assets less than or equal to $10,000 (usual exemptions apply, including your home, a car you need to get to the doctor)
Countable income less than 200% of the federal poverty level (currently $17,724 per year, or $1,477 per month)
Income includes any Social Security or other income, as well as work income
Income includes spouse's income
Deductions from income include taxes, transportation, day care expenses, union dues, life insurance or retirement plan withholding, special work expenses, small lunch allowance ($9 per month)

How much are the premiums?

Premiums vary from nothing to $100 per month, depending on income, and source of income. Examples:

Person A: Social Security check of $400, countable work income of $200, premium = $25 per month
Person B: Social Security check of $600, countable work income of $600, premium = $50 per month
Person C: Social Security check of $1100. Countable work income of $100, premium = $75 per month.

How does someone apply?

Fill out an application and mail it with the required documentation to

Health Benefits for Workers with Disabilities
P.O. Box 19145
Springfield, IL 62794-9145

You can get an application from the AIDS Legal Council of Chicago, from the SSI Coalition for a Responsible Safety Net, or by calling 800-226-0768.

No interview is required for the program.

When do benefits start?

Benefits do not start until premiums are paid. If the first premium is paid before the 20^th of the month, benefits will start the 1^st of the next month. If the first premium is paid after the 20^th of the month, benefits will start a month later.

Can benefits be retroactive?

Yes. Like other Medicaid programs, benefits can be retroactive three months before the month of applications (example, you apply in March: benefits can be retroactive to December). But you will have to pay premiums for the retroactive months.

When are benefits terminated?
Benefits can be terminated for the following reasons:
Failure to pay premiums
Failure to provide proof of employment
Stopping employment for medical reasons for more than 90 days
Stopping work for any other reason for more than 30 days

Who can answer questions?

You can call the Illinois Department of Public Aid at 800-226-0768. Most legal services programs and disability rights groups will also be able to answer questions about the program. You can also call the SSI Coalition.

Prepared by the AIDS Legal Council of Chicago, January 2002. You can contact the Council at 312-427-8990.

Reprinted with Permission.
HDA: Health & Disability Advocates
Health & Disability Advocates
For A Responsible Safety Net
Security with Dignity for Low Income Elderly and Disabled

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