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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

     
        

State Medicaid Buy-In Program Design Features

June, 2006

Table 1.  Medicaid Buy-In Program Income Eligibility Criteria                                Page 2

Whose Income is Counted?

What is the Countable Income Eligibility Limit?

What Disregards apply in determining Countable Income?

Is there a Separate Unearned Income Limit?

 

Table 2.  Medicaid Buy-In Program: Resources Limits and Exclusions                    Page 5

                                                What is the Resource Limit?

                                                                Are Retirement Accounts Excluded from Countable Assets?

                                                                Are Medical Savings Accounts Excluded from Countable Assets?

                                                                Are Approved Accounts for Employment or Independence Excluded?

           

Table 3.   Cost Sharing Policies:  Minimum Income Level and Premium Method    Page 8

                                                Income Level at which Premiums or Cost Shares Start

                                                                Premium is a Percent of Income

                                                                Payment based on Income Brackets

                                                                Separate Premiums or Cost Share for Earned & Unearned Income

 

Table 4. Work-Related Policies and Protections                                                          Page 15

                                                                  Work Requirements

                                                Protections for Temporary Loss of Employment

                                                                Protections When Returning to Other Eligibility Categories


 

 




 

Table 1

Medicaid Buy-In Program Income Eligibility Criteria

 

Whose Income is Counted?

What is the Countable Income Eligibility Limit?

What Disregards apply in determining Countable Income?

Is there a Separate Unearned Income Limit?

Alaska

Individual and spouse for total income;

Individual for unearned income

Two part test:

1. Family net income less than 250% FPL

2. Individual unearned income less than Alaska Public Assistance (APA) standard of need.

Standard SSI disregards

Yes.  Unearned income must be less than APA standard of need.

Arizona

 

Individual

250% FPL

Disregard unearned income and

Standard SSI disregards

Including  disregarding IRWEs

No

Arkansas

Individual

250%  FPL

Standard SSI disregards

Yes. Unearned income must be less than SSI standard plus $20

California

Individual and spouse

250% FPL

Standard SSI disregards

No

 

Connecticut

Individual

450% FPL

$6,250/mo (gross) or $3,082/mo (net) after SSI disregards

Standard SSI disregards

No

Idaho

Individual

500% of FPL

Standard disregards under state Aid to the Aged, Blind & Disabled

No

Illinois

 

Individual and spouse

200% of FPL

Net after taxes

Standard SSI disregards and work related expenses

 

No

Indiana

 

Individual

350% of FPL

Standard Medicaid income disregards in Indiana including IRWE

 

No

Iowa

 

Individual and spouse

250% FPL for family size

Standard SSI disregards

No

Kansas

 

Individual and spouse

300 % FPL

Standard SSI disregards plus IRWEs

No

Louisiana

Individual

250% FPL

Standard SSI disregards

No

 

Maine

Individual and spouse

Two part test:

1. Countable unearned income less than 100% FPL

2. Earned and unearned combined less than 250% FPL.

Standard SSI disregards, plus additional state disregard on unearned or earned income of $55.

Yes. Unearned income limit is 100% FPL plus $75.

 

Maryland

Individual and spouse

300% FPL

Standard SSI disregards

No

 

Whose Income is Counted?

What is the Countable Income Eligibility Limit?

What Disregards apply in determining Countable Income?

Is there a Separate Unearned Income Limit?

Massachusetts

Sec. 1115 Medicaid Waiver

 

 

No income eligibility maximum.

 

 

Michigan

Individual

No income limit

Standard SSI disregards

Yes. Unearned income limit is 100% of FPL

Minnesota

Individual

No income limit.

1902(r)(2) All earned and unearned income ignored

No

Mississippi

 

 

 

 

 

Missouri

Program ended August 28, 2005

Individual and spouse’s income if over $100,000

250% FPL gross income

None

No

Nebraska

Individual and spouse

Two part test:

1. 250% FPL for family size using standard SSI disregards

2. Sum of all unearned and spouse’s earned income less than SSI benefit level for family size

Standard SSI disregards

 

Individual’s earned income disregarded in part 2 of eligibility test. 

Individual’s unearned income if from Trial Work Period.

Yes.  Unless an individual is in a Trial Work Period or Extended Period of Eligibility, SSDI income (minus disregards must be less than SSI income standard.

Nevada

Individual

250 % FPL Net income

Taxes

Some income disregards (not all SSI)

Yes

$699 per month

New Hampshire

Individual and spouse

 

450%  FPL Net income

Standard SSI disregards

No

New Jersey

 

Individual and spouse

250% of FPL

Standard SSI disregards

Yes. Unearned income other than SSDI or SSI has limit is 100% of FPL

New Mexico

 

Individual

250% FPL

Standard SSI disregards and IRWEs and Work related expenses including cost of  heatlh insurance

 

Yes

Unearned income less than $1,090 a month

New York

 

Individual  and spouse

250% FPL Net income

Standard SSI disregards

No

 

North Dakota

 

Family

225% of FPL

Standard SSI disregards

No

Oregon

Individual

250% FPL for individual

All unearned income, standard SSI disregards, and Employment and Independence Expenses.

No

 

Whose Income is Counted?

What is the Countable Income Eligibility Limit?

What Disregards apply in determining Countable Income?

Is there a Separate Unearned Income Limit?

Pennsylvania

 

Individual

250%  FPL net income of individual

Standard SSI disregards

No

Rhode Island

Individual

250% of FPL

Standard SSI disregards including IRWEs

Yes Unearned income no more than 100% of FPL

Or would meet the eligibility requirements under the states Medically Needy program.

 

South Carolina

Individual

250%  FPL

Standard SSI disregard

Yes

Unearned income no more than  Federal SSI standard

Utah

 

Individual and spouse

250%  FPL  net income

Standard SSI disregards

No

Vermont

Individual and spouse

Pre July 1, 2005

Two part  test:

1. Family net income less than 250% FPL

2. Family net income less earnings and $500 of SSDI at or below medically needy protected income level

Effective July 1, 2005

SSDI and Veterans benefits no longer counted toward unearned income limit

Standard SSI disregards.  Disregard all earnings and $500 of SSDI for part 2 of eligibility test.

Effective July 1, 2005

SSDI and Veterans benefits no longer counted toward unearned income limit

Yes. Unearned income limit is the Medically Needy program's Protected Income Level plus $500.

No Effective July 1, 2005

SSDI and Veterans benefits no longer counted toward unearned income limit

Virginia

(Enacted June 06 All details not available)

 

 

 

Yes, Unearned income limit is 80% of Federal Poverty  Level

Washington

 

Individual and spouse

But only individual income if spouse’s income is equal to or less than ½ of the SSI standard.

450% of Federal Poverty level based on gross income for single individual or 450%  of Federal Poverty Level  for couple if married and spouse had income greater than ½ of  Federal SSI standard.

Standard SSI disregards and IRWE’s

No

West Virginia

 

Individual

250% of FPL

Standard SSI disregards and including IRWEs

Yes.

The individual’s unearned income, that does not exceed the SSI Federal benefit standard plus the general income exclusion ($20)

Wisconsin

Individual and spouse

250% net family

 

Standard SSI disregards

No

Wyoming

 

Individual

100% FPL

No disregards

Yes.

Unearned income not in excess of $600 per year

 

Table 2.  Medicaid Buy-In Program: Resources Limits and Exclusions  

                
 

 

What is the Resource Limit?

Are Retirement Accounts Excluded from Countable Assets?

Are Medical Savings Accounts Excluded from Countable Assets?

Are Approved Accounts for Employment or Independence Excluded?

Alaska

$2,000 Individual

$3,000 Couple

Draft regulations proposed by Medicaid agency  for resources limit of : $10,000 individual &

$15,000 couple in mid 2006

No

No

 

No

Arizona

 

No resources limit

Yes

Yes

Yes

Arkansas

 

$4000 Individual

$6000 Couple

No

No

Yes. Up to $10,000 in an Approved Account with interest on account not counted toward limit.

California

$2000 Individual

$3000 Couple

Yes

No

No

Connecticut

$10,000 Individual

$15,000 Couple

Yes

Yes

Yes

Illinois

 

$15,000

No

No

No

Idaho

$10,000

 

Yes

No

No

Indiana

 

$2000 Individual

$3000 Couple

Yes

No

Yes. Up to $20,000as approved by state

Iowa

$12,000 Individual

$13,000 Couple

Yes

Yes

Yes, Assistive Technology Accounts.

Louisiana

$25,000 Individual

Yes

Yes

No

Kansas

$15,000

Yes

No

IDA accounts excluded

Maine

$8,000 Individual

$12,000 Couple

No

No

No

Maryland

$10,000 (includes spouse)

Yes, first $4,000 does not count toward resource limit

No

No

Massachusetts

 

(Part of Section 1115 waiver program)

 

 

 

 

What is the Resource Limit?

Are Retirement Accounts Excluded from Countable Assets?

Are Medical Savings Accounts Excluded from Countable Assets?

Are Approved Accounts for Employment or Independence Excluded?

Michigan

 

$75,000

Yes

No

No