Texas Medicaid Buy-In Program available 9/1/06

Beginning September 1, 2006, the well talked about Medicaid Buy-In Program will be available statewide in Texas. Authorized by Senate Bill 566, 79th Legislature and housed in the Texas Health and Human Services Commission (HHSC) Office of Family Services, this program will allow eligible Texans with disabilities the opportunity to purchase their health insurance through Medicaid by paying a monthly premium (based on earned and unearned income). Program participants will receive services either through traditional Medicaid (fee-for-service) or the Primary Care Case Management (PCCM) program (based on residency). 

Applicants must meet the following work and disability related requirements as well as resource and income limits: 

Work Requirement 
Must have enough earnings and FICA contributions in a calendar quarter for the Social Security Administration (SSA) to count as a qualifying quarter (currently, $970/quarter). 

Disability Requirement
Disability requirements are automatically met for applicants who receive disability benefits from the Social Security Administration (SSA). If not, the HHSC's Disability Determination Unit will process applicants' information using Supplemental Security Income (SSI) criteria without consideration of earned income. 

Resource Limit 
Must have $2000 or less in countable resources. Certain resources will be excluded from the person's countable resources. 

Income Limit
For Adults you must meet the disability and income rules for the program. Texas Medicaid uses the Social Security disability guidelines to determine if you have a disability.

  • If you already get Social Security disability benefits, you meet the disability rules for the program.
  • If you don't get Social Security disability benefits, we will review your case to decide if your disability meets the rules.

HHSC doesn't use the Social Security disability guidelines on limits on working or how much you earn. To meet the income guidelines for the program:

  • The amount of money you earn before taxes each month must be less than $2,453.
  • The amount of money you have, such as cash, banks and retirement accounts (countable assets) must be no more than $2,000.

Money that doesn't count:

  • Earned income tax credit and child tax credit payments
  • Work expenses due to a disability
  • Plan to Achieve Self-Support (PASS) funds and independence accounts

For Children, Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly or annual income is the same or less than the amount listed, your child might be able to get MBIC.

 
Family Members (Adults plus children) Monthly Family Income
1* $1,562
2 $2,114
3 $2,667
4 $3,219
For each additional person, add: $553

*A family of one might be a child who does not live with a parent or other relative.

The Medicaid Buy-In Program is expected to help relieve the fears of many people with disabilities who desire to return to work or maintain employment, but are concerned about losing health coverage as income levels rise. 

For additional information, refer to the following link to: https://hhs.texas.gov/services/health/medicaid-chip/children-adults-disabilities/medicaid-buy-adults