Working Disabled Medicaid Buy-In

Who Is Eligible?
The Working Disabled Medicaid Buy-In is a category of Medicaid intended to encourage an individual with a disability to work (if able) by giving or extending their access to health coverage. An individual with a disability who is ineligible for Adult Public Assistance (APA) and related Medicaid because they have too much earned income (their own or their spouse's)
may qualify for Medicaid under this category.


Determining Eligibility
The eligibility determination is a two-step process.


Step 1 - The Family Income Test
The family's monthly net income must be below 250% of the Federal Poverty Guideline (FPG)
for Alaska. Here is what 250% FPG for 2000 looks like:


Family Size








Each Add'l

250% FPG










Net income is determined by subtracting certain disregards, including impairment related work expenses and 50% of the family's earned income. The rules used for the supplemental Security Income (SSI) and APA programs are the rules used here. A "family" is considered the individual with a disability, the individual's spouse, and any dependent children of either the individual or spouse who are living in the same household a majority of the time. If the family's net income is equal to or greater than 250% FPG for the appropriate household size, the individual is not eligible for this category. If the family net income is less than 250% FPG the individual passes the Step 1 test. Proceed to Step 2.


Step 2 - Individual Unearned Income Test
If the family's monthly net income is below 250 % FPG, the individual must then pass Step 2, the Individual Unearned Income Test. In this step, all of the earned income of the individual (and spouse) is disregarded. Counting only unearned income, the individual must meet the financial and nonfinancial requirements to be eligible for SSI/APA related Medicaid. For example, a single individual living on his or her own, must have monthly unearned income of less than $951 ($1144, if married). The individual must have countable assets of less than $2000 ($3000, if married).


Disability Determination Needed
The individual must have a documented disability determination from the Social Security Administration or the state. If a new disability determination is required, the Disability Determination Service disregards the usual limitation on an individual's "substantial gainful activity."


Premiums May Be Required
Here is the "buy-in" part. An individual who is eligible under this category may have to pay a premium to the Division of Medical Assistance to continue to receive coverage. Determining the premium amount, sending premium due notices, and collecting premiums are done by the Division of Medical Assistance Third Party Liability (TPL) Unit. Premiums are assessed on a sliding fee schedule based on the family's annual net income. A family whose annual net income is below 100% FPG does not pay a premium. The premium amount will not exceed 10% of the family's annual net income. The first premium is not due until the second month of eligibility following the month the application is approved. If an individual is at least 60 days delinquent in payment of premiums, Medicaid eligibility under the Working Disabled Buy-In category is terminated.


Where To Apply
An individual may apply for Medicaid, including the Working Disabled Medicaid Buy-In, at any office of the Division of Public Assistance.