Medicaid Buy-In for Adult

The Medicaid Buy-in for Adults (MBI) was created to make a way for an adult with a disability to work AND retain Medicaid health care and associated programs (such as Medicaid waivers, Primary Home Care (PHC) and DAHS (Day Activity and Health Services).

HHSC website official summary page

Much more detailed info in the Medicaid MEPD Handbook MBI section

To qualify, a person must:

  • Texas resident
  • Disabled using the SSI determination criteria
  • Be employed or self-employed full or part-time
  • Income: (MBI Budget Reference Chart)
    1. Earning at least $1,120 in a Qualifying Quarter (Jan-Mar, Apr-June, July-Sept, Oct-Dec)
    2. Countable earned income less than $2,513/month
      • (Income calculation: Gross salary less all eligible exclusions)
        • Exclusions:
          • $20 General Income Exclusion
          • $65 Earned income Exclusion
          • Income set aside & used for HHSC-approved PASS plan
          • Earned income to pay Impairment-related work expense
          • Withholding FICA taxes on earnings
          • 1/2 of remaining monthly earned income
  • Countable resources less than or equal to $5,000
    1. Resources not counted:
      • Plan to Achieve Self Support (PASS): Resources set aside, separate from other money, additional info available at SocialSecurity.gov
      • Independence account: A designated, separate account in a financial institution of earnings set aside to be used for future health care and work-related expenses that will increase a person’s independence and employment potential (up to 50% of earnings can be saved)
      • Retirement-related accounts: IRAs, 401()s, TSAs, KEOGHs

If a person qualifies, they will be given a monthly premium based on:

    1. Earned income
    2. Unearned income

What can a premium cost? Maximum $500

    1. Based on Earned income: $0-$40/month
    2. Based on Unearned income: Total unearned income minus $674 (ex. if Unearned income is $700, then premium for Unearned income would be $26)

Download this presentation for more info and calculation examples.

The MBI program has different budgeting than other Medicaid programs.

  • There are two income-related budgets for the MBI program
  • Normally exempt income is considered in the MBI Income Verification. For example, irregular and infrequent income of $30 or less per quarter is excluded in other programs. In the Income Eligibility Budget, all irregular and infrequent earned income is counted.
  • The Income Eligibility Budget is based on monthly gross earned income only. Do not consider gross unearned income in the income eligibility budget.
  • The Post Eligibility – Premium Budget is based on gross monthly unearned and monthly net earned income.
  • Mandatory order of allowable exclusions.
    • Income Limit — 250% federal poverty level (FPIL)
    • Income Verification — Verify that a person currently is employed. Use established verification of earnings.
    • Eligibility Budget — Based on all gross earned income, after all allowable exclusions and tested against 250% FPIL. Unearned income is not considered.
    • Post Eligibility Budget – Premium Budget — Unearned income and earned income is used to determine the MBI monthly premium amount.

To apply, you can either:

Fax completed application with “MBI” written at the top to: 1-877-447-2839.

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