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).

Official info available at https://hhs.texas.gov/laws-regulations/handbooks/chapter-m-medicaid-buy-program/mepd-m-1000-medicaid-buy-mbi-program

To qualify, a person must: (Download this worksheet to help you go through the qualifications!)

  • Texas resident
  • Disabled using the SSI determination criteria
  • Be employed or self-employed full or part-time
  • Income: (Medicaid Buy-In Historical Income Limit)
    1. Earning at least $1,120 in a Qualifying Quarter (Jan-Mar, Apr-June, July-Sept, Oct-Dec)
    2. Countable earned income less than $2,257/month (Income calculation: Gross salary less all eligible exclusions)
      1. Exclusions:
        1. Expenses
        2. Earned income to pay Impairment-related work expense
        3. Monthly income exclusion ($20)
        4. Income set aside & used for HHSC-approved PASS plan
        5. $65
        6. 1/2 of remaining monthly earned income
        7. earned income tax credit payments
        8. child tax credit payments
    3. Paying FICA taxes on earnings
  • Countable resources less than or equal to $5,000
    1. Resources not counted:
      1. Retirement-related accounts: IRAs, 401()s, TSAs, KEOGHs
      2. PASS Resources: Resources set aside, separate from other money, as part of an HHSC-approved “Plan to Acheive Self-Support” (PASS)
      3. 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)

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

    1. Earned income
    2. Unearned income

What can a premium cost?

    1. Earned income: $0-$40/month
    2. Unearned income: Total unearned income less $674

Download this presentation for more info and calculation examples.

To apply, you can either:

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

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