How to Apply for a Medicaid Buy-In Program When You're Working

What a Medicaid Buy-In program does and who runs it

A Medicaid Buy-In program lets you keep working and stay on Medicaid even though your income is above the usual limit. Instead of losing coverage when you earn too much, you pay a monthly premium — usually between $20 and $200, depending on your income and which state you live in — and keep your Medicaid benefits. The program exists because regular Medicaid has strict income caps that would force people off coverage the moment they start earning.

Each state runs its own Buy-In program with its own name, income limits, and premium structure. Some states call it the "Medicaid Buy-In," others use names like "Medicaid for Employed Individuals with Disabilities" or "Work Incentive Program." Your state Medicaid office administers it, not a federal agency, so the rules and the application process are specific to where you live.

Key Takeaways

• You must already receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) to enter a Buy-In program, or meet your state's disability criteria through a separate evaluation.
• Your income can be higher than the standard Medicaid limit, but it cannot exceed your state's Buy-In threshold, which varies widely — some states allow $75,000 annually, others cap it at $35,000.
• You pay a monthly premium based on your income, and your state Medicaid office calculates it using your most recent tax return or pay stubs.
• The application goes to your state Medicaid office, either online through your state's portal, by mail, or in person at a local office — contact your state first to learn which method is fastest.
• Processing takes two to four weeks after you submit all required documents, and coverage usually starts the first day of the month after approval.

Whether you meet the disability requirement

Most states require that you already receive SSDI or SSI to enter a Buy-In program. If you do, you are already past the disability gate — you do not need to prove it again. Your Social Security award letter is your proof.

Some states have a separate disability evaluation for Buy-In applicants who do not receive SSDI or SSI. This evaluation is not the same as the Social Security disability information. Your state Medicaid office will tell you whether you need one and what medical records or doctor's statement they require. If your state does require it, you submit those documents with your application.

A small number of states have Buy-In programs for people with specific conditions — HIV/AIDS, multiple sclerosis, or traumatic brain injury — without requiring SSDI or SSI. Check your state's program rules to see whether a condition-based route exists.

Income and asset limits for your state

Your income limit under Buy-In is higher than standard Medicaid, but it is not unlimited. The threshold varies sharply by state. Some states set it at 250% of the federal poverty level (roughly $35,000 for an individual in 2024), while others allow up to 450% of poverty or higher. A few states have no income cap at all for Buy-In participants, only a premium based on what you earn.

Your state Medicaid office publishes its Buy-In income limit on its website or can tell you by phone. Call before you apply so you know whether your current or projected income falls within the range. If you are close to the limit, ask whether your state counts only earned income or includes other sources like interest or rental income.

Asset limits — the total value of savings, investments, and property you can own — are usually higher under Buy-In than under regular Medicaid, or absent entirely. Some states have no asset limit for Buy-In participants. Your state office will confirm this when you call.

Documents you need before you start

Gather these items before you contact your state Medicaid office or open an application:

• Your Social Security award letter (SSDI or SSI), or a doctor's statement of disability if your state requires separate evaluation.
• Proof of income: your most recent pay stubs (last two months), or your most recent tax return if you are self-employed.
• Proof of citizenship or legal residency: a birth certificate, passport, or state ID.
• Your Social Security number.
• Bank account information if you want the state to deposit any refunds or overpayment reimbursements.

Some states also ask for proof of residence (a utility bill or lease) and a list of any other health insurance you currently carry. A few states require a work history or letter from your employer confirming your job and hours. Ask your state Medicaid office which documents they specifically need — requirements differ, and submitting the wrong set slows down processing.

How to find your state Medicaid office and start the application

Go to your state's Medicaid website and search for "Buy-In" or "Medicaid for Employed Individuals with Disabilities." The site will show you the income and asset limits, the monthly premium formula, and the application method. Most states offer online applications through a portal, mail-in forms, or in-person appointments at a local Medicaid office.

If you cannot find the Buy-In program on your state's main Medicaid site, call your state Medicaid customer service line (the number is on your Medicaid card or on the state website). Tell them you want to learn about the Buy-In program and ask which application method is fastest right now. Some offices have long mail delays but fast online processing, or vice versa.

Online applications are usually the quickest route. You create an account, enter your information, upload your documents, and submit. The system typically sends you a confirmation number and tells you when to expect a decision. Mail-in applications take longer because the office has to receive, scan, and enter your information manually.

What happens after you submit your application

Your state Medicaid office will review your documents to confirm you meet the disability requirement, your income is within the Buy-In limit, and you have provided proof of citizenship. This review takes two to four weeks. If they need more information — for example, a clearer copy of a pay stub or a missing document — they will contact you by mail or phone.

Once approved, you will receive a notice in the mail stating your monthly premium and the date your coverage starts. Coverage usually begins the first day of the month after approval. You will also receive a new Medicaid card or a notice that your existing card remains active under the Buy-In program.

Your first premium payment is typically due within 30 days of the approval notice. You can usually pay online, by mail, or by automatic bank withdrawal. If you miss a payment, your coverage may be suspended, though most states give you a grace period to catch up before terminating enrollment.

What to do if your application is denied

If your state denies your application, the denial notice will explain why — usually because your income exceeds the Buy-In limit, you do not meet the disability requirement, or you did not provide required documents. The notice will also tell you how to request a hearing to challenge the decision.

If the reason is missing documents, you can reapply immediately with the correct paperwork. If the reason is income, you may be able to reapply once your income drops, or you can ask your state whether a different program (such as regular Medicaid with a work incentive) might work for you. If the reason is disability, ask whether your state offers a separate disability evaluation or whether you need to pursue SSDI or SSI first.

A hearing request must usually be filed within 30 days of the denial notice. Your state Medicaid office will tell you how to request one and whether you can do it online, by mail, or by phone.

Frequently Asked Questions

Do I have to report my income every month?

Most states do not require monthly reporting. You report your income once when you apply, and the state recertifies your enrollment once a year. If your income changes significantly between recertifications, contact your state office to report it — a large increase might raise your premium or end your enrollment, while a decrease might lower your premium.

What happens to my Buy-In coverage if I stop working?

If you stop working and your income drops below your state's Buy-In threshold, you can usually stay enrolled and your premium will decrease or disappear. Some states automatically move you to regular Medicaid if your income falls low enough. Contact your state office to report the change and ask whether your coverage type will shift.

Can I use Buy-In coverage in a different state if I move?

No. Medicaid is state-specific, so your Buy-In coverage ends when you move. You will need to apply for the Buy-In program in your new state, which may have different income limits and premiums. Start the application process in your new state before your current coverage ends.

Does Buy-In coverage include dental, vision, and prescription drugs?

That depends on your state. Some states include dental and vision in Buy-In coverage, others do not. Prescription drug coverage is usually included, but the formulary (the list of covered drugs) may be different from regular Medicaid. Ask your state Medicaid office what services are covered under Buy-In before you enroll.

What if my income is too high for Buy-In but I still need health insurance?

If you earn above your state's Buy-In limit, you may be able to purchase coverage through your state's health insurance marketplace using the income you report on your tax return. You might also may have access to for subsidies to lower your premium. Visit healthcare.gov to explore marketplace plans in your state.