Jeffrey Wade
Medicaid is a federal program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Each state has its own eligibility requirements and thresholds for Medicaid, and it is essential to check with your state's administrative agency to understand the specific rules and requirements. If you are offered private insurance through your employer but prefer to keep your Medicaid coverage, you can choose to do so as employment does not affect Medicaid eligibility. However, if you lose your Medicaid coverage, you may qualify for a special enrollment period to add coverage through your employer outside of the standard open enrollment period.
| Characteristics | Values |
|---|---|
| Can you drop insurance at work to get state Medicaid? | Yes, you can drop your employer health insurance to get state Medicaid. |
| What is Medicaid? | An insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. |
| Who is eligible for Medicaid? | Eligibility for Medicaid is based on income, family size, and other factors. Each state has a different threshold amount, including different threshold amounts for people who are blind. |
| What happens if you lose Medicaid coverage? | Losing Medicaid coverage is considered a qualifying event, and you can enroll in a new health plan within 60 days. |
| What are the alternatives to Medicaid? | Alternatives to Medicaid include employer-provided insurance, Medicare (if eligible), and health insurance plans from the Health Insurance Marketplace. |
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What You'll Learn
Work doesn't impact Medicaid eligibility
Currently, Georgia is the only state with a work requirement waiver in place. Arkansas was the only state to implement the policy with consequences for non-compliance, resulting in 18,000 people losing coverage. Courts struck down many of the waiver approvals, and the Biden administration rescinded the remaining waivers. However, several other states are pursuing work requirement waivers, anticipating a change in policy under a potential new Trump administration.
Medicaid eligibility is based on income, not access to insurance through employment. Even if your employer offers health insurance, you can still qualify for Medicaid if your income is below the state threshold. Each state has a different threshold amount, which is calculated based on the values of SSI cash benefits, Medicaid benefits, and publicly funded personal or attendant care benefits.
If you are offered private insurance through your job but cannot afford it, you can keep your Medicaid coverage. Losing Medicaid coverage for this reason would be considered a qualifying event, allowing you to add coverage through your employer outside of the open enrollment period.
In some states, if you are disabled and no longer qualify for free Medicaid due to your work income, you may be able to apply to buy Medicaid from the state Medicaid agency through the Medicaid Buy-In Program. Additionally, Social Security's Ticket to Work Program supports career development for people who receive Social Security disability benefits and want to work. This program is free and voluntary and helps individuals with disabilities move towards financial independence.
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Medicaid While Working
Medicaid is a federal program that provides free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. While eligibility criteria vary by state, it is primarily based on income, not access. This means that you can qualify for Medicaid even if your employer offers health insurance.
If you are offered private insurance through your employer but cannot afford it, you may be able to keep your Medicaid coverage. However, you will need to meet certain income requirements, and the rules for keeping Medicaid while eligible for other coverage may vary by state. It is important to note that if you lose your Medicaid coverage, you may be able to add coverage with your employer outside of the open enrollment period.
In some states, through the Medicaid Buy-In Program, you may be able to purchase Medicaid from the state if you are disabled and no longer qualify for free Medicaid due to your work. Additionally, Social Security's Ticket to Work Program supports career development for people aged 18-64 who receive Social Security disability benefits and want to work. This program is free and voluntary and helps individuals with disabilities achieve financial independence.
If you are no longer eligible for Medicaid, it is crucial to enroll in alternative health insurance promptly. You typically have 60 days to enroll in a new plan, which is known as a "special enrollment period." You can explore options such as your employer's work-based health plan or the Health Insurance Marketplace, which offers plans covering prescription drugs, doctor visits, urgent care, and hospital visits.
Medicare, on the other hand, is a separate government-run health insurance program. While employment does not play a role in Medicare eligibility, it is generally available to individuals aged 65 or older. Medicare consists of Part A (inpatient services) and Part B (outpatient services), with optional Part D plans offering prescription drug coverage.
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State-specific thresholds
Medicaid is a joint federal and state program that provides health coverage to a wide range of Americans. While federal law requires states to cover certain groups, such as low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI), each state has its own specific eligibility criteria and thresholds.
For instance, some states have expanded their Medicaid programs to cover all people below certain income levels, while others have implemented the Medicaid Buy-In Program, which allows individuals with disabilities who are no longer eligible for free Medicaid due to their work to purchase it from the state agency. Additionally, each state has a different threshold amount for gross earned income, which is calculated based on SSI cash benefits, Medicaid benefits, and publicly funded personal or attendant care benefits. These thresholds determine eligibility for Medicaid While Working, and they vary for individuals who are blind.
The specific details of state-specific thresholds can be found in Social Security's Red Book, which provides information on each state's threshold amount. Additionally, some states have multiple pathways to Medicaid eligibility, such as the Medically Needy Pathway, and allow the use of Miller Trusts or Qualified Income Trusts to help individuals become income-eligible.
It's important to note that even if an individual's income exceeds the state's threshold, they may still qualify for Medicaid through other means, such as working with a Certified Medicaid Planner or utilizing the Continued Medicaid Eligibility Work Incentive (Section 1619(B))).
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Medicaid Buy-In Program
The Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) offers Medicaid coverage to people with disabilities who are working and earning more than the allowable limits for regular Medicaid. This program allows them to earn a higher income without losing their healthcare coverage.
To qualify for the MBI-WPD, you must meet the Social Security Administration's (SSA) definition of having a disability and be eligible for SSI if you earned less income. Additionally, your non-exempt resources must not exceed the Medicaid resource limit of $39,125 for a one-person household and $52,875 for a two-person household. It's important to note that retirement accounts are disregarded when determining eligibility for this program.
If you are already working and receiving Medicaid coverage with a monthly spenddown, you can still opt for the MBI-WPD. This program has no spenddown requirements, and Medicaid may cover the cost of the premium for your insurance coverage. However, it's important to note that the MBI-WPD does not offer family coverage. If you have family coverage through your employer, you may need to explore other options, as maintaining family coverage is important.
If you believe you meet the qualifications for the MBI-WPD, you can apply through your state's Medicaid agency to determine your eligibility. It's important to note that each state has different threshold amounts for eligibility, and they may vary for people who are blind. You can refer to the Social Security Red Book to find your state's specific threshold. Additionally, even if you earn more than your state's threshold, you may still be eligible for Medicaid While Working if you have publicly funded personal attendant expenses or medical expenses above your state's average amount.
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Marketplace plans
When considering a Marketplace plan, it is important to understand how it interacts with other forms of insurance, such as employer-sponsored coverage or Medicaid. If you have a Marketplace plan and gain access to employer-sponsored insurance, you can cancel your Marketplace plan at any time during the year. However, it is recommended to align the cancellation with the start of your new employer-sponsored coverage to avoid paying full price for the Marketplace plan once you become eligible for the employer's plan. Federal rules allow state-run Marketplaces to require termination requests to be submitted at least 14 days in advance of the desired coverage end date.
If you have Medicaid or the Children's Health Insurance Program (CHIP) and want to switch to a Marketplace plan, you can do so, but you will no longer qualify for savings on your Marketplace plan. You must also remember to end your Marketplace coverage when your Medicaid or CHIP coverage begins to avoid repaying any premium tax credits received.
To apply for a Marketplace plan, you can visit coverva.org, contact your local Department of Social Services, or log in to your Marketplace account to update your existing application or create a new one.
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Frequently asked questions
Working does not necessarily mean losing access to federal or state healthcare benefits. There are protections in place, called Work Incentives, that help people who work and receive disability benefits to keep those benefits.
Work Incentives are programs that allow you to pursue your career goals with the Medicaid support you need. One such program is the Continued Medicaid Eligibility Work Incentive (Section 1619(B)), which allows you to qualify for continued Medicaid coverage even if your earnings become too high to receive SSI.
Medicaid eligibility is governed by state law and is income-based. Each state has a different threshold amount, which can be found in the Social Security Red Book. Even if you earn more than your state's threshold amount, you may still be eligible for Medicaid if you have publicly funded personal attendant expenses or medical expenses above your state's average amount.
If you lose your Medicaid coverage, you can re-apply through your state at any time to see if you still qualify. You can also apply for a Marketplace plan, which offers low-cost, quality health coverage, within 60 days before or 90 days after your Medicaid coverage ends.
Yes, you can drop your employer health insurance and go on Medicaid if you meet the eligibility requirements, which are based on income, family size, and other factors.
