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Medicaid Buy-In

Low-cost health care for people with disabilities who work

What is the Medicaid Buy-In program?

It helps people with disabilities who work.

This program offers low-cost Medicaid health care services — including community-based services and supports. Some people might have to pay a monthly fee.

Who can be in the Medicaid Buy-In program?

A person who:

  • Has a disability.
  • Is working.
  • Lives in Texas.
  • Does not live in a state institution or nursing home all the time.

Note: If you get home and community-based services through a Medicaid waiver program, you also might be able to be in the Medicaid Buy-In program. Some examples of Medicaid waiver programs are Community Based Alternatives (CBA), Community Living and Support Services (CLASS), and Home and Community-based Services (HCS).

What health care benefits can I get?

Medicaid Buy-In benefits are the same as regular Medicaid benefits. Examples:

  • Doctor / clinic visits
  • Mental health care
  • Hospital stays
  • Vision care
  • Emergency care
  • Hearing care
  • Medicine
  • Speech therapy (help learning to speak better)
  • Glasses
  • Occupational therapy (help learning how to do everyday tasks)
  • X-rays
  • Physical therapy (help learning how to move around better or become stronger)

You also might be able to get help in your home or at another place during the day. These services also are known as Day Activity and Health Services (DAHS) or Primary Home Care (PHC).

How do I know if my disability meets the Medicaid Buy-In rules?

  • If you already get Social Security disability benefits, you meet the disability rules for the program.
  • If you don’t get Social Security disability benefits, HHSC will review your case to decide if your disability meets the rules.
  • HHSC uses the Social Security disability guidelines — except for limits on working and the amount of money you get from a job.

What are the rules for the amount of money I (the applicant) can get and still be in this program?

  • The amount of money you get must be less than $2,328.
  • The amount of money you have such as cash, banks, and retirement accounts (countable assets) must be less than $2,000.
  • Only the money you get counts. Money other family members get isn’t counted.
  • Money that doesn’t count includes:
    • Plan to Achieve Self-Support (PASS) funds and independence accounts.
    • Earned income tax credit and child tax credit payments.
    • Work expenses due to a disability.

How much do I have to pay?

Your cost is based on:

  • The money you get from work. We will take out amounts we don’t have to count. After that, if you still have more than $1,397, you will have to pay part of the cost.
  • Any other money you get above $698. Examples of other money are Social Security benefits, retirement checks, and money from rental property.

How do I apply for the Medicaid Buy-In program?

Fill out an application form. You can get it one of these ways:

  • Download the form: [English] [Spanish]
  • Call 2-1-1 and ask to have an H1200 form mailed to you.
  • Pick up a form at an HHSC benefits office. Call 2-1-1 or 1-877-541-7905 (toll-free) to find one near you.

Where do I turn in my application form?

You can turn in your form one of these ways:

  • Take it to an HHSC benefits office. Call 2-1-1 to find an office near you.
  • Fax it to 1-877-447-2839 (toll-free). If your form is 2-sided, fax both sides.
  • Mail it to:
    Health and Human Services Commission
    P.O. Box 14600
    Midland, TX 79711-4600.

Before you send your form to apply, be sure to:

  • Write “MBI” in big, bold letters on the top of the first page.
  • Send copies of the items we ask for (pay stubs, etc.).

How long will it take to find out if I can be in this program?

We will let you know within 45 days. It might take up to 90 days if HHSC needs to find out more about your disability. In either case, we will send a letter to tell you if you can be in the Medicaid Buy-In program. If you can, the letter will tell you:

  • How much your cost will be (your premium).
  • When your payment is due (usually the end of the month).
  • When your benefits will begin.

Questions?

  • Call 2-1-1. Pick a language and then press 2.
  • Call or visit an HHSC benefits office. To find an office near you, call 2-1-1 (toll-free).