Medicaid is a state operated health insurance program for low income and Medically Needy people. Medicaid is funded by both federal and state dollars, providing coverage to some 72.5 million children, elderly people and persons with disabilities. Regardless of a person’s abilities, a Medicaid enrollee must meet very low financial income requirements defined by each state within federal guidelines.
For example, in Maryland, Medicaid is available to most adults aged 19 - 65 with incomes at or below 138% of the Federal Poverty Level or about $16,753 per year for one person in 2018. Without applying an exception to reduce countable income, an enrollee that exceeds $1,396 per month in work-related income or has more than $2,500 in assets (bank accounts, stocks, bonds, life insurance, etc.) will be kicked out of Medicaid.
In 1965, when Medicaid was signed into law, it was thought of as a short-term health insurance program to help low income Americans recover from tough financial times. Years later, Medicaid became a primary funding source for long-term services for people with disabilities to live in the community rather than institutions.
Medicaid is the only major form of health insurance that pays for substantial, long-term services for people with disabilities. Any lifelong disability whether physical, mental or both that results in substantial lifelong expenses creates a dependency on finding an acceptable long-term healthcare solution. Outside of Medicaid long-term care benefits, there is no long-term care insurance plan within the private insurance market available to purchase for someone with a significant disability. Without turning to Medicaid, persons with paralysis, behavioral, intellectual or other disabilities who need long-term services are forced to pay all long-term care expenses out-of-pocket, which is not financially feasible but for a few.
The problem is most people need to remain poor to stay eligible for Medicaid.
Over time, states recognized that forcing persons with disabilities to meet Medicaid’s low-income requirements resulted in depressingly low employment statistics. To this day, persons with disabilities are the most unemployed and underemployed working population in the United States. In 2016 the US Bureau of Labor statistics reported that 17.9% of persons with a disability were employed compared to 65.3% without a disability.
In 1997 and 1999, Congress for the first time passed new laws to try to address this unrealistic working reality by creating Medicaid Buy-In options for states. This resulted in states implementing programs that would allow persons meeting the definition of disability within the Social Security Administration (SSA) regulations to exceed the current Medicaid low income financial requirements. SSA regulations define disability as:
“The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
The congressional intent of the Medicaid Buy-In programs was to mainly develop a cost-saving program promoting community integration and financial responsibility for working persons with disabilities.
Medicaid.gov Medicaid Employment Initiatives webpage “recognizes that employment is a fundamental part of life for people with and without disabilities. Employment provides a sense of purpose, how we contribute to our community and are associated with positive physical and mental health benefits [...] All individuals, regardless of disability and age, can work and have access to pre-vocational services, education and training opportunities that build on strengths and interests.”
Maryland’s Medicaid Buy-In program is called Employed Individuals with Disabilities (EID).
To qualify, a person must:
Please refer to the EID countable resources fact sheet for the most up-to-date information.
See instructions at https://mmcp.health.maryland.gov/eid/Pages/Home.aspx.
You can apply for EID on your own or with help from other agencies.
If you have any questions and would like to get more involved with the Willing to Work Maryland campaign please contact Josh Basile at firstname.lastname@example.org or through the contact us form below.