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H. B. 664 and S. B. 369 Medicaid Buy-In (MBI)

Facts on the Medicaid Buy In Bill

Goal: To have written into Ohio law that people with disabilities have the option of buying into a Medicaid Buy-In program; therefore, allowing people with disabilities to go to work and become taxpaying citizens. How It Works: Federal legislation passed in 1999 expands a Medicaid option to allow states to provide Medicaid health insurance coverage to working individuals with disabilities who do not qualify for Medicaid under current income and asset rules. In the seven years since the federal legislation was passed, Ohio does not offer this option; however, 32 other states have MBI programs with more than 80,000 enrollees nationwide. The proposed bill will do the following:

• Increase the Medicaid asset limit from $1,500 to $10,000 for eligible Ohioans with disabilities who are working.

• Increase maximum income levels for eligible Ohioans who are on Medicaid, and who are working, to 250 % of poverty – excluding the first $20,000 of earned income. MBI would permit a person to earn up to $44,500 per year and still retain Medicaid coverage.

• Create a rational premium based on income.

• Change no premiums until the employed person with a disability exceeds 150% of poverty level in earnings. That is $14,700 for a single person.

• Establishes the Directory of Job and Family Services as Administrator of the Medicaid Buy-In Program.

• States that no Medicaid funded long term care services may be provide if the beneficiary equity interest in a home exceeds $500,000 or $750,000 if they qualify for Medicaid long term insurance policy – These amounts

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shall be increased in 2011 and every year after according to necessity by the Director of Job and Family who can also bypass these limits with a waiver.

• The Director of Job and Family Services must implement a program for those who exhaust long term care insurance policy

• Sets up the qualifications for the Medicaid buy in program

o Must apply o Be between the ages of 16 and 65 o Carry a disabled status o Have less than $10,000 in assets

This amount is personal assets minus assets yet to be determined by the Director

• Sets up rules for qualification based on income and assets

o In short there are guidelines but Director of Job and Family makes final decisions

o These qualifications will be reassessed ever year by the Director and submitted for review

• After the Director and Board (made up of several directors of disability related field/companies) set up rules for the original any changes must be approved by the Board

o The Director and Board must meet quarterly • Director must submit a state of the program every year

for review • Adds protection for those in the MBI program so that

they do not lose benefits for participating o No individual receiving services under a

component shall have any patient liability for the services for any period during which the individual also participates in the Medicaid buy-in for workers with disabilities program.

o No individual shall lose eligibility for services under a component on the basis that the individual's income or assets increase to an amount above the eligibility limit for the component if the individual is participating in the Medicaid buy-in for workers with disabilities program and the amount of the individual's income or assets does not exceed the eligibility limit for the Medicaid buy-in for workers with disabilities program.

o No individual shall lose eligibility for services under a component on the basis that the

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individual also receives services under the Medicaid buy-in for workers with disabilities program

• Individuals can earn up to 250% of FPL and still stay eligible for Medicaid

• Must pay premium equal to 10% of the amount of income that exceeds 150%of FPL after subtracting and health insurance paid to an employer

Increase the Medicaid asset limit from $1,500 to $10,000 for eligible Ohioans with disabilities who are working.

Increase maximum income levels for eligible Ohioans who are on Medicaid, and who are working, to 250 % of poverty – excluding the first $20,000 of earned income. MBI would permit a person to earn up to $44,500 per year and still retain Medicaid coverage.

Create a rational premium based on income.

Change no premiums until the employed person with a disability exceeds 150% of poverty level in earnings. That is $14,700 for a single person.

Costs: Estimated start up costs are projected in the $2 – 3 million range per year. It will take 5 – 7 years to reach full implementation at about $14 million per year. Offsets in increased premiums and additional income tax are hard to project. Sponsors: Ohio Senator Steve Stivers and Representative Jon Peterson.1

1Expanded upon http://www.dsagt.org/news.html with further review of the legislation