What does Medicaid buy-ins not take into account when determining eligibility?

Medicaid buy-ins are designed to provide healthcare coverage to individuals with disabilities who have returned to work and may have a higher income than standard Medicaid limits. When determining eligibility for Medicaid buy-in programs, the concept of Substantial Gainful Activity (SGA) is not a factor considered. SGA refers to a level of earnings that indicates whether an individual is engaging in work that is considered substantial, which could affect a person’s eligibility for Social Security disability benefits, but it does not apply in the context of Medicaid buy-in eligibility.

In contrast, eligibility for Medicaid buy-in programs typically does take into account factors like income and resources to ensure that individuals still meet the necessary financial criteria, even while working. Employment status is also a consideration, as it directly influences income levels and may determine whether the individual qualifies for the buy-in program.

Understanding that SGA is not relevant to Medicaid buy-in eligibility helps clarify how these programs are designed to support individuals striving to maintain employment while also needing access to essential healthcare services.