Josh BasileMost disabled people have heard of the Medicaid Buy-In program, but they don’t know how to enroll, stay enrolled or capitalize on the financial freedom the program can bring.

As a C4-5 quadriplegic and full-time medical malpractice attorney, I rely heavily on my state’s Medicaid Buy-In program so I can simultaneously work and maintain my healthcare benefits. Medicaid Buy-In allows employed workers with disabilities to keep our benefits while earning above a particular state’s Medicaid income limits. Considering that these limits are low no matter where we live, Buy-In programs are often the best way for us to earn a living wage without losing needed medical coverage.

In the late 1990s, Congress passed two laws that allow states to create their own Medicaid Buy-In programs. States can choose limits on an enrollee’s age (typically 16 to 64), how much they can earn (income) and save (assets), whether or not their spouse’s income and assets are counted, and the amount they pay in monthly program premiums.

Below are answers to five frequently asked questions about Medicaid Buy-In.

1. How do I know if I’m eligible?

First, your state must have its own Medicaid Buy-In program. As of 2020, the only ones that don’t are Alabama, Florida, Hawaii, Oklahoma and Tennessee. The District of Columbia doesn’t have one either. Then, you must have a qualifying disability that meets Social Security’s definition, such as most spinal cord injuries. Finally, eligibility is determined by whether you meet your state’s unique Medicaid Buy-In rules and requirements.

For example, I live in Maryland and our program is called