Health Benefits for Workers with
Illinois Medicaid Buy-In
Questions and Answers
What is the Medicaid Buy-in program?
The Medicaid Buy-in program allows people
with disabilities who are working to enroll
in Medicaid, or stay in Medicaid without a
spenddown, by paying a monthly premium.
Who is it for?
The program is designed for people who
receive SSDI benefits and want to return to
work, but won’t be able to get health
insurance on the job.
What about people who receive SSI or both SSDI and
People who receive SSI or both SSI and
SSDI before they return to work can already
keep their Medicaid without a spenddown under
the Section 1619 programs. They are better
off sticking with those programs because
those programs do not require any premiums
and have higher income limits.
What are the eligibility requirements?
U.S. citizen or lawful immigrant in a category
eligible for Medicaid
Disabled as defined by Social Security
Illinois Resident age16 to 64
Employed (someone is making FICA contributions)
What are the income and asset rules?
Assets less than or equal to $10,000
(usual exemptions apply, including your home,
a car you need to get to the doctor)
Countable income less than 200% of the
federal poverty level (currently $18,624 per
year, or $1,552 per month)
Income includes any
Social Security or other income, as
well as work income
Income includes spouse’s
from income include taxes,
transportation, day care expenses,
union dues, life insurance or
retirement plan withholding,
special work expenses, small lunch
allowance ($9 per month)
How much are the premiums?
Premiums vary from nothing to $100 per
month, depending on income, and source of
Person A: Social
Security check of $400, countable
work income of $200, premium = $25
Person B: Social Security
check of $600, countable work income of
$600, premium = $50 per month
Person C: Social Security
check of $1100. Countable work income of
$100, premium = $75 per month.
How does someone apply?
Fill out an application and mail it with
the required documentation to
for Workers with
P.O. Box 19145
Springfield, IL 62794-9145
You can get an application from the
AIDS Legal Council of Chicago, from the
Health & Disability Advocates, or by
calling 1 800 226 0768.
No interview is required for the program.
When do benefits start?
Benefits do not start until premiums are
paid. If the first premium is paid before the
20th of the month, benefits will
start the 1st of the next month.
If the first premium is paid after the 20th
of the month, benefits will start a month
Can benefits be retroactive?
Yes. Like other Medicaid programs,
benefits can be retroactive three months
before the month of applications (example,
you apply in March: benefits can be
retroactive to December). But you will have
to pay premiums for the retroactive months.
When are benefits terminated?
Benefits can be terminated for the
to pay premiums
to provide proof of employment
employment for medical reasons for more than 90
work for any other reason for more than 30 days
Who can answer questions?
You can call the Illinois Department of
Public Aid at 1 800 226-0768. Most legal services
programs and disability rights groups will also be
able to answer questions about the program. You
can also call the Health & Disability
Advocates (Formerly SSI Coalition) at
Prepared by the AIDS Legal Council of Chicago,
January 2002. You can contact the Council at 312 427-8990.