Medicaid for Transition Age Youth and Workers with Disabilities

Medicaid for Transition Age Youth
and Workers with Disabilities
Annette Shea, Center for Disability and Aging Policy
December 12, 2013
• Affordable Care Act and Medicaid for transition age youth
• Medicaid and non-Medicaid provisions
– Eligibility and Enrollment
– Medicaid Buy-In
Affordable Care Act: New Opportunities for States
• Transition-aged youth with disabilities will have the opportunity to
enter the workforce and choose employment instead of committing to
not working and relying on social security benefits.
• Younger adults making occupational decisions can enter adulthood
with less risk of losing access to health coverage.
• States expanding Medicaid will offer individuals with income up to
133% of the federal poverty level access to Medicaid without an asset
ACA provisions currently in effect:
• Lifting of pre-existing condition in offering private or commercial
health insurance
• No more life time caps
• Coverage of Dependents to age 26
Medicaid Eligibility and Enrollment for Youth in Transition
• Income from children, through age 18, is not counted toward financial
eligibility for the family when SSI methodologies are applied.
• MAGI rules apply regarding how income is counted.
• An adult individual applying for Medicaid may:
– Use streamlined eligibility without consideration due to disability.
– Identify a disability as consideration for eligibility; financial and
non-financial criteria would be used to determine eligibility.
• Criteria is state-specific
• Annual redeterminations would be for the eligibility group a
beneficiary is enrolled in.
• Applicants have right to appeal decision.
Medicaid Buy-In
Medicaid Buy-In Programs are authorized by CMS and operated by State Medicaid
agencies. Enrollment nationally is approximately 200,000.
There are 46 Medicaid Buy-In programs nationally. Most recently approved state is
Colorado with a current enrollment of more than 1000.
Financial eligibility criteria is states specific. States have great flexibility in regards
to the treatment of income and assets for Medicaid Buy-In programs.
States also have some benefit flexibility, state plan and community-based longterm care programs.
Over the past 10 years more than 400,000 individuals with disabilities have been
enrolled in the program.
Total earnings among all participants in 2011 was about $1.15 billion.
• Transition age youth with disabilities have opportunities for
successful employment experiences and access to critical
community-based benefits.
• Youth with disabilities transitioning to adulthood have
benefit options within Medicaid and the private health
insurance market.
Contact information
Annette Shea
Center on Disability and Aging Policy (CDAP)
Administration for Community Living (ACL)
US Department of Health and Human Services
One Massachusetts Avenue NW
Washington, DC 20001
(202) 357-3427
Email: [email protected]
ACL website:

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