• Jason Hahr

Florida Needs Medicaid "Buy-in" or Similar Employment Support Program


In today’s America jobs are a frequent topic of conversation. Whether we talk about bringing jobs back to America, creating a living wage or jobs in general, it is clear that this is a conversation in American life that is not ending anytime soon.

A crucial demographic that is often forgotten in the conversation are persons with disabilities. The Social Security Administration definition of disability in and of itself excludes people with intellectual and developmental disabilities from the relevant market when it defines disability as: “. . . an inability to engage in any substantial, gainful activity.” Put into simpler terms, this can translate into the inability to work. In a real world application though, many people with disabilities want to work and have the ability to work in a substantial and gainful manner, but the risk of losing the “jobs roulette” with their benefits is too great because current regulation phases out Social Security and Medicaid benefits as income increases.

How is this draconian idea behind disability still prevalent in the 21st century? Even though the question is a perplexing one there is a hope that this will change over time. At the present time, that hope comes in the form of advocacy to explore a program in Florida to provide relief for this dilemma. In fact, FL SAND has included such an endeavor as one of its three legislative priorities.

One of the key prongs of successful employment for persons with disabilities involves keeping their Medicaid services, including, but not limited to essential Home and Community Based Services. Currently, Florida is one of only three states that does not have a program to provide relief for this dilemma. Many states address this problem through Medicaid “buy-in” programs. Medicaid “Buy-in” provides a way for persons with disabilities to “buy in” or contribute a portion of their wages to offset their Medicaid expenses, much like a traditional health insurance premium. This allows a person with a disability to earn higher income without losing their Medicaid coverage.

As with all governmental programs, whether at the state or federal level, there are requirements to qualify. For example, in New York state, one must

  • Be a resident of New York State;

  • Be at least 16 years of age (coverage up to 65 years of age);

  • Have a disability as defined by the Social Security Administration;

  • Be engaged in paid work (includes part-time and full-time work);

  • Have a gross income that may be as high as $61,332 for an individual and $82,236 for a couple; and

  • Have non-exempt resources that do not exceed the MBI-WPD resource level of $20,000 for a one-person household and $30,000 for a two-person household

Other states with Medicaid “Buy-in” have similar requirements. The 2018 Florida legislative session began January 9. FL SAND voted to make employment one of its top legislative priorities because it understands that people with disabilities are an untapped resource in this country and that while their full potential cannot be realized overnight, exploring programs like Medicaid “Buy-in” is a crucial step in the right direction.

FL SAND President Amanda Baker said that the group made this a legislative priority because “employment touches on almost every part of self-advocacy. It is self-sufficiency, self-confidence, standing up for oneself, and even social relationships.....employment contributes to it all.”

As we are dealing with a lot of divisive issues currently in this country, this is one issue we can all get behind if we really think about it. Not only would it improve the lives of our fellow citizens, but it would also create more revenue for Florida and our communities leading to a more robust economy.

Florida self-advocates can share their voice on this issue by contacting their legislators and urging them and Governor Scott to explore a Medicaid “Buy-in” or similar program for working people with disabilities. FL SAND members will be sending post-cards to legislators on Developmental Disabilities Awareness Day, sharing stories regarding their desire to work and keep essential services.

Anyone can send a card and we urge you to do so. You can download a copy of FL SAND’s legislative priority postcards here and find the address to your legislators here.

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FL SAND and Florida Self-Advocacy Central are projects provided by the Florida Developmental Disabilities Council, Inc., supported in part by grant numbers 1801FLBSDD, 1901FLSCDD-01, and 2001FLSCDD-01 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.