Medicaid benefits for workers with disabilities 

Individuals with disabilities who receive Medicaid may be concerned about losing their Medicaid benefits when they take a job. There are different ways that workers with disabilities can work and keep or seek Medicaid coverage. Consider your options and decide which works best for you. 

If a person with a disability is already receiving SSI and Medicaid, they should research whether they have 1619(b) status. If you have 1619(b) status, you can keep your Medicaid even if you lose your SSI when you start working. 1619(b) status is based on an individual's disability, not their income, so there are no spenddown criteria. There are disability reviews, though. 

If you don't qualify for 1619(b) status, there are other options available. The first is Medicaid spenddown. 

The Illinois Department of Healthcare and Family Services (HFS) has a spenddown program. The program helps people who have too many assets or too much income to qualify for Medicaid. In a spenddown program, you pay for the cost of your medical care up to a set amount each month based on your income and assets. Your spenddown can vary based on whether you are looking for Medicaid assistance while you are at home and working or if you need help paying for residential care. 

Another option for workers with disabilities is the Medicaid buy-in program, known as Health Benefits for Workers with Disabilities (HBWD). HBWD allows people with disabilities who are working to enroll or stay in Medicaid by paying a monthly premium rather than having to do a spenddown. More information about HBWD is included below.

Eligibility for HBWD

In order to qualify for the Medicaid buy-in program, you must be:

• A U.S. citizen or lawful immigrant in a category eligible for Medicaid,
• Disabled (as defined by Social Security),
• An Illinois resident age 16 to 64, and
• Employed by an employer that makes FICA contributions.

Also, your property or assets must not be worth more than $25,000 (usual exemptions apply, including your home and a car you need to get to the doctor). Your income must be equal to or less than 350% of the federal poverty level. Income includes:

• Wages,
• Social Security or other income, and 
• Spouse’s income.

Deductions from income include:

• Taxes,
• Transportation,
• Day care expenses,
• Union dues,
• Life insurance or retirement plan withholding,
• Special work expenses, and
• The small lunch allowance.

How to apply

You can apply online for benefits. You can also download an application and mail it to:

Health Benefits for Workers with Disabilities

P.O. Box 19145

Springfield, IL 62794-9145   

For more information or to ask for an application to be mailed to you, call 1-800-226-0768.

When 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 one month later.

Like other Medicaid programs, HBWD benefits can be retroactive 3 months before the month of your application. For example, if you apply in March, you can get benefits for the past December, January, and February. But you will have to pay premiums for the retroactive months.

When benefits end

Benefits can end because of the following reasons:

• Failure to pay premiums,
• Failure to provide proof of employment,
• Stopping employment for medical reasons for more than 90 days, or
• Stopping work for any other reason for more than 30 days.

Learn more about Illinois Medicaid and the HBWD program.