The Medicaid Buy In for disabled children is available for children whose family “countable” income is up to 150% of the poverty line. Once a child receives Medicaid, either through the buy in or through SSI, the Health Insurance Premium Payment plan is available.
For a minor to receive disability benefits from Social Security the child has to be eligible for Supplemental Security Income. If a child is disabled, but does not meet the non-medical criteria for SSI, Texas has the Medicaid Buy In for Children (MBIC) to help with medical care. To be eligible for MBIC, the child must be:
2) 18 years old or younger (eligibility ends the first of the month following the month the child turns 19)
3) Not married and
4) The family’s countable income must be at or below 150% of the poverty line.
Countable Income. What is “countable income”? Earned income.
Earned income received a 50% reduction on what’s “countable” income. This means the short answer for earned income as long as family income is less than or equal to 300% of the poverty line the child is eligible.
The actual formula used is:
(A) Total the following:
(i) Monthly countable income of the child applying for or receiving MBIC.
(ii) Combined monthly countable income of the child’s parents.
(iii) Countable monthly income of each of the child’s ineligible siblings that is in excess of 150% of the FPIL for a household of one, multiplied by 2, plus $85.
(B) Subtract $85 from the total arrived at in subparagraph (A) of this paragraph.
(C) Divide the total arrived at in subparagraph (B) of this paragraph by 2.
(Taken directly from Texas Administrative Code Rule N-1100 *361.111)
Unearned income is not treated as kindly as earned income. For unearned income the 50% reduction is not applied to the income. However, the first one-third of child support is not “countable” income. Also, “in kind” support (food, shelter) does not count as income for MBIC purposes.
Applying For Benefits. In order to apply for benefits you will need to get in touch with the department of Health and Human Services. Here’s where the issue gets maddening…..
The web page will not allow you to apply for the Medicaid Buy In for Children.
Yes, that’s right. You CANNOT apply through the web page. If you try, the web page will screen you for CHIP or regular Medicaid eligibility, which have a lower financial cut off. It WILL NOT allow you to apply.
Even if you attempt to apply through the section for disabled individuals HHS processes the claim as for a disabled adult, not the child, and will reject the claim saying that the wrong type of application was filed. I learned this the hard way when attempting to obtain benefits for my son.
In order to properly apply you MUST either go in person to the HHS office or have HHS mail a copy of the application to you AND attach a cover letter indicating you are applying for the MBIC program. Even simply filling out the application is insufficient since the MBIC program does not have a separate application form.
The Application.The application is fairly straight-forward and can be filled out in less than an hour. What’s important is including the supporting material for the application.
For the non-medical criteria this is proof of income (pay stubs), proof of insurance (a copy of the front and back of the insurance card), and if applicable proof of citizenship.
For the medical criteria, you need to submit enough medical evidence that HHS can make a determination on disability. If you already have a determination from Social Security noting the disability you’re good to go. If not, you must include medical records establishing the disability, and an argument on how the medical records establish the disability. It’s important to note the HHS uses the same criteria the Social Security Administration uses to determine disability.
The Interview. Once HHS receives your application they will call for an interview. You are usually notified via the mail when the interview is scheduled. Usually the notice is short – less than a week, and sometimes Friday notice for a Monday interview – and is arranged at HHS convenience not yours. It’s imperative you answer the phone for the interview – they will close your case out for failure to appear for the interview if you don’t.
Appeal. Should you be denied the appeal process is simple. HHS will send you the denial in the mail with an address where to appeal. To appeal, simply write a letter stating why you disagree with the decision and asking for an appeal. It’s also helpful to dial 2-1-1 and make the appeal there to secure your place in line for the appeal process while the letter is on the way to Austin.
Health Insurance Premium Payment (HIPP). Once the minor obtains Medicaid you potentially are eligible for the HIPP program. Medicaid is the payor of last resort, so any insurance coverage pays before Medicaid pays. Because of this, the state has instituted the HIPP program. This is a separate application that you have to file once the child becomes Medicaid eligible. With this application Medicaid determines whether it’s more cost effective to provide care without insurance, or if it’s more cost effective for Medicaid to pay for the health insurance premium and the out of pocket limit. If it is more cost effective for Medicaid to pay the health insurance premium and the out of pocket limits Medicaid will reimburse you for your healthcare insurance premium.
What’s great about this program is that the minor is almost always a family member attached to the parent’s insurance plan. HIPP will pay the entire premium, not just the part of the premium that covers the child.
It’s important to note that HIPP is only available for workplace provided insurance. An insurance policy purchased outside of work (say through einsurance.com or the marketplace) is not eligible for HIPP.