Does Medicaid Offer a Buy-In Program for Workers With Disabilities? (2026)

Direct Answer: Does Medicaid Have a Buy-In for Working People With Disabilities in 2026?

Yes. As of 2026, 47 states plus the District of Columbia run a Medicaid Buy-In program that lets people with disabilities keep Medicaid while earning more than standard Medicaid limits allow, usually up to 250% of the federal poverty level, in exchange for a premium. Alabama, Oklahoma, and Tennessee do not offer one. Rules on income caps, asset tests, and premiums vary sharply by state.

What the Medicaid Buy-In Program Actually Does

The Medicaid Buy-In for Workers with Disabilities is not a separate insurance plan. It is a special Medicaid eligibility category that raises the income limit, and in most states the asset limit, that normally applies to Aged, Blind, and Disabled (ABD) Medicaid. A worker who qualifies gets the same full Medicaid benefit package (doctor visits, prescriptions, home and community-based services, personal care attendants) as any other Medicaid enrollee, but is allowed to earn substantially more without losing coverage. Enrollees typically pay a monthly premium set by their state instead of getting Medicaid for free.

Congress created the option in two steps. The Balanced Budget Act of 1997 first let states cover workers with disabilities earning up to 250% of the federal poverty level. The Ticket to Work and Work Incentives Improvement Act of 1999 then gave states permission to raise or eliminate that income cap entirely and to keep covering people whose medical condition improved, as long as they still had a severe, medically determinable impairment and needed Medicaid to keep working.

Income and Asset Limits by State (2026)

Every state that runs a Medicaid Buy-In sets its own dollar threshold, and the differences are large. Most states still use the original Balanced Budget Act formula and cap income near 250% of the federal poverty level, about $39,900 a year for an individual in 2026. Five states removed the income cap entirely, and two states set a lower threshold than the national norm. The table below groups states by the income model they use in 2026.

What You Pay: Premiums and Cost-Sharing

Nearly every Medicaid Buy-In program charges a monthly premium instead of offering coverage for free, and the range is wide. Texas charges between $20 and $500 a month depending on income, New Jersey charges between $203 and $1,218 a month, and Connecticut caps the premium at 7.5% of income after subtracting any employer health premiums the enrollee already pays. Missouri and a handful of other states charge nothing for enrollees at the lowest end of the income scale. Premiums typically rise on a sliding scale as income rises, and most states send a grace-period notice before terminating coverage over a missed payment.

States Without a Medicaid Buy-In Program: Alternatives

Alabama, Oklahoma, and Tennessee do not run a Medicaid Buy-In program in 2026. Workers with disabilities in those three states must qualify through standard SSI-linked Medicaid, which typically caps income near the SSI federal benefit rate and caps resources at $2,000 for an individual, or they must look outside Medicaid entirely. The Ticket to Work program still applies nationwide regardless of Buy-In availability: it lets SSDI and SSI beneficiaries test employment for up to nine months (the trial work period, $1,210 a month in 2026) without losing cash benefits, and it does not require a state Buy-In program to function. Workers in non-Buy-In states who earn too much for standard Medicaid can also shop an ACA-compliant marketplace plan, which must cover the same essential health benefits Medicaid covers and cannot deny enrollment or charge more for a preexisting condition.

Medicaid Buy-In vs. Medicare's QDWI Program for Disabled Workers

Medicare runs a parallel, smaller program called Qualified Disabled and Working Individuals (QDWI), and it is easy to confuse with the Medicaid Buy-In. QDWI only pays the Original Medicare Part A premium (the full premium is $565 a month in 2026, or $311 a month for someone with 30 to 39 work quarters) for people under 65 who returned to work and lost their premium-free Part A. QDWI income limits are set at 200% of the federal poverty level, about $31,920 a year for an individual in 2026 after standard income disregards, with a resource limit of $4,000 for an individual.

Someone can qualify for both programs at different points in their work history. A person who collects SSDI typically gets Original Medicare Part A and Medicare Part B automatically after a 24-month waiting period. Once Medicare starts, a Medicaid Buy-In enrollee usually becomes dual-eligible, and Medicaid picks up the Medicare Part B premium and cost-sharing, while Medicare Part D covers prescriptions and dual-eligible enrollees automatically qualify for the Part D Low-Income Subsidy. A dual-eligible worker can also enroll in a Medicare Advantage Dual Special Needs Plan instead of Original Medicare, though most states do not guarantee Medigap access to beneficiaries under 65, so Medicaid itself typically serves as the secondary coverage instead of a private Medigap policy.

How to Apply for the Medicaid Buy-In in Your State

Every state's Buy-In program has its own name (New York calls its version the Medicaid Buy-In Program for Working People with Disabilities, Illinois calls its version Health Benefits for Workers with Disabilities), so the fastest first step is to search your state Medicaid agency's website for "Buy-In" or "Workers with Disabilities." The federal starting point is Medicaid.gov's Ticket to Work page, which links out to every state's program.

• Confirm you meet Social Security's disability definition, either through an existing SSDI or SSI award or a state medical review team determination.
• Gather proof of earned income, unearned income, and resources: recent pay stubs, your latest tax return, and bank statements.
• Contact your state Medicaid agency (or SSA field office) and ask specifically for the Medicaid Buy-In or Workers with Disabilities application.
• Report any employer or union health coverage you already have, since some states coordinate the Buy-In with existing insurance.
• Set up your monthly premium payment if your state charges one, and mark your state's annual redetermination deadline.

Does every state have a Medicaid Buy-In program for working people with disabilities?

No. As of 2026, 47 states plus the District of Columbia run one, but Alabama, Oklahoma, and Tennessee do not. Workers with disabilities in those three states must qualify through standard SSI-linked Medicaid instead, which has much lower income and resource limits than a Buy-In program.

What is the 2026 income limit for the Medicaid Buy-In program?

It depends entirely on your state. Most states cap income at 250% of the federal poverty level, about $39,900 a year for an individual in 2026. Maryland, Massachusetts, Minnesota, New Jersey, and Rhode Island have no income limit at all, while Idaho's cap is the highest published state threshold at 500% of the federal poverty level.

Do I have to pay a premium to stay enrolled in the Medicaid Buy-In?

In most states, yes. Premiums are usually set on a sliding scale tied to income. Texas charges $20 to $500 a month, New Jersey charges $203 to $1,218 a month, and Connecticut caps the premium at 7.5% of income. Missouri and a few other states charge nothing at the lowest income levels.

Does the Medicaid Buy-In use Social Security's substantial gainful activity (SGA) test?

No, and that is the whole point of the program. Regular SSDI-linked Medicaid can end if earnings exceed the SGA threshold ($1,690 a month for non-blind individuals, $2,830 for blind individuals in 2026). The Medicaid Buy-In lets a worker earn well above SGA and keep Medicaid, as long as they stay under their state's Buy-In income and asset limits.

What happens if my income drops or I lose my job?

If your income falls, your premium usually decreases on the sliding scale, and you may become eligible for regular Aged, Blind, and Disabled Medicaid at no premium. If you lose your job entirely, you generally remain eligible for standard Medicaid or SSI-linked Medicaid; contact your state Medicaid agency before your next redetermination to avoid a coverage gap.

Is the Medicaid Buy-In the same as Medicare's QDWI program?

No. Qualified Disabled and Working Individuals (QDWI) is a Medicare program that only pays the Original Medicare Part A premium ($565 a month in 2026) for people under 65 who lost premium-free Part A after returning to work. The Medicaid Buy-In is a full Medicaid eligibility pathway covering doctor visits, prescriptions, and long-term services, not just a Part A premium subsidy.

Which states have no income or asset limit for the Medicaid Buy-In?

Maryland, Massachusetts, Minnesota, New Jersey, and Rhode Island eliminated the income cap on their Buy-In programs, and most also dropped the asset test. This lets someone earn a high salary while still qualifying, as long as they meet Social Security's disability definition and pay any required premium.

How do I find my state's Medicaid Buy-In program and apply?

Start at Medicaid.gov's Ticket to Work page, which links to every state's program, since each state uses its own name (New York's is the Medicaid Buy-In Program for Working People with Disabilities; Illinois calls its version Health Benefits for Workers with Disabilities). You can also call your state Medicaid agency directly and ask for the Buy-In application by name.