M-1200, Program Overview

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Revision 22-3; Effective September 1, 2022

The MBI program is a Medicaid program for people with disabilities who are working and earning more than the allowable limits for regular Medicaid. MBI allows people with disabilities who are working to earn more income without the risk of losing vital health care coverage. The income limit is up to 250% of the federal poverty level (FPL). A person may have to pay a monthly premium as a condition of eligibility. The amount of the premium is determined on a sliding scale, based on the recipient’s earned and unearned income.

MBI recipients receive a Your Texas Benefits Medicaid ID card. If a recipient is eligible for both Medicare and Medicaid, prescriptions are available through a Medicare Part D Prescription Drug Plan.

All regular MEPD policies apply to this program except for the eligibility items specifically identified in this chapter. For example, citizenship and Texas residency are not addressed in this chapter. Therefore, follow regular MEPD policies for citizenship and Texas residency.

All eligibility requirements for this program must be verified. MBI is not a client-declaration program.

M-1300, MBI and Other Programs

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M-1310 MBI and Home and Community-Based Services Waivers

Revision 16-2; Effective June 1, 2016

If a person is currently eligible for Medicaid Buy-In (MBI) and requests waiver services, the Long-Term Services and Supports (LTSS) programs (such as STAR+PLUS Waiver) do not require a change in Medicaid type program for payment of services. Do not do a program transfer for ME-Waivers.

Do not calculate a copay for individuals who are MBI-eligible and receive waivers services. A person is not subject to a financial copay unless financial eligibility is determined using the 300% of Supplemental Security Income, Special Income Group limit, e.g., ME-Waivers.

M-1320 MBI and Medicare Savings Programs

Revision 11-4; Effective December 1, 2011

An MBI-eligible applicant/recipient can also have:

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)

An MBI-eligible applicant/recipient cannot have:

  • Qualifying Individuals-1 (QI-1). The applicant/recipient must choose between MBI and QI-1.
  • Qualified Disabled Working Individuals

Note: Deeming of income and resources and support and maintenance applies to the Medicare Savings Program.