Medicaid Buy-In Eligibility for Working People With Disabilities: Earn Up to $3,325 a Month in Iowa and Keep Medicaid

9 min read · Last updated November 2, 2026

The Medicaid Buy-In for Working People with Disabilities is a state option that raises the income and asset limits for workers with disabilities in exchange for a monthly premium. Iowa allows net countable income up to $3,325 a month in 2026, more than double the standard Medicaid line, while its asset limit runs $12,000 instead of the usual $2,000 for a single applicant.

In this article

• What the Medicaid Buy-In Is
• Medicaid Buy-In Eligibility: Disability Status and Income Limits
• What the Buy-In Covers: Premiums and Asset Limits
• How to Apply
• Why Buy-In Coverage Gets Denied or Lost
• Frequently asked questions

Medicaid Buy-In eligibility comes down to one swap: you pay a premium, and your state raises the income and asset limits enough that a real paycheck no longer costs you Medicaid. Iowa’s version caps net countable income at $3,325 a month for one person in 2026, and your earnings are never tested against Social Security’s Substantial Gainful Activity (SGA) standard the way ordinary Social Security Disability Insurance (SSDI) work rules test them.

What the Medicaid Buy-In Is

Congress built this option in two steps. The Balanced Budget Act of 1997 first let states cover working people with disabilities whose earnings exceed the regular Medicaid line. The Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) expanded it into the structure most programs use today, per the Centers for Medicare & Medicaid Services (CMS).

This is a state option, not a federal entitlement. CMS reports 46 states provide some version of it, through the TWWIIA Buy-In, the earlier Balanced Budget Act Buy-In, or a Section 1115 waiver, leaving a handful of states with no version at all.

Because it is optional, the program goes by different names depending on where you live. Iowa calls its version Medicaid for Employed People with Disabilities (MEPD). Maryland calls its version Employed Individuals with Disabilities (EID).

Other states use names like M.E.D. Works (Indiana) or Working Healthy (Kansas).

Most state programs sort enrollees into two groups. The Basic Coverage Group covers people who currently meet Social Security’s medical definition of disability and are working.

The Medical Improvement Group covers people who already had Basic Coverage Group eligibility, then lost it because a medical review found their condition improved, while they kept working and kept a serious impairment. New applicants cannot enter this group directly.

Medicaid Buy-In Eligibility: Disability Status and Income Limits

Every state version shares one starting test: you must meet the Social Security Administration’s medical definition of disability, the same standard used for Supplemental Security Income (SSI) and SSDI. You do not need to already collect SSI or SSDI cash benefits, just the underlying disability finding, plus earnings that would otherwise push you over the ordinary Medicaid line.

Past that shared starting point, states diverge sharply on where they draw the income line. Two real 2026 examples show how differently this can look:

• Iowa’s MEPD requires net countable income under 250% of the federal poverty level. For a household of one, Iowa’s own 2026 schedule sets that at $3,325 a month. Go over it, and you fall off the program entirely; there is no premium large enough to buy your way back in. A separate option, Medicaid’s medically needy spend-down, works differently and may still apply if your income is too high here.
• Maryland’s EID does not use a hard income ceiling at all. Its premium table keeps climbing instead of cutting someone off: once annual income passes $95,760 for an individual, Maryland’s schedule charges 7.5% of countable income as a premium, with no stated point where coverage stops.

Age rules vary too. Maryland requires you to be at least 16 and under 65. Iowa requires only that you be under 65 and still meet SSI’s medical disability criteria.

In both states, you also need actual earned income from a job or self-employment. The Buy-In exists to support work, so having no paid work at all generally disqualifies you from this specific pathway.

What the Buy-In Covers: Premiums and Asset Limits

The Buy-In’s premium is the price of the higher income line. Iowa charges nothing when monthly gross income sits at or below $1,995 (150% of the federal poverty level). Above that, premiums start at $44 a month and rise in steps based on gross income, reaching $115 a month at $3,325 gross (250% of the federal poverty level) and $144 a month at $3,990 gross (300%).

Maryland charges nothing below $15,960 a year in individual income, then moves through flat premiums of $25, $40, and $55 before switching to a percentage of countable income, topping out at 7.5%.

Asset limits get the bigger, more consequential boost. The standard Medicaid and SSI resource test, set in federal regulation and unchanged since 1989, allows just $2,000 in countable resources for a single applicant. Iowa’s MEPD raises that to $12,000, and Maryland’s EID sets it at $10,000.

That gap is the whole point for someone trying to build any savings at all. Under the regular $2,000 test, a modest retirement account can cost you Medicaid outright; under the Buy-In’s raised limit, it does not.

A worked example: Marcus in Iowa.

Marcus gets SSDI and lives in Iowa. He takes a full-time job paying $4,200 a month gross, more than double the 2026 SGA threshold of $1,690 for non-blind workers. Iowa’s MEPD ignores the SGA test entirely and checks net countable income against the $3,325 eligibility ceiling instead.

Using standard SSI-style disregards ($85 excluded, then half the remainder counted), his net countable income is $2,057.50 a month: $4,200 minus $85 is $4,115, half of which is $2,057.50. That sits well under Iowa’s $3,325 ceiling, so he keeps Medicaid.

His premium is a separate calculation based on gross income, not the disregarded figure. Iowa’s table keys his $4,200 gross income into the “more than $3,990” (300% of the federal poverty level) bracket, for a $144 monthly premium.

He has also saved $9,000 toward retirement. The regular $2,000 resource test would end his Medicaid over that; MEPD’s $12,000 limit does not.

How to Apply

You apply through your state Medicaid agency, not the Social Security Administration. Iowa’s MEPD application goes to your local Iowa Health and Human Services office by mail, fax, or in person. Maryland’s EID application goes to the state’s Eligibility Determination Division in Baltimore.

Across both states, expect to provide:

• Proof of disability, or documentation to support a new determination if you are not already on SSI or SSDI
• Recent pay stubs or self-employment records
• Documentation of your resources, checked against the state’s raised asset limit, not the standard $2,000 test
• A completed state-specific application, since there is no single national Buy-In form

Budget for a premium starting the month coverage begins; both states treat timely payment as a condition of staying enrolled.

Why Buy-In Coverage Gets Denied or Lost

The most common way people lose this coverage has nothing to do with a raise. Moving to a state without a Medicaid Buy-In program, or with a much lower income ceiling, ends your eligibility on arrival. Check the destination state’s program before any move.

Three other denial triggers show up repeatedly:

• A missed premium payment. Both states treat an unpaid premium as grounds to close your case, not just a late fee. Ask about a hardship exception before you miss a payment, not after.
• Assuming retirement savings are automatically protected. The raised asset limit is real, but it is still a limit. Going over $12,000 in Iowa or $10,000 in Maryland can still disqualify you unless your state separately excludes that account type.
• Trying to apply directly into the Medical Improvement Group. It only exists for people who already held Basic Coverage Group eligibility and lost it to medical improvement.

Frequently asked questions

Does every state offer a Medicaid Buy-In program?

No. It is a state option under federal law, and the Centers for Medicare & Medicaid Services reports 46 states run some version of it. A few states have never adopted it. Check your own state Medicaid agency’s website, since the program goes by different names like MEPD, EID, or Working Healthy.

Will earning more than Social Security’s SGA limit disqualify me?

No. The Medicaid Buy-In tests your income against your state’s own ceiling, not against Social Security’s Substantial Gainful Activity standard. Earnings that would end an SSDI cash payment under ordinary work-incentive rules do not automatically end Buy-In Medicaid, since the two programs measure different things.

What happens to my retirement savings under the asset limit?

Most Buy-In programs raise the standard $2,000 Medicaid resource limit substantially, to $12,000 in Iowa and $10,000 in Maryland for a single applicant. That gives room for real retirement savings that the regular Medicaid asset test would not allow. Going over your state’s raised limit can still cost you coverage.

Can I apply if I am not already getting SSDI or SSI?

Yes, as long as you meet Social Security’s medical definition of disability and have earned income. You do not need an existing SSDI or SSI award. You do need either a current disability determination or documentation your state can use to establish one as part of the Buy-In application.

What happens to my Buy-In Medicaid if I move to another state?

It generally ends, because the Medicaid Buy-In is a state-specific program, not a portable federal benefit. If you move to a state with no Buy-In program, or one with a lower income ceiling than your current state, you lose eligibility on arrival and would need to re-apply under your new state’s own rules.