Medicaid Buy-In for Children with Disabilities

Health-care coverage is a very important piece of getting our children the care they need. For many families, Medicaid and its related programs offer a much-needed source of free or low-cost health care coverage and benefits.

Most Medicaid programs require that families have a very low income to be approved. However, Medicaid Buy-In programs use higher income requirements to help children and adults with disabilities or special health care needs get Medicaid health care coverage and benefits.

What is Medicaid Buy-In For Children?

There are 2 Medicaid Buy-In programs:

• Medicaid Buy-In for Children allows families who meet income requirements to buy Medicaid coverage for children age 18 or younger with disabilities or special health care needs.
• Medicaid Buy-In allows adults age 19 and older who have disabilities or special health care needs and earn a certain amount of income through a job to buy Medicaid coverage.

Who Can Get Medicaid Buy-In?

To get Medicaid Buy-In for Children, a child must:

• Have a disability or special health care need that meets the same rules used to get Supplemental Security Income (SSI). This means that your child’s disability or special health care need must significantly restrict their daily activities.
• Be age 18 or younger.
• Not be married.
• Live in Texas and be a U.S. citizen or legal resident.
• Have a family income that meets certain requirements. You can find these income amounts on the Medicaid website.

To take part in Medicaid Buy-In, an adult must:

• Have a disability or special health care need that meets the same rules that are used to get Supplemental Security Income (SSI).
• Be working.
• Live with family or independently.
• Live in Texas and be a U.S. citizen or legal resident.
• Meet certain income and asset requirements. You can view these requirements on the Texas Health and Human Services Commission’s Medicaid Buy-In page.

In addition, if an adult gets home and community-based services through a waiver program, and they begin to earn more than the waiver’s limit, they might be able to keep getting waiver services through Medicaid Buy-In.

How Do Medicaid Buy-In Programs Work?

For either Medicaid Buy-In program, once you or your young adult has turned in an application and has been accepted into the program, your child will be able to use Medicaid services. To learn more about Medicaid services, see our Medicaid page.

There is a monthly premium (fee) and cost share for these services through the Buy-In program. The amount will be based on how much money your child and family are getting from work, SSI benefits, or other sources. To find out what your premium costs would be, you can call 2-1-1 or 877-541-7905. When you call, pick a language and then press 2. Follow the “Medicaid” choices.

How Medicaid Buy-In for Children Works

Medicaid Buy-In for Children helps working parents get health care coverage for their children with disabilities or special health care needs.

The monthly premium is based on the amount of money that your family makes (you, your spouse, and your children who live with you), the number of people in your family, if you get insurance through work, and if you are in the Medicaid Health Insurance Premium Payment (HIPP) program.

The cost share means that you will be expected to pay part of the cost of your child’s doctor's visits, hospital stays, medications, therapies, and other health care services. Once you reach your yearly limit, you might not have to pay your monthly premium or co-payments until after you renew your benefits the next plan year.

There are 2 ways that you can use Medicaid Buy-In for Children:

• If your child doesn’t have other health insurance, you can use Medicaid Buy-In for Children to get Medicaid as your child’s only insurance policy.
• If you have health insurance for your child through your job, you can use Medicaid Buy-In for Children to get Medicaid as a second health insurance policy for your child. Medicaid will help pay for some things that your other insurance might not cover, like in-home care, certain therapies, or transportation to doctor’s visits. If your employer will pay at least half of the cost of covering your child on their health insurance plan, you must sign up for that insurance plan for your child or you won’t be able to sign up for the Medicaid Buy-In for Children.

Header: How Do I Apply for a Medicaid Buy-In for My Family?

In Texas, Medicaid programs are managed by the Health and Human Services Commission (HHSC). You or your child can apply for any HHSC program by visiting your local office. You can find that office by calling 2-1-1 or visiting 2-1-1 Texas online. If you and your child don’t want to go apply in person, there are other choices listed below. You can also get free help applying for Medicaid services from a community partner organization. To apply, get the application form and fill it out.

• For a child age 18 and younger, you will need to fill out form 1200-MBIC in English or form 1200-MBIC in Spanish.
• For an adult age 19 or older, you will need to fill out form H1200-MBI.
• You can also call 2-1-1 and ask for these forms to be mailed to you.

When you apply, you will need to show or send:

• Proof of money earned from a job (pay stubs or earning statements).
• Proof of income not from a job (veterans, SSI, and other benefits).
• Medical costs records (bills or statements from doctors, hospitals, drug stores, and other health care providers from the past 6 months). It is helpful to keep these in a care notebook. You can learn more about care notebooks on our Organizing Medical Records page.

Once you have filled out the application and gathered your other proof, you can:

• Take it to an HHSC benefits office. Call 2-1-1 to find an office near you.
• Fax it to 877-447-2839. If your form is 2-sided, fax both sides.
• Mail it to the state office at:

Health and Human Services Commission P.O. Box 149024 Austin, TX 78714-9024

You should expect to hear back within 45 days, on average, and HHSC might need to find out more about your child’s disability or your family’s situation. You will get a letter that will tell you if you are approved for the program, how much you’ll have to pay monthly, and when your coverage will begin.