Medicaid Buy-In Program

What is it about?

• For families who need health insurance, but make over the limit income for traditional Medicaid.
• Families “buy in” to Medicaid by making a monthly payment (premium) like any other insurance company.
• Medicaid Buy-in might be an option for our clients whose insurance does not cover Speech Therapy.
• Medicaid Buy-in does not cover ABA therapy.
• Some families have to pay for part of the costs of doctor visits, hospital stays, medicine, therapy, and other services. These costs are usually from monthly premiums, co-pays, and deductibles.
• There is a limit to the costs that a family has to pay every 12 months. Families that reach the limit might not have to pay monthly payments for the rest of the benefit period.

What does it cover?

• If a family has health insurance from work, Medicaid buy-in might pay for services the insurance doesn’t cover. Or it can serve as a Secondary Insurance
• Medicaid will pay only for services from a Medicaid provider
• Doctor & Clinic visits
• Hospital visits
• Emergency Care
• Medicine
• Glasses
• Dentist visits
• Mental health care
• Care in the home
• Therapy (speech/occupational/physical)
• Regular checkups and help with Medicaid services (case management)

Qualifications:

• Up to $4,633 for a family of 3
• Up to $7,498 for a family of 6
• The most a family will pay is $230 each month.

Where to get more information:

• Call 2-1-1 or 1-877-541-7905 (8 a.m. to 8 p.m. Central Time)
• Go to www.hhsc.state.tx.us Click on “How to get help” – Click on “Children”.
• Call 2-1-1. Ask to have a Form H1200-MBIC mailed to you.
• Go to an HHSC (Health and Human Services Commission) office near you. Call 2-1-1 to find one near you.