Originally published: October 2025 | Reviewed by Perry Morrison
Working people with disabilities in North Carolina often worry about losing Medicaid coverage when their income goes up. That fear can make folks hesitate to take new jobs or move up at work.
Many SSDI and SSI recipients are unaware of the options available to them to maintain their health coverage while working. It’s a real shame because there are ways to make work possible without losing vital care.
North Carolina’s Medicaid Buy-In program, officially known as Health Coverage for Workers with Disabilities (HCWD), allows individuals with disabilities aged 16-64 to maintain Medicaid coverage even if their income exceeds the standard limits.
The program bridges the gap between disability benefits and employment, allowing workers to pay affordable premiums to maintain their health insurance.
Medicaid for workers with disabilities in NC provides full coverage if you qualify. It’s a lifeline for many.
The program’s rules differ slightly from those of regular Medicaid. You’ll find specific requirements for income, assets, and disability status.
North Carolina’s Medicaid Buy-In program allows working individuals with disabilities to maintain their health coverage even when they earn income from employment.
The program charges premiums and gives full Medicaid benefits to disabled workers who’d otherwise lose coverage because they’re earning too much.
A Medicaid buy-in program serves workers with disabilities who earn income above traditional Medicaid limits. The name comes from the fact that people pay premiums to “buy in” to Medicaid coverage.
The main purpose? Remove barriers to work. Plenty of people with disabilities avoid jobs because they’re scared of losing health benefits.
This creates a loop where folks stay dependent on government help. The buy-in program tries to break that cycle.
It lets people with disabilities work and still get the medical care they need. States can charge premiums as part of keeping Medicaid eligibility.
Key Features:
NC’s Medicaid for Workers with Disabilities program covers people ages 16 through 64 who have disabilities and work any number of hours. You don’t need to work full-time to get in.
The program helps both SSDI and SSI recipients. SSI work incentives help people reduce the risk of losing benefits when they start working.
SSDI recipients can also benefit, especially when they’re stuck in the Medicare waiting period.
Eligible Groups Include:
Income limits change by state. The median income limit for Medicaid buy-in programs is 250% of the Federal Poverty Level—that’s $3,261 per month in 2025.
Asset limits also come into play. The median asset limit is $10,000 for singles and $14,470 for married couples.
Participants get complete Medicaid benefits through the buy-in program. This isn’t a stripped-down plan—it’s the same as regular Medicaid.
Full Coverage Includes:
The coverage fills significant gaps for working individuals with disabilities. SSDI recipients often face a 30-month wait before Medicare coverage kicks in, and the buy-in program fills the gap during that time.
For SSI recipients, this means they can work immediately without losing their health benefits. That security makes it easier to take a chance on work.
Premiums depend on income and state rules. Even with those costs, you maintain access to full medical care while building work experience and earning an income.
Morrison Law Firm helps North Carolina residents protect their Medicaid while receiving SSDI or SSI. If you’re unsure about eligibility, contact us today to schedule your free consultation.
If you’re ready to get started, call us now!
The NC Medicaid Buy-In program has specific requirements for working individuals with disabilities.
You must meet specific age, residency, disability, work, income, and resource requirements to be eligible for coverage.
Applicants must be between 16 and 64 years old. If you’re over 65, this buy-in option isn’t for you.
You must live in North Carolina and plan to stay. Temporary visitors don’t qualify.
You need to meet one of these:
You must be working or have earned income. That can include:
If you don’t have any earned income, you can’t qualify for this program.
NC Medicaid eligibility sets strict resource limits for the buy-in. Countable resources must be $25,728 or less for an individual.
Countable Resources Include:
Exempt Resources:
Married couples might see different calculations based on their spouse’s income and assets.
The buy-in program caps unearned income at 150% of the Federal Poverty Level. For 2025, that’s $1882 per month for one person.
Unearned Income Types:
The first $65 of earned income plus half of the rest doesn’t count. This rule allows working people to keep more of their pay while remaining covered.
SSDI payments sometimes push people over the unearned income limit. Folks with high SSDI might not qualify.
All basic Medicaid eligibility requirements still apply. That means citizenship, Social Security number, and some cooperation requirements.
Citizenship Requirements:
Additional Requirements:
Non-citizens face extra immigration rules. Some immigrants have to wait before getting full benefits.
You have to complete the standard Medicaid application process. There’s no shortcut around the paperwork and documentation.
Income limits depend on your family size and the specific program rules that apply. The buy-in utilizes both 150% and 200% of the Federal Poverty Level thresholds.
| Family Size | 100% FPL Annual | 150% FPL Monthly | 200% FPL Monthly |
| 1 person | $15,060 | $1,883 | $2,510 |
| 2 people | $20,440 | $2,555 | $3,407 |
| 3 people | $25,820 | $3,228 | $4,303 |
| 4 people | $31,200 | $3,900 | $5,200 |
Note: Monthly figures are rounded to the nearest dollar. The official guidelines are published annually.
Earned income gets better treatment than unearned income. The program allows you to earn more overall if most of it comes from work wages, rather than benefits.
Married folks have to count their spouse’s income. Even if the spouse doesn’t apply, their income can affect your eligibility.
Premiums also change based on income and family size within the qualifying ranges.
The NC Medicaid Buy-In program charges fees based on how much you earn above federal poverty guidelines.
Workers pay a $50 annual fee if earnings exceed 150% FPL, and monthly premiums if income surpasses 200% FPL.
Workers with disabilities face a $50 annual enrollment fee once their income goes above 150% of the Federal Poverty Level. This fee applies regardless of how much they earn beyond that mark.
The 150% FPL threshold is the first cost-sharing milestone in the program. Workers under this level get coverage without any enrollment fees.
This fee structure supports the ticket to work initiative by keeping costs down for lower-earning participants. It encourages people with disabilities to try working without running into immediate financial roadblocks.
The annual fee remains fixed at $50, regardless of changes in income throughout the year. Workers pay it just once per calendar year if they qualify for the program.
Monthly premiums start when workers earn more than 200% of the Federal Poverty Level. These premiums go up on a sliding scale as income rises.
The premium structure depends on household size and total earnings. As income climbs above the 200% FPL threshold, premiums increase.
Premium amounts use formulas that factor in both earned and unearned income. The state sets maximum premium limits to keep things affordable for working participants.
These work incentives help people with disabilities keep health coverage while aiming for financial independence.
Workers must pay premiums each month to maintain their Medicaid coverage. Late payments can mean losing coverage.
The premium policy framework follows federal Medicaid guidelines for buy-in programs. States have to set clear premium schedules and collection procedures.
North Carolina bases premium amounts on income brackets above 200% FPL. The state can’t charge premiums over 7.5% of a worker’s monthly income.
Premium calculations leave out certain types of income and deductions. Workers can appeal premium amounts through the standard Medicaid appeals process.
The framework provides hardship exemptions for workers experiencing temporary financial difficulties. These protections help people keep access to essential health services.
Payment options include automatic deductions, online payments, and regular billing. Workers receive advance notice before any premium changes take effect.
SSDI recipients switch to Medicare after 24 months, while SSI recipients can keep Medicaid through the 1619(b) provision even when working.
These programs interact differently with North Carolina’s Medicaid Buy-In for working individuals with disabilities.
Social Security Disability Insurance recipients are automatically eligible for Medicare coverage after 24 months of receiving benefits. This waiting period applies to all SSDI beneficiaries, regardless of age.
Once Medicare starts, SSDI recipients become eligible for Medicare instead of Medicaid. Medicare becomes the primary insurance for medical expenses.
The NC HCWD program is important for SSDI recipients who wish to work. Medicare by itself might not cover everything Medicaid does.
Key Medicare limitations include:
HCWD lets working SSDI recipients buy into Medicaid as secondary coverage. This fills the gaps that Medicare leaves behind.
Premium costs for HCWD depend on income. Higher earnings mean higher monthly premiums for Medicaid buy-in coverage.
Supplemental Security Income recipients can keep Medicaid coverage through Section 1619(b) continued Medicaid eligibility even when working. This provision removes the fear of losing healthcare coverage for earning an income.
SSI recipients qualify for 1619(b) if their earnings go over the substantial gainful activity limit, but they still need Medicaid. Their income may not be sufficient to replace both SSI and Medicaid benefits.
1619(b) requirements include:
North Carolina sets annual earning limits for 1619(b) eligibility. These limits change based on individual needs and medical expenses.
The 1619(b) provision works in conjunction with NC’s HCWD program. Some SSI recipients can use both programs, depending on their work income and medical costs.
SSI disability benefits stay closely tied to Medicaid, more so than Social Security disability insurance. This makes it easier for many SSI recipients to try working.
Health Coverage for Workers with Disabilities gives full Medicaid coverage to working individuals with disabilities. The program covers the same services as regular NC Medicaid.
HCWD participants get the same Medicaid coverage as traditional NC Medicaid. The program pays for doctor visits, hospital stays, medical equipment, home care, and mental health services.
Medical Services Include:
Additional Coverage:
Preventive care services are fully covered, like annual checkups, vaccinations, and health screenings.
Vision and dental services might be available, depending on the plan. Recipients should check what their coverage includes.
Most HCWD participants use NC Medicaid managed care plans. These plans coordinate care and manage benefits for members.
Participants must select a managed care organization when they enroll. Each plan has its own network of doctors and hospitals.
Key Requirements:
Emergency care is always covered, no matter which hospital you use. Urgent care centers in the network offer after-hours treatment.
Plan changes usually happen during open enrollment periods. Sometimes, special situations let you switch outside those times.
Morrison Law Firm guides clients through SSDI, SSI, and Medicaid applications every day. Call us now to schedule your consultation.
If you’re ready to get started, call us now!
You can apply through the online ePASS system or visit your local Department of Social Services office. DSS calculates countable income using specific formulas to figure out eligibility and premium amounts.
The ePASS online portal is the fastest way to send in a Medicaid Buy-In application. Applicants create an account and complete digital forms from the comfort of their own homes.
If you want in-person help, you can visit or call your local Department of Social Services office. Every county has a DSS office with staff available to assist.
Phone applications are available too. You can call your local Department of Social Services to apply over the phone.
The NC Medicaid Contact Center at 1-888-245-0179 can help you find the nearest DSS office. Staff will give you the office addresses and phone numbers.
Application Methods:
Applicants must gather specific paperwork before beginning. Missing documents can slow things down.
Required Documents:
SSDI recipients should bring their Social Security award letters. SSI recipients need their current benefit statements.
Workers need employment verification letters from employers. If you’re self-employed, bring tax returns and business records.
Medical records may be required when applying for disability benefits. These documents help verify the qualifying disability.
DSS uses federal formulas to figure out countable income for Medicaid Buy-In eligibility. This number decides both the qualification and premium amounts.
Income Exclusions Applied:
Gross monthly income gets reduced by these exclusions. The leftover amount is the countable income for eligibility.
DSS compares countable income to federal poverty guidelines. If countable income is up to 250% of the poverty level, applicants might qualify.
Premiums are based on a sliding scale according to countable income. More countable income means higher monthly premiums.
Example Calculation:
Working participants must report income changes promptly to maintain their Medicaid Buy-In eligibility.
North Carolina conducts regular reviews to check ongoing qualification and update premium amounts based on current earnings.
Participants must report job changes within 10 days of their occurrence. This covers starting new jobs, changes in work hours, wage increases or decreases, and changes in job duties.
Income reporting requirements include:
Participants also need to report changes in resources within the same time frame. This includes changes to bank account balances, property ownership, or receiving inheritances or gifts exceeding $100.
The state uses this info to recalculate premium amounts and check eligibility. Workers with disabilities can maintain coverage if their earnings remain below the substantial gainful activity levels.
If participants don’t report changes, they could face overpayment demands or lose coverage. The state might ask for repayment of benefits received during periods of unreported income.
North Carolina does Medicaid Buy-In redeterminations every 12 months. You’ll receive a renewal packet approximately 45-60 days before your coverage expires.
The redetermination process includes:
You have 30 days to return the completed forms and all accompanying documents. If you miss the deadline, the state will automatically close your case.
While the review is in progress, your coverage and premium remain the same. New premium amounts start the month after approval.
If your paperwork’s incomplete, the state might ask for more info.
If you disagree with a redetermination decision, you can ask for a fair hearing within 30 days. If you request a hearing within 10 days, your coverage will continue during the appeal process.
When your income changes, it can affect your premiums and eligibility. The state recalculates your premiums when you report income changes during the year.
If your income drops:
If your income goes up:
For 2025, you can earn up to 250% of the Federal Poverty Level and still qualify. That’s about $3,200 a month for one person.
If your income goes over the limit, you lose Buy-In eligibility. However, you may have other options, such as employer insurance or Marketplace plans.
Both programs help working individuals with disabilities maintain their Medicaid coverage.
HCWD is for workers who may not qualify for SSI, while SSI 1619(b) helps current SSI recipients maintain Medicaid when their earnings become too high for cash payments.
| Feature | HCWD | SSI 1619(b) |
| Age Range | 16-64 years old | No age limit |
| Income Limit | No earnings limit | $43,358 gross annual income in 2025 |
| SSI Requirement | Not required | Must be eligible for SSI |
| Application | Must apply separately | Automatic if on SSI |
| Premium Cost | May have a sliding scale premium | No premium |
| Resource Limits | $2,000 individual, $3,000 couple | $2,000 individual, $3,000 couple |
If you’re already getting SSI, you automatically get 1619(b) protection. There’s no need to fill out an extra application for that.
On the other hand, HCWD asks you to apply separately, but it does let in workers who never qualified for SSI in the first place. That can be a relief for folks who fall outside the usual SSI path.
Clients across North Carolina repeatedly share how Morrison Law Firm has guided them through some of life’s most difficult challenges.
These stories highlight what makes Morrison Law Firm different:
When your health coverage and financial security are at stake, you deserve a law firm that treats you like family and fights for your future.
When your health coverage and financial stability are at risk, trust Morrison Law Firm to protect your SSDI, SSI, and Medicaid rights. Contact us today to schedule your free consultation.
What is the NC Medicaid Buy-In Program (HCWD)?
It’s a Medicaid category for North Carolina residents with disabilities aged 16 to 64 who are working. It allows individuals with higher incomes and resources to remain on full Medicaid.
Who qualifies for HCWD in North Carolina?
You must be under 65, meet SSA disability rules, or be “medically improved,” be employed, live in NC, and stay within income and resource limits.
How much can I have in resources and still qualify?
HCWD allows up to $25,728 in countable resources (cash, savings, investments, retirement, life insurance value). This is higher than the standard Medicaid cap of $2,000.
Do I pay a premium for HCWD coverage?
Below 150% FPL, there’s no fee. Between 150–200% FPL, you pay a $50 annual enrollment fee. Above 200% FPL, you pay a monthly premium on a sliding scale.
Can I keep both Medicare and Medicaid through HCWD?
Yes. If you’re on SSDI and qualify for Medicare after 24 months, you can still maintain Medicaid coverage under HCWD for dual protection.
Does part-time work count for HCWD?
Yes. Any level of paid employment counts—there’s no minimum hours rule. What matters is your total income and resources.
How do I apply for HCWD?
You can apply at any time through ePASS or your county’s DSS office. Bring proof of disability, employment, income, resources, identity, and residency.
What happens if I earn too much or stop working?
DSS will reassess eligibility. If you exceed income or resource limits, you may move to a different Medicaid category or lose coverage. Always report changes promptly.
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