One of the most common concerns for individuals receiving Medicaid is the “benefit cliff”—the fear that a new job or a hard-earned raise will lead to an immediate loss of healthcare. While income limits are a reality, there are several legal pathways designed to help you maintain coverage or transition smoothly while you grow your career.
If you are working in North Carolina, South Carolina, Tennessee, Alabama, or Maryland, here is a breakdown of the programs that help keep you covered.
1. Medicaid Buy-In Programs for Workers with Disabilities
Many states recognize that healthcare is a prerequisite for employment, not just a result of it. “Buy-In” programs allow individuals with disabilities to earn a higher income while maintaining Medicaid benefits by paying a modest monthly premium.
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Maryland: The Employed Individuals with Disabilities (EID) program is known for having generous income and asset limits, making it a powerful tool for Marylanders returning to the workforce.
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North Carolina & South Carolina: Both Carolinas offer specific Medicaid categories for workers with disabilities, ensuring that professional growth doesn’t mean sacrificing medical stability.
2. Section 1619(b) Continuation
For those receiving Supplemental Security Income (SSI), federal law provides a safeguard called Section 1619(b). This provision allows your Medicaid to continue even after your earnings become too high to receive an SSI cash payment. Section 1619(b) of the Social Security Act lets you keep your Medicaid even after your earnings push your SSI cash payment to zero, as long as you stay under your state’s threshold. For 2026, these state-specific thresholds range from $40,026 in Alabama to $84,208 in Minnesota, meaning many working individuals in the states we serve retain full Medicaid coverage well into middle-income earning ranges. Social Security assigns a different annual threshold amount to each state, and the more a state Medicaid program spends per capita, the higher the threshold amount will be. If your gross earnings exceed your state’s standard threshold, SSA may still calculate an individualized threshold based on your specific medical expenses, so it is important to review your situation carefully before assuming coverage will end.
3. Transitional Medical Assistance (TMA)
If your income increases beyond the standard limit, you may not lose coverage immediately. Transitional Medical Assistance can provide a “buffer” period—often up to 12 months—where your Medicaid remains active regardless of your new salary. This gives you a full year to settle into your new role and evaluate long-term insurance options without a gap in care.
4. Health Insurance Marketplace Transitions
If your income eventually exceeds the limits for Medicaid and TMA, you typically qualify for a Special Enrollment Period to select a plan through the Health Insurance Marketplace. Depending on your earnings, tax credits can significantly lower the cost of these private plans, often making them a viable next step for your family’s health and financial security.
5. State-Specific Variations: TN and AL
Eligibility rules for programs like TennCare in Tennessee or Alabama Medicaid can be nuanced, particularly regarding how household size and specific disability designations impact your income ceiling. Navigating these rules requires a clear understanding of current state-level regulations to ensure you aren’t leaving benefits on the table.
Protect Your Coverage and Your Future
Employment should be a milestone to celebrate, not a source of stress regarding your healthcare. Because Medicaid laws vary significantly between MD, NC, SC, TN, and AL, it is vital to understand the specific rules in your jurisdiction. For more information on federal guidelines, you can visit the official Medicaid.gov website.
Our team focuses on the legal complexities of Medicaid crisis planning, ensuring your healthcare and assets remain secure as your career grows. We help you navigate these transitions so you can focus on your professional goals without the fear of a “benefit cliff.”
Ready to learn more? Visit us at sawyer-law.com or call us today to schedule a consultation. Let’s make sure you stay covered while you move forward.
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