The Buy-in to Medicaid program is a form of work incentive that was initiated to provide Medicaid to disabled individuals who, because of the amount of their earned income, would not qualify for Medicaid. Individual states may, but are not required, to provide this incentive by creating a new eligibility group. Currently, just over half the states offer this program with many more planning to do so. Individuals "buy-in" to the program by paying a premium or other fee. However, participating states are not required to seek such payments.
> Compensability
In most jurisdictions, an injured employee must make a claim for workers' compensation within a specified time. By imposing a time limitation on filing a claim, the states have attempted to protect employers from old or stale claims that would be difficult to adequately investigate and defend. An employee's failure to file his claim promptly will result in the claim be denied, even if it is shown that the employer was not actually prejudiced by the delay. As a general rule, it is presumed that the employer is prejudiced by an untimely claim due to the inherent difficulty in defending old claims.
As a general rule, if an injured employee fails to either provide timely notice of his injury or file a timely claim for workers' compensation, he will be denied benefits. However, in some instances, the employer or its insurance carrier may waive the limitations periods. For example, if an employer has actual knowledge of the employee's accident and resulting injury, the employer may be said to have waived formal notice of the injury. Likewise, if the employer voluntarily makes compensation payments to the employer, he may be deemed to have waived the requirement that the employee file a claim.
As a correlative step in its disability evaluation, the Social Security Administration examines an individual's residual functional capacity (RFC). The nature of the individual's impairment(s) will determine to what degree his ability to work is impacted. The bedrock of the RFC assessment is what is the most that an individual can do; not the least. An individual's RFC is that remaining functionality that the individual has despite the limitations caused by his impairment. An RFC assessment is made based on all the evidence, which may include the individual's own account of his limitations, observations by physicians, psychologists, friends, neighbors, and the like, work attempt records, and the individual's medical records.
