Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 20 - Division of County Operations
Rule 016.20.12-002 - MS Policy 28000 - 28070 - Workers with Disabilities and the DCO-950
Current through Register Vol. 49, No. 9, September, 2024
28000 Medicaid Coverage for Workers with Disabilities
MS Manual 07/01/12
The "Ticket to Work and Work Incentives Improvement Act of 1999" (TWWHA), enacted on December 17,1999, provides states with new options for making it possible for people with disabilities to join, or remain in, the workplace without fear of losing their Medicare and Medicaid coverage. Arkansas elected to provide Medicaid coverage in the "Basic Coverage Group" of TWWIIA. Under this group, Medicaid can cover individuals at least 16, but less than 65 years of age, who, except for earned income, would be eligible to receive Supplemental Security Income (SSI). Medicaid for the Workers with Disabilities in Arkansas became effective February 1, 2001.
SGA (substantial gainful activity) is not an eligibility factor for the Workers with Disabilities category; therefore, persons with disabilities may increase their earnings or return to work and either retain or obtain Medicaid coverage.
Individuals who lose SSI and SSI related Medicaid, due to earnings, are potentially eligible for Medicaid under the Workers with Disabilities policy. There is no requirement that an individual must have at one time been an SSI recipient to be eligible for Medicaid under this category. However, if an individual was not an SSI recipient or a recipient of SSA disability, a disability determination must be made by MRT. Although SGA is not considered for this determination, the individual's unearned income must be under the SSI payment amount for one person.
28010 Extent of Services
MS Manual 07/01/12
Recipients of Medicaid in the Workers with Disabilities category will be eligible for the full range of Medicaid services. Cost sharing will be assessed at the point of service in the form of co-payments for medical visits and prescription drugs (Re. MS 28045).
Recipients will also be able to access services available through the AAPD Waiver provided the medical criteria for AAPD have been met as well as the financial criteria of the Workers with Disabilities category. (Refer to MS 26125 for guidance and procedures regarding the medical assessment process.) Applicants will be advised by the caseworker that if they accept services from AAPD Waiver providers while their applications are pending and are subsequently denied for AAPD Waiver, they will be responsible for paying the provider.
28015 Workers with Disabilities Eligibility Criteria
MS Manual 07/01/12
Individuals eligible for Medicaid under the Workers with Disabilities program must:
28020 Definition of Woriting
MS Manual 07/01/12
As defined for this category, working means being employed in any ongoing work activity for which income is received and reported to the IRS. Employment must be verifiable by viewing paycheck stubs, tax returns, form 1099, or proof of Quarterly Estimated taxes for self-employment. The individual with a disability must be working at the time of application. If an individual stops working temporarily, and states that he/she intends to return to work, coverage can continue for up to six months. If the individual has not returned to work by the end of the sixth month, a ten-day advance notice will be given on form DCO-700, and the case closed after the tenth day. The caseworker will review the individual's circumstances to determine if he/she is eligible in another Medicaid category, and if so, certify the individual in that category.
28025 Disability Determination
MS Manual 07/01/12
Only individuals with current, on-going, physical or mental disabilities should be considered for Workers with Disabilities.
The individual must have a disability according to the SSI definition of disability. To be eligible, the applicant must have already had disability established through SSI or SSA, or disability must be established through the Medical Reviev\/ Team.
Individuals who are currently employed, and apply for Medicaid to cover medical bills for a temporary disability due to illness or surgery and plan to return to vi/ork after a period of recuperation, are not eligible in this category and should not be referred to MRT. Such applicants should be evaluated for eligibility in other Medicaid categories.
Persons who have received SSI or SSA disability within the last year, and lost entitlement solely due to employment, can automatically be considered to have a disability at the time of application. However, disability must be re-determined at the first annual re-evaluation. Procedures for verifying disability through SSI/SSA and the Medical Review Team found at (MS 33221 through MS 3323.6 should be followed.
A disability determination through MRT for this category will not consider whether an individual is engaged in substantial gainful activity (SGA).
Note: Individuals may still be receiving SSA based on disability and have earnings over the SGA. SSA allows beneficiaries who earn over the SGA to continue receiving benefits for up to 12 months before SSA benefits are suspended. This time period includes a 9 month Trial Work Period plus a 3 month Grace Period. If SSA benefits cause the individual to be income ineligible for Workers with Disabilities, the County Office should inform the applicant to reapply after SSA benefits stop.
28030 Income Determination MS Manual 07/01/12
Income eligibility will be determined in a two-step process. Only the income of the individual with a disability will be used to determine eligibility. Any income of the spouse or children will be disregarded.
Step 1:
First determine the amount of unearned income for the individual. Only individuals with unearned Income under the SSI/SPA will be eligible in this category. SSI exclusions and disregards (Re. MS 3348-3348.1) will be allowed. Total all unearned income for the Individual and subtract the $20.00 general exclusion. If the resulting amount is under the SSI/SPA for an individual, proceed to the second step. If the resulting amount is over the SSI/SPA, deny the application.
step 2:
Determine the individual's gross monthly earnings. If there was no unearned income, subtract the $20.00 general exclusion from the earned income. Deduct $65.00 plus % of the remaining gross earnings. Add the net unearned income, if any, and remaining net earnings to determine countable income. Compare the total to 250% of the federal poverty level for the individual's family size. If the income falls below the 250% level, the individual is eligible. (Refer to the FPL chart at Appendix F for current amounts.)
Family, in this category, is defined as the applicant, his/her spouse, and the minor children, natural or adoptive, of either spouse. To be included in the family unit, children must be under 18 years of age and reside in the home of the individual with a disability.
28035 Resources
MS Manual 07/01/12
Workers with Disabilities Resource Limits
|
1 Household Size |
Resource Limit |
|
1 (Individual) |
$4000 |
|
2 (Individual & Spouse) |
$6000 |
|
3 |
$6200 |
|
4 |
$6400 |
|
5 |
$6600 |
|
6 |
$6800 1 |
V NOTE: Add $200 for each additional family member.
Countable resources are determined according to LTC guidelines (Re. MS 3330-3333) with certain exceptions. A second car can be disregarded as a resource if it is used by the spouse to maintain employment. There will be no penalty imposed for the transfer of resources; and all funds held in retirement accounts, including private retirement accounts such as IRAs and other individual accounts and employer-sponsored retirement plans such as 401(K) plans, Keogh Plans and employer pension plans will be disregarded as resources.
Only the resources of the individual and the spouse will be counted. Although children are included in the standard, their resources are not counted. Countable resources are compared to twice the Medically Needy Resource Limit (MNRL) for the family size. An "approved account"
can be established by the individual with a disability and be used to enhance independence and increase employment opportunities. Funds in the approved account, up to an established maximum, are disregarded in the resource calculation (Re. MS 28040).
28040 Approved Account
MS Manual 07/01/12
An approved account may be used to save for any expense that will enhance an individual's independence and/or increase employment opportunities. The account must be kept separate from all non-exempt accounts such as regular savings and checking accounts. Up to $10,000.00 of an approved account can be disregarded as a countable resource. Interest generated on an approved account will not be counted as income. If the interest generated causes the approved account to exceed $10,000.00, or the approved account otherwise exceeds $10,000.00, the amount in excess of $10,000.00 will be counted toward the resource limit for the individual's family size.
If an individual declares a checking account, savings account, or cash at the time of application, he/she will be given the opportunity to designate all or part of the funds as an approved account. If the individual designates only a portion of the funds as an approved account, he/she should be given a written notice via the DCO-700 with instructions to separate the account and provide verification of the new account within 10 days. If the funds designated for the approved account are not deposited into a separate account, they will be counted as a resource.
Some approved expenditures follow:
Educational Expenses: Expenditures for training to enhance employment and independent living skills which include tuition, fees, books and other related expenses. Work-Related Expenses: Expenditures for job accommodations, equipment, service animals, computer software and hardware, business capital, tools and other related expenses.
Home Purchase/Modification: Costs of acquiring, constructing, modifying or reconstructing a residence to meet the needs of the individual with a disability.
Transportation: Cost of acquiring, modifying, maintaining or repairing a motor vehicle to be used by the individual with a disability, or an immediate family member, on his/her behalf. The cost of insurance for the vehicle is also included.
Medical Expenses-Medically related expenditures, including dental bills, not covered by Medicaid or other insurance, and Medicaid co-pays.
Assistive Technology and Related Services-Expenditures for assistive technology devices, which include any item, piece of equipment, product system, or assistive technology service that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. The term "assistive technology service" means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. These services include:
When establishing the approved account, the individual must state in writing the intended purpose of the account. The signed statement must include the projected cost of the item(s) or services for which they are saving. If at any time the individual has no intended use for the money in the account, or the intended use is for items that do not meet the definition of an approved item, the account will become a countable resource.
At each re-evaluation, the County will review the approved account history for the past year. The individual must provide receipts for any expenditure from the account. If the individual has accessed the account and used the money for a non-approved reason, the amount withdrawn will be considered unearned income in the month withdrawn. A new signed statement of intended use must be provided at each re-evaluation.
In the case of qualified emergencies, funds may be withdrawn and used for living expenses if there is a hardship on the family caused by such instances as extended illness, loss of employment, natural disasters, or similar events beyond the control of the individual.
28045 Cost Sharing
MS Manual 07/01/12
Recipients of Medicaid for Worl[LESS THAN]ers with Disabilities with gross income under 100 percent of the Federal Poverty Level for their family size (Re. FPL chart at Appendix F for current amounts) will be subject to the usual Medicaid co-pays. Recipients with gross income equal to or greater than 100 percent of the FPL will be assessed co-payments at the point of service for medical visits and prescription drugs according to the following schedule:
After certification, any increases in income that will cause the individual to exceed 100% of the FPL, will not be processed until the next reevaluation. If the individual reports a decrease in income that puts him under the 100% FPL, his income will be adjusted when reported to reflect the lower co-payment amounts. Any increase in co-payments determined at reevaluation will require a 10-day advance notice. A DCO-700 will be sent and the changes keyed after the notice is up.
28050 Approval of Applications
MS Manual 07/01/12
Applications for the Workers with Disabilities will be made on form DCO-950, "Workers with Disabilities Medicaid Application for Assistance", by the individual requesting assistance, or his/her authorized representative, at the DH5 County Office located in the individual's county of residence.
In instances where disability is already established, the County Office will have 45 days to dispose of the application by approval, denial, or withdrawal. When eligibility must be established by MRT, 90 days will be allowed for processing.
28055 Denials and Withdrawals
MS Manual 07/01/12
If an applicant does not meet all of the eligibility requirements for Workers with Disabilities, the application will be denied.
The caseworker will record the pertinent Information stating the reason for denial; complete the denial data on the application form and notify the applicant of the denial by DCO-700 or a system generated notice.
If an individual wishes to withdraw the application, the caseworker should obtain a signed statement from the applicant stating that he/she wishes to withdraw the application. The procedures for denying an application will then be followed.
28060 Effective Date of Eligibility
MS Manual 02/01/01
Eligibility will begin on the date of application unless retroactive coverage is needed. If retroactive coverage is needed, and eligibility is established for a retroactive period, eligibility can begin up to 3 months prior to the date of application; but in no case can coverage be authorized before February 1, 2001.
28065 Re-Evaluations
MS Manual 07/01/12
Medicaid eligibility for the Workers with Disabilities will be re-evaluated annually by the County Office. The application form and all other forms required at initial application will be completed. If the individual has an approved account, the County will review the account history for the past year, and a new statement of intended purpose for the account will be obtained.
An MRT disability re-determination may or may not be necessary at re-evaluation, tf a reexamination by MRT is necessary, it will be indicated on the DCO-109. Individuals that did not require an MRT decision initially due to loss of SSA or SSI in the previous year will require an MRT determination at the first re-evaluation.
28070 Changes and Closures
MS Manual 02/01/01
When a change occurs that affects eligibility, or an increase in the cost sharing (Re. MS 28045). a ten-day advance notice of action will be given unless advance notice is not required {Re. MS 3633). Case closure will be effective the date the notice expires.
Work, Save and Keep Your Health Benefits
Many Arkansans with disabilities want to work but can't afford to lose their Medicaid or Medicare health benefits. The Workers with Disabilities Medicaid program gives Individuals the opportunity to work, earn a good income, save for the future and have Medicaid health care benefits.
The Workers with Disabilities program is intended for people with disabilities who support themselves by work rather than by disability benefits. This program covers only the individual with a disability and does not provide family coverage.
Who Qualifies for Workers with Disabilities Medicaid?
Age
You must be at least 16 and less than 55.
Disability
You must have a significant disability expected to last 12 months or longer, based on Social Security guidelines. Unlike Social Security, you may work full-time and earn more than the Substantial Gainful Activity (SGA) limit. The SGA is Sl,010/month in 2012.
Work
You must be working and provide proof that your work income is reported to the IRS. Paycheck stubs, tax returns, Form 1099 or quarterly estimated tax receipts for self-employment could be used to prove that you work.
Income
Only the applicant's income is counted for the Workers with Disabilities program. Income of the spouse and other family members is not counted. There are two income limits which apply to all applicants:
1. Non-Work Income may not exceed the SSI individual benefit plus $20 ($698 + $20 = $718/month in 2012), regardless of your family size. Non-Work Income is income such as Social Security, worker's comp, VA benefits, or interest on your bank account.
Workers with Disabilities Medicaid covers Arkansans ages 16-64 who:
* Meet the Social Security/SSI disability definition
* Work and have work income reported to the IRS
* Support themselves by work rather than disability benefits
* Need health care coverage or home and community-based services
2. Net Personal Income must be less than 250% of the Federal Poverty Level for your family size. Net Personal Income = ALL Non-Work Income + HALF of Work Income (wages, salary, income from your business).* 1 person $2,327.08/month * 2 persons $3,152.08/month, plus $825 for each child under 18 living at home.
250% of the 2012 Federal Poverty Level:
How much can I earn from Work?
You'll be surprised how much you can earn and still qualify because only half of your work income is counted. However, almost all non-work income is counted.
For example, Joe is single and receives a Social Security check of $500/month. He could earn up to $3,600 a month and still qualify for Workers with Disabilities coverage. After his Social Security check stops, he could earn up to about $4,600/month.
Resource Limits
Your countable resources (cash, savings, investments, and property other than your home and household goods) must be less than $4,000 for a single person, or $6,000 for a couple, plus $200 for each additional person. Only resources belonging to you and your spouse are counted.
Your home, household goods and one car are not counted. A second car is allowed if your spouse needs it to work. Retirement accounts such as IRAs, pensions and 401Ks are not counted. Additional funds may be saved in an approved account (see below).
Save for Your Future and Self-Sufficiency
You can also save up to $10,000 in a special Approved Account approved by DHS. This account must be separate from your regular checking or savings account. This account can be used for expenses to help you w/ork or become more independent, such as:
* Education that helps you work and live independently
* Work-related expenses, such as job accommodations, tools, service animals or starting a business
* Home purchase, construction and/or modification
* Vehicle purchases, modification, maintenance or repair
* Medical expenses (such as contact lenses) not covered by Medicaid
Medicaid Services
Medicaid covers a wide range of health care services including doctor visits, hospital care, prescription drugs and therapy. Medicaid also covers personal care and other home and community services. There are no premiums, but there are co-pays for most services, such as $10 for doctor visits.
If you already have Medicare, Medicaid will pay your Medicare premiums, deductibles and co- pays and cover services that are not covered by Medicare or health insurance such as personal care. Medicaid can also provide secondary coverage for other insurance coverage.
Before You Get a Job, Get Advice
If you are currently receiving disability benefits, going to work may affect your benefits. That's why It's important to talk to a benefits counselor before looking for work. Free, confidential counseling is available by calling Project AWIN at 1-888-284 -7521.
Workers with Disabilities Examples:
Example 1: Jimmy has a disabling medical condition but still works when he is able. He is uninsured and needs help with medical bills. He applies for Workers with Disabilities Medicaid and is approved.
Example 2: Martha has a disability and works part-time. She lost her SSI benefits and Medicaid when she got married. She may qualify for Workers with Disabilities coverage because her husband's income is not counted.
Example 3: Joe has a disability and works. He earns $3,000/month from work. Joe qualifies for Workers with Disabilities because after work related deductions are applied, only half of his salary is counted.
Example 4: Bobby is 17 and lives with his parents. He has a disability and works. He is not eligible for SSI because his parents earn too much. He is able to qualify for Workers with Disabilities because his parents' income is not counted.
Example 5: Jerry has a disability and works. His Social Security disability benefits stopped due to earnings but he still has Medicare. He also qualifies for Workers with Disabilities Medicaid, which pays his Medicare premiums, deductibles and co-pays and covers some services not covered by Medicare.
How to Apply
Submit the enclosed application form to the local Arkansas Department of Human Services County office. Financial eligibility should be determined within 45 days. If you have not received Social Security Disability or SSI benefits in the last 12 months, your disability must be verified. This process may take up to 90 days.
If you have problems applying, call Project AWIN, toll-free at 1-888-284 -7521.
When completing an application for Workers with Disabilities, some of the items that you will need to provide are:
* Verification of your bank accounts
* Proof of your monthly income
* Social Security card or number
* Your Medicare card
* Proof of life and health insurance
If you have sold or transferred any property, please provide deeds.
* If you receive SSI or Social Security Disability, you may be able to work part time and continue to receive your disability check.
* If you work full time, you may be able to continue to receive Medicare and/or Medicaid, if your disability continues.
* If you work and have Medicare only, you may qualify for Workers with Disabilities Medicaid.
For more information about employment and your benefits, call the Social Security Administration or Project AWIN at 1-888-284 -7521.
* Work and earn a living
* Save for the future
* And have health-care coverage
