Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 20 - Division of County Operations
Rule 016.20.13-006 - Medical Services Policy Sections B-330 and E-100; Form DCO-950, Workers with Disabilities Application for Medicaid
B-300 Aid to the Aged, Blind and Disabled (AABD) Eligibility Groups
B-330 Workers with Disabilities
MS Manual 01/01/14
This group consists of individuals at least 16 years of age, but less than 65 years of age, who, except for earned income, would be eligible to receive Supplemental Security Income (SSI). The intent of this group is to allow SSI eligibles to go to work or increase their earnings without losing their eligibility for Medicaid.
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 or SSA disability recipient, a disability determination must be made by MRT (MS F 122). Substantial Gainful Activity (SGA) is not considered for the disability determination. In addition, the individual's unearned income must be under the SSI payment amount for one person. Refer to Appendix S.
Recipients of Medicaid in the Workers with Disabilities category will be eligible for the full range of Medicaid services.
E-100 Financial Eligibility
MS Manual 01-01-14
Each individual applying for or receiving Medicaid benefits must have a financial eligibility determination made at application and, if eligible, on an on-going annual basis or when a change affecting eligibility occurs. Financial eligibility consists of an income test and if the category requires, a resource or asset test.
Most Medicaid eligibility groups have an income limit which an individual's countable income must fall under in order to be eligible for coverage in that group. Income limits and the manner in which countable income is determined vary by eligibility groups. The groups to which an income limit does not apply, and therefore no income determination is made, are the following:
* Newborns (MS B-220);
* Former Foster Children (MS B-260);
* Workers with Disabilities (MS B-330).
NOTE: For the Workers with Disabilities category, income is disregarded in the financial eligibility determination, but earned and unearned income will be used to determine cost sharing. See MS B-330.
A resource limit applies to most of the eligibility groups that do not use MAGI methodologies for financial eligibility. For these groups, the value of an individual's countable resources must be determined. There is no resource limit, and therefore no resource determination is made, for the following groups:
* Those using MAGI methodologies (MS E-110);
* Newborns (MS B-220);
* Former Foster Children (MS B-260);
* Workers with Disabilities (MS B-330).
Work 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 65.
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 $l,040/month in 2013.
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.
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.
Income
The applicant's earned income is disregarded when determining eligibility for the Workers with Disabilities program.
Non-Work Income may not exceed the SSI individual benefit plus $20 ($710 + $20 = $730/month in 2013), 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.
The applicant's total income will be used to determine the cost sharing amount.
Resource Limits
There is no resource limit for the Workers with Disabilities program. You will not need to provide any verification of resources to establish eligibility for the program.
Before You Get a Job, Get Advice
If you are currently receiving disability benefits, going to work may affect your benefits. Contact the local Social Security Administration office for more information about employment and how it may affect your Social Security or SSI disability benefits.
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 neither her income nor her husband's income is counted.
Example 3: Joe has a disability and works. He earns $3,000/month from work. Joe qualifies for Workers with Disabilities because none 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.
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 visit.
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.
How to Apply
Submit the enclosed application form to the local Arkansas Department of Human Services County office. Keep a copy of your application. 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.
For more information about Workers with Disabilities Medicaid, call the Choices in Living Resource Center at 1-866-801 -3435.
When completing an application for Workers with Disabilities some of the items that you will need to provide are:
* Proof of your monthly income.
* Social Security card or number.
* Your Medicare card.
* Proof of health insurance.
Workers with Disabilities have Other Options
* 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 Social Security or SSI benefits, contact the local Social Security Administration office.
