Medicaid Buy In for Working Disabled Under the Balanced by icecube

VIEWS: 0 PAGES: 15

									 VI. STATE WORK INCENTIVE POLICY OPTIONS: MEDICAID BUY
 IN PROGRAMS AND INCOME ASSISTANCE DEMONSTRATIONS


B. Eligibility Criteria for the Optional Medicaid Buy In Program:
Federal Guidelines and Examples of State Responses –Updated 2001 HHS Poverty
Guidelines
States are utilizing the new options to develop Medicaid Buy In programs to create a variety of
policies under the broad Federal policies established in Federal law and guidelines. The various
States’ Medicaid Buy In programs reflect the significant differences among the States in their
current Medicaid program and the policies they have adopted under the Federal policies. Examples
of the States explanations of their programs can provide an overview of some of the policy options
available to states.

       1. Federal Law and Guidelines
       The Balanced Budget Act of 1997 (Public Law 105-33) added a new provision in the
       Medicaid program [Section 1902(a)(10)((A)(ii)(XIII) of the Social Security Act] that allows
       states to elect to provide Medicaid coverage to persons with disabilities who are working
       and who otherwise meet SSI eligibility criteria but have net income up to 250% of the
       Federal poverty guidelines.

       Under # 3 below is a copy of the letter sent by the Health Care Financing Administration of
       the Department of Health and Human Services (HCFA) to State Medicaid Directors in
       March 1998, which provided the interpretation of the income eligibility criteria for the
       Medicaid Buy In program authorized under the Balanced Budget Act of 1997. In that letter
       HCFA also stated that:

       ―Under section 1902(r)(2) of the Act, States may use more liberal income and resource
       methodologies than are used by the SSI program in determining eligibility for this group.
       Also, 209(b) States may, but are not required to, apply their more restrictive eligibility
       policies in determining eligibility for this group.‖

       On December 17, 1999 President Clinton signed into law The Ticket to Work and Work
       Incentives Improvement Act of 1999 (Public Law 106-170). Under the Act, effective
       October 1, 2000 states may establish one or two additional optional Medicaid eligibility
       categories. States will have the option to cover individuals with disabilities (aged 16-64)
       who, except for earnings, would be eligible for SSI who are working individuals with
       incomes below as well as above 250% of the Federal poverty level to buy-into the Medicaid
       program by paying premiums and other cost-sharing charges on a sliding-fee scale based on
       income. [Section 1902(a)(10)(A)(ii)(XV) to the Social Security Act]

       If a state provides Medicaid coverage to individuals under the Medicaid Buy In program for
       persons who meet the disability criteria, a state will have the option of providing coverage to
       employed persons with disabilities (aged 16-64) whose medical condition has improved (and
       as a result are no longer eligible for SSDI or SSI and therefore are no longer eligible for
       Medicaid) but who continue to have a severe medically determinable impairment as defined
       in regulations issued by the Secretary of HHS. [Section 1902(a)(10)(A)(ii)(XVI) to the
       Social Security Act]

       As part of the amendments to Medicaid law included in the Medicaid Buy In option in the
       Ticket to Work and Work Incentives Improvement Act of 1999, is language providing that
       under the Medicaid Buy In options, a State could establish uniform limits on assets,
       resources, and earned or unearned income (or both) for this group that differ from the
       Federal SSI requirements.

       2. Federal Poverty Guidelines
       Federal law for the Medicaid Buy In State Plan options references the Federal Poverty
       Guidelines. On February 16, 2001, the Department of Health and Human Services
       published the 2001 HHS Poverty Guidelines. The following is the information on the
       Federal Poverty Guidelines that can be found on the web page for the Assistant Secretary for
       Planning and Evaluation of the Department of Health and Human Services. This same
       information can be found at http://aspe.hhs.gov/poverty/01poverty.htm

                                       2001 HHS Poverty Guidelines

There are two slightly different versions of the federal poverty measure:

   The poverty thresholds, and
   The poverty guidelines.

The poverty thresholds are the original version of the federal poverty measure. They are
updated each year by the Census Bureau (although they were originally developed by Mollie
Orshansky of the Social Security Administration). The thresholds are used mainly for statistical
purposes — for instance, preparing estimates of the number of Americans in poverty each year.
(In other words, all official poverty population figures are calculated using the poverty thresholds,
not the guidelines.) Poverty thresholds since 1980 and weighted average poverty thresholds
since 1959 are available on the Census Bureau's Web site.

The poverty guidelines are the other version of the federal poverty measure. They are issued
each year in the Federal Register by the Department of Health and Human Services
(HHS). The guidelines are a simplification of the poverty thresholds for use for administrative
purposes — for instance, determining financial eligibility for certain federal programs.

The poverty guidelines are sometimes loosely referred to as the "federal poverty level" (FPL), but
that term is ambiguous and should be avoided, especially in situations (e.g., legislative or
administrative) where precision is important.

A more extensive discussion of poverty thresholds and poverty guidelines is available on the
Institute for Research on Poverty's Web site.
                      Comprehensive Person-Centered State Work Incentive Initiatives
                               The Center for the Study and Advancement of Disability Policy


                                 2001 HHS Poverty Guidelines
                                     48 Contiguous
  Size of Family Unit                States and D.C.                                      Alaska    Hawaii
  1                                  $ 8,590                                              $10,730   $ 9,890
  2                                  11,610                                               14,510    13,360
  3                                  14,630                                               18,290    16,830
  4                                  17,650                                               22,070    20,300
  5                                  20,670                                               25,850    23,770
  6                                  23,690                                               29,630    27,240
  7                                  26,710                                               33,410    30,710
  8                                  29,730                                               37,190    34,180
  For each additional person add     3,020                                                3,780     3,470

SOURCE: Federal Register, Vol. 66, No. 33, February 16, 2001, pp. 10695-10697.

The separate poverty guidelines for Alaska and Hawaii reflect Office of Economic Opportunity
administrative practice beginning in the 1966-1970 period. Note that the poverty thresholds —
the original version of the poverty measure — have never had separate figures for Alaska and
Hawaii.

The poverty guidelines apply to both aged and non-aged units. The guidelines have never had an
aged/non-aged distinction; only the Census Bureau (statistical) poverty thresholds have separate
figures for aged and non-aged one-person and two-person units.

Programs using the guidelines (or percentage multiples of the guidelines — for instance, 125
percent or 185 percent of the guidelines) in determining eligibility include Head Start, the Food
Stamp Program, the National School Lunch Program, the Low-Income Home Energy
Assistance Program, and the Children's Health Insurance Program. Note that in general, cash
public assistance programs (Aid to Families with Dependent Children and its block grant
successor Temporary Assistance for Needy Families, and Supplemental Security Income) do
NOT use the poverty guidelines in determining eligibility. The Earned Income Tax Credit
program also does NOT use the poverty guidelines to determine eligibility.

The poverty guidelines (unlike the poverty thresholds) are designated by the year in which they
are issued. For instance, the guidelines issued in February 2001 are designated the 2001
poverty guidelines. However, the 2001 HHS poverty guidelines only reflect price changes
through calendar year 2000; accordingly, they are approximately equal to the Census Bureau
poverty thresholds for calendar year 2000. (The 2000 thresholds are expected to be issued in
final form in September or October 2001; a preliminary version of the 2000 thresholds is now
available from the Census Bureau.)

The computations for the 2001 poverty guidelines are available.




                                                                                                              3
                      Comprehensive Person-Centered State Work Incentive Initiatives
                                The Center for the Study and Advancement of Disability Policy


       3. HCFA Letter to State Medicaid Directors March 9, 1998, Interpreting
          the Intent of the Income Eligibility Ceilings in the Medicaid Buy In
          Provisions in the Balanced Budget Act of 1997
       A copy of this letter can be found on the HCFA web site at:
       http://www.hcfa.gov/medicaid/bba4733.htm

March 9, 1998

Dear State Medicaid Director:

This letter is one of a series that provides guidance on the implementation of the Balanced Budget
Act.

We are writing to alert you to a change in policy on section 4733 of the Balanced Budget Act of
1997 (BBA) from that set forth in our State Medicaid Director letter dated November 24, 1997.
Section 4733 created an optional categorically needy group designed to provide Medicaid eligibility
to disabled working individuals who, because of relatively high earnings, cannot qualify for Medicaid
under one of the other statutory provisions under which disabled working individuals may be eligible
for medical assistance.

In an enclosure to the November 24 letter, we described a two-step eligibility process consisting of
a family income test of 250 percent of the Federal poverty level, followed by an individual eligibility
determination. The family income test required that the family's gross income, essentially without
deductions or exemptions, be compared to 250 percent of the poverty level for a family of the size
involved.

Since release of the November 24 letter, concerns have been raised about the use of the family's
gross income for the family income test. The primary objection is that using the family's gross
income limits the amount of income individuals could have and still qualify for eligibility under this
group to a point where, in approximately half the States, the income standard under section 4733 is
lower than the income standard under section 1619(b) of the Act.

In view of these concerns, and after careful consideration of the options available, we have decided
to change our policy on the family income test. Instead of using the family's gross income, States
wishing to cover this group should measure the family's net income against the 250 percent family
income standard. The family's net income is determined by applying all appropriate SSI income
disregards, including the earned income disregard, to the family's total income. The result, i.e., the
family's net income, is then compared to the 250 percent income standard.

Use of the family's net, rather than gross, income will have the affect of greatly increasing the amount
of income a disabled individual can have and still qualify for eligibility under this group. This in turn
will enable States to provide Medicaid to a greater number of disabled individuals, who without
such coverage might not be able to work.



                                                                                                         4
                      Comprehensive Person-Centered State Work Incentive Initiatives
                               The Center for the Study and Advancement of Disability Policy


The revised enclosure explains use of the net, rather than gross, family income test. It also provides
information, which was not included in the earlier version, on use of section 1902(r)(2) more liberal
methodologies, as well as use of more restrictive policies in 209(b) States. We also make it clear
that the SSI income standard, which is used to determine the individual's eligibility following the
family net income test, includes optional State supplementary payments. Finally, the revised
enclosure discusses the use of substantial gainful activity (SGA) as a criterion in determining
eligibility under this group.

We apologize for any inconvenience issuance of our previous policy may have caused. Any
questions about this provision or this letter should be directed to Roy Trudel of my staff at (410)
786-3417.

Sincerely,

/s/

Sally K. Richardson
Director
Center for Medicaid and State Operations

Enclosure

cc:
All HCFA Regional Administrators
All HCFA Associate Regional Administrators for Medicaid and State Operations
Lee Partridge - American Public Welfare Association
Joy Wilson - National Conference of State Legislatures
Jennifer Baxendell - National Governors' Association
HCFA Press Office



Enclosure

Determining Eligibility for Individuals Under Section 4733 of BBA

The eligibility determination for individuals in this group is essentially a sequential two-step process.

1. The first step is a net income test, based on the family's combined income, including all
   earnings. (A family can also be just one individual; i.e., a family of one). The family's net
   combined income must be less than 250 percent of the federal poverty level for a family of
   the size involved. Family income is determined by applying all appropriate SSI disregards and
   exemptions, including the earned income disregard, to the family's total income. If the family's
   income, after all deductions and exemptions have been applied, is equal to or exceeds 250
   percent of the appropriate poverty level, the individual is not eligible for Medicaid under this
   provision.


                                                                                                         5
                      Comprehensive Person-Centered State Work Incentive Initiatives
                               The Center for the Study and Advancement of Disability Policy


   It is up to the State to determine what constitutes a "family" in the context of this provision.
   As one example, a State could choose to consider a disabled adult living with his or her
   parents as a family of one for purposes of meeting the 250 percent family income standard.

2. Assuming the individual has met the net family income test, the second step is a determination
   of whether he or she meets the disability, assets, and unearned income standards to receive
   an SSI benefit. Income of other family members used in Step 1 is not included (unless the
   individual has an ineligible spouse whose income is subject to the SSI deeming rules). To be
   eligible under this provision, the individual must meet all SSI eligibility criteria (including
   categorical requirements).

   SSI methodologies are used in making this determination except that all earned income
   received by the individual is disregarded. The individual's countable unearned income (e.g.,
   title II disability benefits) must be less than the SSI income standard (in 1998, $494 for an
   individual), or the standard for optional State supplementary payments (SSP) if the State
   makes such payments. If unearned income equals or exceeds the SSI/SSP income standard,
   the individual is not eligible for Medicaid under this provision.

   The individual's countable resources must be equal to or less than the SSI resource standard
   ($2,000 for an individual).

   Under section 1902(r)(2) of the Act, States may use more liberal income and resource
   methodologies than are used by the SSI program in determining eligibility for this group. Also,
   209(b) States may, but are not required to, apply their more restrictive eligibility policies in
   determining eligibility for this group.

   There is no requirement that the individual must at one time have been an SSI recipient to be
   eligible under this provision. However, if the individual was not an SSI recipient, you must do
   a disability determination to ensure that the individual would meet the eligibility requirements
   for SSI. A disability determination for an individual who was not previously an SSI recipient
   should not consider whether the individual engaged in substantial gainful activity (SGA), since
   use of SGA as an eligibility criterion would in almost all instances result in the individual not
   being eligible under this group, effectively negating the intent of this provision.




                                                                                                       6
              Comprehensive Person-Centered State Work Incentive Initiatives
                       The Center for the Study and Advancement of Disability Policy


4. Explanations Provided by States of their Medicaid Buy In Program’s
   Income Eligibility Requirements
States have and are applying the income eligibility options in Federal law in various ways.
The provision for a two-step approach to determining eligibility and then determining cost
sharing and fees which participants may be asked to provide results in a number of different
means of explaining a particular State’s policies. The following are excerpts from material
published by States and other explanations provided by State officials.

Oregon’s Employed Persons with Disabilities Program
      The following is an explanation of the Oregon Employed Persons with Disabilities
Program prepared by Oregon officials:

              Oregon’s Employed Persons with Disabilities Program

Oregon has taken advantage of Section 4733 of the 1997 Balanced Budget Act to develop the
Employed Persons with Disabilities (EPD) program. This program provides Medicaid
coverage to employed persons with a disability(s) that meets the definition used by the Social
Security Administration. The EPD program is designed to remove a significant barrier to
employment; the loss of necessary health and long term care insurance coverage.

Oregon’s EPD program was developed with the philosophy that individuals with disabilities
should be able to maximize their potential and creative policies were developed to provide
this opportunity for many individuals with disabilities. This is done by utilizing the following
unique and progressive policies:

Unearned Income:
For determining eligibility, all unearned income is disregarded. Having SSDI benefits or other
unearned income over the SSI standard does not make an individual automatically ineligible.
However, any unearned income in excess of the Oregon Supplemental Income Program
(OSIP) standard ($513.70) is given to the state as a client Cost Share.

Resources:
The present resource limit for Medicaid is $2,000. Under Oregon’s program, $10,000 of
resources are disregarded, effectively raising the resource limit to $12,000. Also disregarded
are any monies in Approved Accounts. These accounts are used to save for goods or services
that will enhance the individual’s independence and employment potential, such as van
modifications or assistive technologies. Retirement and Medical Savings Accounts are also
disregarded.

Earned Income Reductions:
Section 4733 requires the individual to have an adjusted income of less than 250% of the
Federal Poverty Level ($20,600, 1999). When determining adjusted income, Employment
and Independence Expenses (EIEs) are deducted during eligibility calculations. These



                                                                                                 7
                          Comprehensive Person-Centered State Work Incentive Initiatives
                                     The Center for the Study and Advancement of Disability Policy


         deductions will also enhance the individual’s independence and employment potential and
         will have eligibility based on true income not on income spent on disability related needs.

         Individuals in this program may be subject to a premium. The amount of premium is based
         on a percentage of countable income above 200% of the Federal Poverty Level ($16,480,
         1999).

         New Opportunities:

         Now that the Ticket to Work and Work Incentives Improvement Act has passed Congress and
         has been signed by the President, Oregon will be exploring ways to serve more individuals
         with disabilities who are working. Within this new law, there are opportunities to provide
         Medicaid to new populations. Parts of this law will be implemented on October 1st, 2000 and
         Oregon is already exploring options. The EPD program has been very successful and this
         new law will promote even more successes.

         Excerpt from Oregon Staff Training material

         Basic Eligibility Criteria
         Must have a disability
         Meets the definition used by Social Security
         Must be employed
         Ongoing activity for which income is received and a potential tax liability is incurred
         Income ―limitation‖
         Adjusted income less than 250% of the federal poverty level ($20,880 or $1740/month)

         Income Limitation
         Unearned income disregarded for eligibility
         Only client’s income – household of 1
         Adjusted income
         All reductions allowed under SSI
       $20 standard income exclusion
       $65 earned income disregard
       Impairment related work expenses(IRWEs)
       Divide by 2
       Blind Work Expenses (BWEs)
       Remainder is adjusted income
Note: Unearned income is looked at for client contribution but not for eligibility

         Income “Limitation” Part 2
         Rule of thumb eligibility
         Gross monthly earnings less than $3500
         Gross annual earnings less than $42,000
         If rule is exceeded, use SDS 850A
         Employment and Independence Expenses(EIE)
         Any expense that can be reasonably expected to enhance the individual’s independence and
         employment potential
         Impairment related work expenses
         Blind work expenses



                                                                                                       8
              Comprehensive Person-Centered State Work Incentive Initiatives
                       The Center for the Study and Advancement of Disability Policy




Other Information about Income Eligibility Limits in Oregon

In Oregon, the size of the ―family‖, in determining whether a person is below 200 % of the
Federal Poverty Level adjusted for family size, and therefore when premiums are to be paid,
is one person. That is, the ―filing group‖ in Medicaid terms consists only of the individual
applying for or receiving Medicaid benefits.




                                                                                               9
                      Comprehensive Person-Centered State Work Incentive Initiatives
                               The Center for the Study and Advancement of Disability Policy


                          Wisconsin Medicaid Purchase Plan
1. Who can become eligible?
     The family must:
                  Have a net income less than 250% Federal Poverty Level
                   Net Income is calculated using the disregards for SSI
                   - $65 + ½ Earned Income
                   - $20 Unearned Income
                   - Work Expenses

       The individual must:
                   Meet the SSI-disability test except for income (earned & unearned)
                   Countable assets under $15,000
                   Age 18 and over
                   Working or participating in an approved Health and Employment Counseling
                 program

2. Who is covered in the Medicaid Purchase Plan? The individual with the disability who is
eligible for and enrolls in the Medicaid Purchase Plan is covered. Family coverage is not available
under the Medicaid Purchase Plan.

3. How much will it cost to enroll? Monthly Premiums will be equal to 3 percent of earned income
plus all unearned income after deductions of a $615 living allowance and medical and work
expenses. Individuals whose gross income is below 150% of the federal poverty level do not have to
pay a monthly premium.

4. Are people in the Wisconsin Medicaid Purchase Plan able to save beyond the current $2000
   limit? Yes, in two ways:
       (a) People are still eligible for the Purchase Plan as long as they have under $15,000 in
           countable assets,
       (b) In addition to the $15,000 disregard, after enrolling in the Purchase Plan, they will be able
           to open Independence Accounts which would allow them to save up to 50% of their
           earnings in a designated, approved account.

5. Do enrollees in the Medicaid Purchase Plan have access to all Medicaid services? Individuals
enrolled in the Purchase Plan will be able to access all Medicaid card services offered by Wisconsin’s
Medicaid state plan.

6. When will the Medicaid Purchase Plan be available? The proposed implementation date is
March 15, 2000. The Medicaid Purchase Plan has been passed as part of the 1999 – 2001 Biennial
Budget.

7. If I want to enroll in the MA Purchase Plan, where do I apply? Similarly to other Medicaid
programs, individuals apply for the MA Purchase Plan through their county human services
department.



                                                                                                      10
                     Comprehensive Person-Centered State Work Incentive Initiatives
                              The Center for the Study and Advancement of Disability Policy


8. Where can I get additional information about this program? Additional information can be
   found on the Wisconsin Pathways to Independence web site at:
   www.dhfs.state.wi.us/aboutdhfs/osf/Pathways/osf-path-index.htm
                                                                                              Revised 12/22/99



   Further explanation provided by Wisconsin:

Wisconsin’s Medicaid Buy In program provides that an individual does not begin to pay a monthly
premium until their countable income is above 150 % of the Federal Poverty Level. In determining
the countable income the State disregards a ―maintenance allowance‖ which is an amount of
unearned income which is equivalent to the SSI income standard in the State ($616 in 2000) and the
individual’s medical and remedial expenses and work expenses. If the amount of unearned income is
less than the disregards allowed for an individual, then the remainder of the individual’s disregards
shall be subtracted from the individual’s gross monthly earned income before applying the earned
income premium calculation.

In determining when an individual begins to pay a monthly premium, the applicable poverty level is
based on the size of the ―family‖ as defined by the State. In the case of Wisconsin, the family
includes the individual’s spouse and any dependent child residing in the same household of the
individual. For example, an individual applying for the Purchase Plan has 2 children. They could
have an SSDI check of $1100 per month, be earning $600 per month and have no premium.

Note: See an explanation of the Wisconsin Medicaid Buy In Amendments that were adopted in 1999
at:
http://www.dhfs.state.wi.us/aboutdhfs/osf/Pathways/pdf-path/path-amend.pdf

See pages 297 – 300 of 1999 Wisconsin Act 9 at the following address on the Wisconsin
Legislature’s web site: http://www.legis.state.wi.us/1999/data/acts/99Act9.pdf




                                                                                                                 11
                     Comprehensive Person-Centered State Work Incentive Initiatives
                              The Center for the Study and Advancement of Disability Policy




Vermont’s Medicaid for the Working Disabled Program
In 1999, the Vermont legislature enacted legislation which provided for the creation of a Medicaid
Buy In program. The following is the language from Vermont Act 62, paragraph (h), directing that
there be established a Medicaid program for working disabled persons.‖

       (h) Of the above special funds, $46,000.00 shall be used to extend Medicaid eligibility to
       disabled workers in families whose income is less than 250 percent of the federal poverty
       level and who would be considered to be receiving supplemental security income (SSI) except
       for earnings in excess of SSI income limits or, subsequent to initial Medicaid eligibility,
       assets in excess of SSI limits that are attributable to savings from earnings. In addition, up to
       $500.00 per month of the disabled worker's Social Security disability insurance payments
       shall be disregarded in the Medicaid eligibility determination. The commissioner shall have
       the authority to establish program premiums and other cost-sharing charges by rule for such
       coverage. These funds shall be matched with available federal funds.

The following is from the State of Vermont Agency of Human Service’s Bulletin No. 99-15P
describing proposed rules for the Medicaid for the Working Disabled program:

  ―This bulletin proposes changes to Vermont’s Medicaid eligibility policy for working disabled
  persons as required by state law (Act 62, paragraph (h) (1999), by adopting an optional Medicaid
  coverage category now available under federal law (42 U.S.C. 1396a (10)(A)(ii)(XIII)).

  These proposed policy amendments support broader changes in Vermont’s human services
  infrastructure furthering implementation of the Vermont Work Incentive Initiative by the Division
  of Vocational Rehabilitation at the Department of Aging and Disabilities. The program
  encourages people with disabilities to earn more income without losing eligibility for health care
  benefits. In this way, persons with disabilities may return to the workforce more fully and thereby
  derive the opportunity for greater long-term independence.

  Working Disabled Subject to Relaxed Medicaid Eligibility Criteria
  Under the proposed policy, in order to be eligible for health care benefits from the Medicaid
  program, a person must fulfill both parts of the following two-step eligibility determination. By
  meeting both parts of the eligibility determination, working disabled persons may be eligible for
  Medicaid even when their family income, including their earnings, would make them otherwise
  ineligible.

  Step one: Compare assistance group’s income to 250% of the Federal Poverty Level (FPL).

  Determine the net income of the Medicaid assistance group using SSI-related Medicaid rules. If
  net income is below 250% of the FPL associated with the size of the assistance group, go to step
  two.

  Step two: Apply special income disregards for working disabled persons



                                                                                                      12
                    Comprehensive Person-Centered State Work Incentive Initiatives
                             The Center for the Study and Advancement of Disability Policy


Redetermine net income according to SSI-related Medicaid rules, this time disregarding the
earnings and up to $500 of the working disabled persons social security disability insurance
benefits (SSDI). Compare this net-income result to the SSI/AABD payment level or Medicaid
protected income level (PIL) applicable to the assistance group’s size. If this result is at or below
either income standard, the assistance group’s net income meets the income test for Medicaid
eligibility. If it meets the other eligibility criteria set forth in the rules for the SSI-related Medicaid
eligibility, the group is eligible for Medicaid.

As Earnings Increase, the Working Disabled Share Responsibility for the Costs of their Own
Health Care by Paying a Medicaid Program Fee
Consistent with the philosophy of a working disabled person gradually developing independence
from publicly funded program, a cost-sharing method based on a sliding scale (as in the Dr.
Dynasaur program) applies to persons eligible under this provision. Those with income of more
than 185% of the FPL but not more than 250 percent of the FPL are charged a program fee
between $10 and $25. Those with income less than or equal to 185 % of the FPL are not assessed
a fee.―




                                                                                                        13
                       Comprehensive Person-Centered State Work Incentive Initiatives
                                The Center for the Study and Advancement of Disability Policy




Alaska
Information about the Alaska Medicaid Buy In program can be found on the Alaska Medicaid web
site at:
http://www.hss.state.ak.us/dma/news.htm#anchor146212

The following is taken from that site.

Alaska Working Disabled Medicaid Buy-In

 Who Is Eligible?
The Working Disabled Medicaid Buy-In is a category of Medicaid intended to encourage an
 individual with a disability to work (if able) by giving or extending their access to health
 coverage. An individual with a disability who is ineligible for Adult Public Assistance (APA) and
related Medicaid because they have too much earned income (their own or their spouse's) may
qualify for Medicaid under this category.

Determining Eligibility
The eligibility determination is a two-step process.

Step 1 - The Family Income Test
The family's monthly net income must be below 250% of the Federal Poverty Guideline (FPG)
for Alaska. Here is what 250% FPG for 2000 looks like:

Family            1             2                 3                   4                  5          6        7
Size
250 %        $2,173        $2,930          $3,686              $4,442             $5,198        $5,955   $6,711
Alaska
FPG
Monthly

 Net income is determined by subtracting certain disregards, including impairment related work
expenses and 50% of the family's earned income. The rules used for the supplemental Security
Income (SSI) and APA programs are the rules used here. A "family" is considered the individual with
a disability, the individual's spouse, and any dependent children of either the individual or spouse
who are living in the same household a majority of the time. If the family's net income is equal to or
greater than 250% FPG for the appropriate household size, the individual is not eligible for this
category. If the family net income is less than 250% FPG the individual passes the Step 1 test.
Proceed to Step 2.

 Step 2 - Individual Unearned Income Test
 If the family's monthly net income is below 250 % FPG, the individual must then pass Step 2, the
Individual Unearned Income Test. In this step, all of the earned income of the individual (and spouse)
is disregarded. Counting only unearned income, the individual must meet the financial and
nonfinancial requirements to be eligible for SSI/APA related Medicaid. For example, a



                                                                                                                  14
                      Comprehensive Person-Centered State Work Incentive Initiatives
                               The Center for the Study and Advancement of Disability Policy


single individual living on his or her own, must have monthly unearned income of less than $951
($1144, if married). The individual must have countable assets of less than $2000 ($3000, if married).

Disability Determination Needed
 The individual must have a documented disability determination from the Social Security
 Administration or the state. If a new disability determination is required, the Disability
Determination Service disregards the usual limitation on an individual's "substantial gainful
activity."

 Premiums May Be Required
 Here is the "buy-in" part. An individual who is eligible under this category may have to pay a
 premium to the Division of Medical Assistance to continue to receive coverage. Determining the
 premium amount, sending premium due notices, and collecting premiums are done by the
 Division of Medical Assistance Third Party Liability (TPL) Unit. Premiums are assessed on a
 sliding fee schedule based on the family's annual net income. A family whose annual net income is
below 100% FPG does not pay a premium. The premium amount will not exceed 10% of the family's
annual net income. The first premium is not due until the second month of eligibility
following the month the application is approved. If an individual is at least 60 days delinquent in
payment of premiums, Medicaid eligibility under the Working Disabled Buy-In category is
terminated.

 Where To Apply
 An individual may apply for Medicaid, including the Working Disabled Medicaid Buy-In, at any
office of the Division of Public Assistance.


   April 19, 2000




                                                                                                    15

								
To top