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

Current through Register Vol. 49, No. 6, June, 2024
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.
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