Get Latest WorkWORLD

VA MEDICAID WORKS - Non-Financial Eligibility

An individual in Virginia's MEDICAID WORKS covered group must meet the same general non-financial requirements as any other group when applying for Medicaid. These requirements are detailed in the Medicaid Non-Financial Eligibility Requirements topic.

Additionally, the individual must also meet certain additional non-financial criteria. Some of these eligibility requirements are different for initial eligibility determination and ongoing eligibility after enrollment, while other requirements are the same at initial eligibility determination and ongoing eligibility, as explained below.

Requirements with Same Criteria at Initial Eligibility Determination and Ongoing Eligibility

NOTE: The earlier requirement that the individual must not be receiving Medicaid covered long-term care services was removed effective 1/1/2008.

·          The individual must meet the definition of blind or disabled.

·          The individual may not be an inpatient in an institution for mental diseases (IMD), or an inmate in a public institution that is not a medical facility.

·          The individual must establish and/or maintain a Work Incentive (WIN) Account, such as a checking or savings account, at a bank or other financial institution. The individual must provide documentation for the case record designating the account(s) as a WIN Account. The account must either be a new account or an existing account with no other income but the wages earned while in MEDICAID WORKS. It cannot contain the individual's Social Security benefits.

·          All individuals requesting enrollment in MEDICAID WORKS must also sign a MEDICAID WORKS Agreement. The agreement outlines the individual's responsibilities as an enrollee in the program.

·          The individual must participate in cost sharing through the payment of a monthly premium to the Department of Medical Assistance Services. The monthly premium is currently waived.

Requirements with Different Criteria at Initial Eligibility Determination and Ongoing Eligibility

·          At initial eligibility determination, the individual must be either competitively employed in an integrated setting or self-employed, or have documentation from an employer establishing the date when employment will begin. After enrollment, he or she must become or remain either competitively employed in an integrated setting or self-employed. If competitively employed, work must occur in a work setting in the community alongside people who do not have disabilities. Work performed in a sheltered workshop or similar setting is not considered competitive employment in an integrated setting. (See the Virginia MEDICAID WORKS - Employment Considerations topic for additional information.)

·          Once enrolled, the individual must receive pay at the minimum wage or at the prevailing wage or "going rate" in the community, and the individual must provide documentation that payroll taxes are withheld. Self-employment must be documented, although competitive employment pay rate requirements do not apply to self-employment.

Also See:

Virginia MEDICAID WORKS - Overview

Virginia MEDICAID WORKS - Agreement

Virginia MEDICAID WORKS - Blindness and Disability

Virginia MEDICAID WORKS - Cost Sharing and Premium Payment

Virginia MEDICAID WORKS - Employment Considerations

Virginia MEDICAID WORKS - Entitlement and Enrollment

Virginia MEDICAID WORKS - Financial Eligibility

Virginia MEDICAID WORKS - Good Cause Exceptions

Virginia MEDICAID WORKS - Safety Net

VA MEDICAID WORKS - Work Incentive (WIN) Account

Source

Some information for this topic was drawn from the DMAS website at:
http://www.dmas.virginia.gov/downloads/pdfs/mb-FactSheet_Medicaid.pdf
http://www.dmas.virginia.gov/downloads/pdfs/rcp-medicaid_applicant_handbook.pdf

Additional information was drawn from Section M0320.211 of the Department of Social Services (DSS) Medicaid Manual.

WorkWORLD™ Help/Information System

   Share/Save: Click the button or link at left to select your favorite bookmark service and add this page.

This is one topic from the thousands available in the WorkWORLD™ software Help/Information System.
Complete information about the software is available at: http://www.WorkWORLD.org