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VA MEDICAID WORKS - Overview

MEDICAID WORKS is a work incentive opportunity offered by the Virginia Medicaid program for individuals with disabilities who are employed or who want to go to work. It is Virginia's Medicaid Buy-In Program.

MEDICAID WORKS is a Medicaid covered group that enables workers with disabilities to gain greater independence, higher income, and retain more in savings, or resources, than is usually allowed by Medicaid while providing the support of continued health care coverage through Medicaid. Individuals enrolled in MEDICAID WORKS are entitled to the standard benefits available to full-benefit Medicaid enrollees.

You may read this overview topic in sequence or jump to any specific section:

· Eligibility

· Allowable Earnings and Resources

· Enrollment

· Continuation

· Safety Net

· Relationship Between MEDICAID WORKS and 1619(b) Status

· Application

Eligibility

MEDICAID WORKS is available to current and new Medicaid enrollees who are blind or disabled, have countable income in 2015 no more than $785 per month for a single individual or $1,008 if a couple, and resources of no more than $2,000 if single ($3,000 if a couple).

For initial eligibility determination, the individual must meet the normal assistance unit policy and procedures that apply to other Aged, Blind, and Disabled individuals with income that does not exceed 80% FPL. Additionally, he or she must meet all of the program's financial eligibility requirements and non-financial eligibility requirements .

NOTE: Current Supplemental Security Income (SSI) recipients, including recipients who have Medicaid coverage under the SSI 1619(b) work incentive, do not have to meet the normal requirement that their countable income not exceed 80% FPL for initial eligibility determination. These individuals are considered to meet the income requirements and no evaluation of income is necessary for the initial eligibility determination. After enrollment, all MEDICAID WORKS participants are subject to the same higher income limits.

After enrollment in MEDICAID WORKS, the individual is treated as an assistance unit of one, and higher income and resource limits apply. See the MEDICAID WORKS - Financial Eligibility topic for additional information.

For the purposes of this program, current participation in the Social Security Administration (SSA) programs of Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) will satisfy the condition for disability. Any other applicant without SSA documentation of disability will have to be evaluated by the state's Disability Determination Services program before eligibility can be established.

Allowable Earnings and Resources

This voluntary plan option allows enrollees to have annual earnings in 2015 as high as $75,000 and resources up to $34,543.

After enrollment, the countable income limit is earned income up to 200% of the Federal Poverty Level (FPL) plus unearned income up to 80% of the FPL. The resource limit is equal to Virginia's 1619(b) threshold amount. Both the FPL and 1619(b) threshold are updated annually.

Enrollment

Individuals with disabilities who meet the financial eligibility requirements and non-financial eligibility requirements for this work incentive plan may choose to enroll in MEDICAID WORKS if they:

·               Complete the MEDICAID WORKS Agreement;

·               Are employed or have documentation from an employer establishing the date when employment will begin;

·               Are at least 16 years of age and less than 65 years of age;

·               Establish a "Work Incentive" (WIN) account at a bank or other financial institution to deposit earned income and keep financial resources in order to remain eligible for Medicaid; and

·               Submit payment of a premium if required. See the MEDICAID WORKS - Entitlement and Enrollment topic for additional information.

Continuation

To continue enrollment in MEDICAID WORKS, enrollees must continue to be disabled, employed, less than 65 years old, and have earnings and resources no higher than the amounts stated above. Eligibility will be re-determined no less often than annually. Enrollees are required to inform their eligibility worker about changes that may affect their coverage, including but not limited to, change of address, change in employment or loss of employment. Periodic reporting of documentation regarding the enrollee's employer, employment status, earned income and WIN account(s) will be required.

NOTE: Current MEDICAID WORKS regulations may potentially impact an enrollee's continuing eligibility for MEDICIAD WORKS in certain scenarios that effect unearned income. These may be changed in the future, but remain in effect as of January 2012.

1. If automatic COLA increases to SSDI cause an enrollee's total unearned income to exceed 80% of the Federal Poverty Level, the person will no longer be eligible for MEDICIAD WORKS.

2. Enrollees must, under the regulations, apply for Unemployment Insurance, which is considered unearned income. If the UI causes total unearned income to exceed 80% of the Federal Poverty Level, the person will no longer be eligible for MEDICIAD WORKS.

Safety Net

Good cause exceptions and safety net components of the program include allowing enrollees who are unable to maintain employment due to illness or unavoidable job loss to remain in the program as unemployed for up to six months with the continued payment of any required monthly premiums. Enrollees who are unable to sustain employment and must terminate from the program will be evaluated expeditiously by the local Department of Social Services to determine if they meet the eligibility requirements for any other Medicaid covered groups. This will be completed before an enrollee is terminated from the program.

Resources accumulated after enrollment in MEDICAID WORKS from enrollee earnings that are held in WIN accounts and are no greater than the WIN limit will not be counted in this eligibility determination. If found eligible and enrolled in another Medicaid covered group, the individual will have up to one year to dispose of these funds before they are counted toward ongoing Medicaid eligibility.

Resources accumulated after enrollment in MEDICAID WORKS from enrollee earnings held in IRS-approved accounts that have been designated as WIN accounts will not be counted in any future eligibility determinations. These include IRS-approved retirement, medical savings, education and independence accounts.

Relationship Between MEDICAID WORKS and 1619(b) Status

The 1619(b) work incentive status available to Supplemental Security Income (SSI) recipients allows you to earn a significantly higher income than the MEDICAID WORKS income limit. However, 1619(b) uses the same resource limits as SSI, while the resource limits for MEDICAID WORKS are significantly higher. If you receive SSI and meet the criteria for Medicaid coverage as a Qualified Severely Impaired Individual (1619(b)), you may choose to participate in MEDICAID WORKS because of the higher resource limit.

Application

To apply for MEDICAID WORKS, contact the local Department of Social Services in the city or county where you live. For help understanding how earned income may affect other benefits, such as SSI, Section 8 housing or Food Stamps, ask how you can contact the Work Incentive Planning and Assistance (WIPA) project in your community.

Also See:

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 - Non-Financial Eligibility

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.

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