The material presented on this website is for informational and educational purposes only as provided by Summit Independent Living Center, Inc. To see if you qualify for the Medicaid for Workers with Disabilities program, we urge you to visit with a Medicaid eligibility specialist at your local Office of Public Assistance as eligibility must be determined on an individual basis.
- What is MWD?
- Eligibility Guidelines
- Income Limits
- Resource Limits
- Monthly Cost Share Fees
- How to Apply
- Stopped Working?
- Other Benefits?
- Employment Resources
- Have More Questions?
- MWD Adopted Rules
- MWD Table of Standards
Montana's Medicaid for Workers with Disabilities program (MWD) recognizes the employment potential of people with disabilities. The Balanced Budget Act of 1997 (BBA) and the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) allow states to provide Medicaid coverage to working individuals with disabilities who, because of their earnings or resources, cannot qualify for Medicaid under other laws or programs. Montana's Medicaid for Workers with Disabilities program is based on the Balanced Budget Act.
Medicaid eligibility is important because Medicaid is a program that covers typical health care expenses for individuals and families with limited incomes, including adults and children with disabilities. In addition, Medicaid covers many disability-specific services and supports not covered by private pay insurance, including things like personal assistance and developmental disability services. The fear of losing Medicaid coverage is one of the primary reasons many adults with disabilities are afraid or reluctant
The 2009 Montana Legislature passed SB 119, an act requiring the creation and implementation of a Medicaid for Workers with Disabilities program, a new Medicaid eligibility category specifically tailored for workers with disabilities. The purpose of the program is to support employment for individuals with disabilities by providing the opportunity to begin or continue to receive Medicaid benefits during their employment.
Under the Medicaid for Workers with Disabilities program, which was first implemented on July 1, 2010, people with disabilities can go or return to work and earn more money without losing their healthcare coverage through the Medicaid program because they can now "buy-in" to the program with a cost-share that is based on a sliding fee scale according to an individuals income.
To be eligible for the Medicaid for Workers with Disabilities program, an individual must:
- Meet all non-financial eligibility criteria for Medicaid
- Currently be considered disabled by Social Security Act criteria, or would be considered disabled if not for current work activities
- Be age 16 or older
- Be employed (including self-employment) full or part time (i.e., are subject to FICA taxes)
- Be within resource limitations of the MWD program
- Have monthly countable family income at or below 250% of the Federal Poverty Level (FPL)
- Not be residing in a residential medical institution
- Pay a monthly cost share fee based on income of the worker(s) with disabilities only
To be eligible for the MWD program, your countable family income can not exceed 250% of the Federal Poverty Level (FPL).
2012 Monthly Income Limits:
- Individual --
- Couple --
*These amounts are "countable income," not gross income.
If eligibility is determined, MWD benefits will only be issued after the Department receives and processes any cost-sharing payments that may be due.
What is "countable income" and how is it calculated?
If you just have Employment (earned) income:
(Gross wages - $85) / 2 = Countable Income
If you have both earned income and unearned (i.e. SSI, SSDI, etc.) income:
(Gross wages - $65) / 2
(Unearned income - $20)
Be aware that the “Financial Responsibility of Relatives” does apply to determining income for eligibility purposes and some income of financially responsible relatives may be considered deemable to the individual applying for benefits; spouses are responsible for spouses and parents/step-parents are responsible for minor children. The Office of Public Assistance will be able to assist you in determining how much, if any, of a responsible relative's income may be deemable to you when you apply for the MWD program.
In addition to the general income exclusions that are used to determine your countable income, you may also qualify for other additional income exclusions, known as Income Related Work Expenses (IRWE), Blind Work Expenses (BWE), or others. For a full description of what IRWE's and BWE's are, along with more information about other income exclusions or employment supports and Social Security, please visit the Social Security Administration's Red Book website or visit with a benefits specialist to determine how working will affect you.
The resource limits for the MWD program are greater than they are for SSI and other Medicaid eligibility categories. To meet the resource limit criteria, household resources must be within the MWD resource limits at some point during the benefit month for the worker with disabilities to qualify for this program.
- Individual --
- Couple --
Be aware that the “Financial Responsibility of Relatives” does apply to resources as well and some resources of financially responsible relatives may be considered deemable to the individual applying for benefits; spouses are responsible for spouses and parents/step-parents are responsible for minor children. The Office of Public Assistance will be able to assist you in determining how much, if any, of a responsible relative's resources may be deemable to you when you apply for the MWD program.
What is counted as a resource?
A resource can be cash or something that can be converted to cash. Some examples are:
- Bank accounts
- Savings, checking, Certificate of Deposit, other investments
- One primary vehicle is allowed per household, additional vehicles are considered resources
- Motor Homes
- Motorcycles, etc.
- Land you do not live on
- Plus others
What is excluded? Some examples include:
- Household goods and personal effects
- Medical devices and adaptive equipment
- Certain life insurance policies
- A person’s home
- One automobile per household
- Some burial funds, burial spaces and life insurance assigned to funeral provider
- Student financial assistance received under Title IV of Higher Ed. Act or Bureau of Indian Affairs
- Individual Development Accounts (IDAs). To find out more about IDAs, including IDA programs in your area, you can visit the Administration for Children and Families Assets for Independence website.
- Some Trusts
Note: Retirement accounts owned by the worker with disabilities are excluded resources that do not count against the resource limit for the MWD program only.
Cost share fees are based on the net countable income of the worker with disabilities. If a qualifying worker with disabilities is married to a person who is not also a qualifying worker with disabilities, only the net countable income of the worker with disabilities will be used in determining monthly cost-share payments. If both spouses are qualifying workers with disabilities, the fee will be based on their combined net countable income.
Note: Enrolled members of federally-recognized tribes who provide verification of their current tribal enrollment will be exempt from cost share fees.
Cost share fees for the MWD program are divided up into four income brackets as follows:
|% of FPL||Income (2012)||Monthly Payment|
|$0.01 to $931||$35|
|Up to 150%
|$931.01 to $1,397||$67|
|Up to 200%
|$1,397.01 to $1,862||$100|
|Up to 250%
|$1,862.01 to $2,328||$135|
Note: this table only shows the Federal Poverty Level (FPL) amounts for a household size of one. The percent of FPL used to determine the cost share fee is the percentage of poverty for the household size equal to the number of workers with
disabilities who qualify for MWD. If the worker with disabilities is married to an individual who is either not disabled or not working, the percent of poverty is based only on the FPL for one person, not two. The FPL for two is only used when determining
cost share if both spouses qualify for MWD. The FPL amounts for a household of two are as follows:
- 100% FPL = $1,261
- 150% FPL = $1,891
- 200% FPL = $2,522
- 250% FPL = $3,153
Now that you know a little bit more about the Medicaid for Workers with Disabilities program, to apply for the program or to see if you qualify you have the following options:
- You can contact your local Office of Public Assistance;
- You may also apply for Medicaid by mailing an application. You can print an application at the Public Assistance website;
- Or, you can apply online using the Montana Connections website.
If you are currently working and enrolled in the Medicaid for Workers with Disabilities program and, for whatever reason, your employment ends, you will no longer qualify for the MWD program in any month in which you have not worked.
States no longer have the option of allowing for a grace period to keep people enrolled in Medicaid through the MWD program for temporary breaks in employment. If your employment ends and you are still in need of Medicaid coverage for months in which you are not employed, you will need to qualify for Medicaid through a different Medicaid eligibility category such as the Medically Needy eligibility category. Some things to keep in mind if this happens are:
- When MWD eligibility ends and other Medicaid programs are considered, the lower resource limits of the other programs will apply to eligibility: typically $2,000 for an individual and $3,000 for a couple;
- Retirement accounts that were considered excluded resources under the MWD program may no longer be considered excluded under other Medicaid eligibility categories; and
- You might not qualify for other Medicaid eligibility categories without first incurring a spend down.
While the Medicaid for Workers with Disabilities program allows qualifying workers with disabilities to continue receiving Medicaid coverage while working, other benefits can still be impacted by increased income from working wages.
If you receive benefits such as Low-Income Energy Assistance (LIEAP), food stamps (SNAP), or housing/rental assistance (Section 8, Public Housing, etc.), be aware that the amount of any assistance you receive will be reduced by an increase to your income because of your ability to pay more of these costs on your own. Likewise, if your income lowers you may be eligible for an increase in the amount of these types benefits you may receive.
Be sure to report any changes to your income to the appropriate agency to ensure the amount of benefits you receive is accurate and to avoid an overpayment, which you may end up having to pay back, or being terminated from a program because you didn't report your income.
If you have specific questions related to the MWD program or to have your eligibility for the MWD program determined, please contact your local Office of Public Assistance.
Have questions about how working may affect your benefits?
Navigating the system and determining how employment can affect your Social Security, your Medicaid coverage, or other benefit programs you may be enrolled in, can be difficult and extremely confusing. We recommend visiting with a benefits specialist to discuss your options and learn how employment will affect you personally if you are considering going or returning to work. To assist in navigating the employment maze that comes from working while disabled and for other questions about how employment can affect you and your benefits, individuals can work with benefit specialists from a variety of locations including:
- Local Centers for Independent Living,
- Vocational Rehabilitation,
- The University of Montana Rural Institute,
- The Disability Navigator Program through your local Job Service,
- or other Employment Network Provider agencies.
Please visit our Employment Resources page for more resources about where to find information about employment and disabilities.
If you have additional general questions about Montana's Medicaid for Workers with Disabilities program, if you would like for us to come and do a training or presentation about Montana's Medicaid for Workers with Disabilities program for your group or organization, or if you would like us to set up an informational booth about Montana's Medicaid for Workers with Disabilities program at your conference or other activity, please contact Justice Ender at the Summit Missoula Office.
Justice can be reached by email or phone using the following contact information:
- Email: firstname.lastname@example.org
- Phone: 406-728-1630
This project was funded (in part) under a contract with the Montana Department of Public Health and Human Services and by the U.S. Department of Health and Human Services--Centers for Medicare and Medicaid Services -- Federal Grant #1QACMS030322-03-00. The statements herein do not necessarily reflect the opinion of the Department. A total of $450 in Federal funding was spent in the development of this MWD webpage.