Montana Medicaid for Workers with Disabilities In Effect July 1st

The Montana Medicaid for Workers with Disabilities (MMWD) program, one of the key achievements of the 2009 Legislature for individuals with disabilities, goes into effect July 1, 2010. The MMWD program is a new Medicaid eligibility category specifically designed for individuals with disabilities to go to or return to work or for those who are already working and may become ineligible for health care coverage under the Medicaid program under other eligibility categories such as the Medically Needy category or through the Supplemental Security Income (SSI) program.

Medicaid eligibility is important for individuals with disabilities 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 to start or return to work. Many adults with disabilities cannot risk losing the benefits that provide them with the services, supports and medical care they need to live on a daily basis. Through the MMWD program, working people with disabilities can continue to participate in the Medicaid program by paying affordable premiums — similar to purchasing private health insurance (with the exception of Native Americans who will not have to pay a premium). Individuals who are eligible to participate in the MMWD program will be able to retain higher income and resource levels, and still maintain their Medicaid coverage.

To be eligible for the MMWD program, an individual must be employed and be able to show proof that they are having FICA taxes withheld from their paycheck or, if self-employed, proof that they are paying FICA taxes.

Individuals must have a net family income that is less than 250% of the Federal Poverty Level (250% FPL = $27,075/year for 2010). An individual’s net family income will be determined using the SSI calculations for evaluating the income of the working individual with a disability and any other financially responsible adult living with that individual.

Individuals participating in the MMWD program will also be able to increase the amount of resources they are allowed to have beyond what is typically allowed in other Medicaid eligibility categories which, is $2000 for an individual and $3000 for a couple. Under the MMWD program, the resource limit will increase by four times the standard amount. Individuals will be allowed to have up to $8000 and a couple will be allowed to have up to $12,000. These limits also include any resources that may belong to other financially responsible relatives or adults that may be deemed to be available to the individual as well.

One exception to the resource limit is that individuals participating in the MMWD program will also be allowed to have a retirement or pension fund. Any amount that the individual saves in a retirement or pension fund will not count as a resource or towards the $8000 or $12,000 resource limits.

One of the most notable differences between the MMWD program and the Medically Needy program that many individuals with disabilities are aware of is the cost-sharing requirement. Instead of having to spend down or incur costs down to a specified threshold ($645 per month for the Medically Needy program after income exclusions), the MMWD has premiums that are based off the level of an individual’s income. Unlike determining eligibility for the MMWD program where an entire family’s net income is counted, MMWD cost share premiums will be based solely upon the individuals total countable income. The monthly premiums range from a base of $35 all the way up to $175 as noted in the following table:

If you would like more information regarding the MMWD program, you can contact Travis Hoffman at Summit Independent Living Center or go to your local Office of Public Assistance.  If you think you or someone you know may be eligible for the MMWD program, contact your local Office of Public Assistance to talk to a Medicaid eligibility specialist.  The Department will begin taking applications for the MWD program beginning July 1st.

Now get back to work!