What is the Medicaid for Workers with Disabilities program?

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, 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 to gain employment.

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 time of 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 net-countable income.

Learn More about Montana’s MWD Program

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. Disability status can also be determined through the MEDS process (refer to 105-1 of the Montana Medicaid Manual located at https://dphhs.mt.gov/hcsd/mamanual) if the individual has not gone through the SSA determination process.
  • 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

For more detailed information about who may qualify for MWD and/or the MWD work requirements, please refer to 201-6 of the Montana Medicaid Manual located at https://dphhs.mt.gov/hcsd/mamanual.

To be eligible for the MWD program, your countable family income can not exceed 250% of the Federal Poverty Level (FPL).

2024 Monthly Income Limits:

Individual — $3,138.00/month*
Couple — $4,258 .00/month*

* 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)
Countable Income

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.

Income Exclusions

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.

For more detailed information about MWD income requirements, please refer to 010 and 602-1 of the Montana Medicaid Manual located at https://dphhs.mt.gov/hcsd/mamanual.

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.

Resource Limits:

  • Individual — $15,000
  • Couple — $30,000

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 items count as resources?

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
  • Vehicles
    • One primary vehicle is allowed per household, additional vehicles are considered resources
    • Motor Homes
    • ATV’s
    • Boats
    • Motorcycles, etc.
  • Property
    • Land you do not live on
  • Plus others

What items are excluded as resources?

  • 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
  • Some 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.
  • ABLE Accounts
  • Some Retirement Accounts*
  • Independence Accounts**
  • Some Trusts

*Retirement Accounts: Retirement accounts owned by the worker with disabilities are excluded resources that do not count against the resource limit for the MWD program only.

**Independence Accounts: Qualifying Independence Accounts (including the interest on and earnings from) are excluded while the individual is receiving coverage under the Montana Medicaid Workers with Disabilities (MWD) program. There is no minimum or maximum limit to establish the account or that can be deposited into an existing account while the individual is receiving coverage under MWD. In order to meet the resource exclusion, the Independence Account must meet all of the following criteria:

  1. The account must be established by the beneficiary when MWD coverage begins or while receiving MWD coverage; AND
  2. The account must meet the Department’s approval and be designated as an Independence Account; AND
  3. The funds in the account must be held separate from non-exempt resources.

Once the individual’s coverage under MWD ends, the following rules apply:

  1. The amounts contributed to the account (including the interest on and earnings from the account) during the individual’s coverage under MWD shall be excluded.
  2. No additional deposits into the account are permitted once the individual’s MWD coverage ends.
  3. Account activities are subject to standard eligibility resource policies including asset transfer evaluations.

For more detailed information about MWD resource requirements, please refer to 001 and 402-1 of the Montana Medicaid Manual located at https://dphhs.mt.gov/hcsd/mamanual.

Cost share fees are based on the net countable income (not gross 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 are exempt from cost share fees.

Cost share fees for the MWD program are divided up into four income brackets as follows:

% of FPL Income (2024) Monthly Payment
100%
(or less)		 $0.01 to $1,255.00 $35
Up to 150%
(above 100%)		 $1,255.01 to $1,883.00 $67
Up to 200%
(above 150%)		 $1,883.01 to $2,510.00 $100
Up to 250%
(above 200%)		 $2,510.01 to $3,138.00 $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 monthly FPL amounts for a household of two are as follows:

    • 100% FPL = $.01 – $1,703.00
    • 150% FPL = $1,703.01 – $2,555.00
    • 200% FPL = $2,555.01 – $3,407.00
    • 250% FPL = $3,407.01 – $4,258.00

For more detailed information about MWD cost-share fees, please refer to 010 of the Montana Medicaid Manual located at https://dphhs.mt.gov/hcsd/mamanual.

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:

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 eligibility categories are considered, the lower resource limits of the other eligibility categories will apply to eligibility, typically $2,000 for an individual and $3,000 for a couple, and you may need to spend down your resources;
  • Retirement accounts that were considered excluded resources under the MWD program may no longer be considered excluded under other Medicaid eligibility categories;
  • Independence accounts that were established while an individual qualified under the MWD program will remain excluded once the individual’s coverage under MWD ends with the following rules:
    • The amounts contributed to the account (including the interest on and earnings from the account) during the individual’s coverage under MWD shall be excluded;
    • No additional deposits into the account are permitted once the individual’s MWD coverage ends;
    • Account activities are subject to standard eligibility resource policies including asset transfer evaluations; and
  • You might not qualify for other Medicaid eligibility categories without first incurring a monthly 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 in your income to the appropriate agency to ensure the amount of benefits you receive is accurate and to avoid an over-payment, which you may end up having to pay back, or being terminated from a program because you didn’t report your income.

MWD Adopted Rules
Medicaid Policy Manual

Still Have Questions?

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:

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 a Summit office near you.

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.