Medicaid Policy
Medicaid Policy
A. General Eligibility
The MWI program is for people of any age who are disabled and who have earned income.
1. People who are eligible for MWI:
· Can have countable assets of up to $15,000, and,
· Income up to 250% FPL for their household size. (462-1)
· Eligible individuals must pay a premium to receive coverage when their countable income is more than 100% of the FPL. (462-1)
2. Individuals who receive SSI or meet SSI Protected Group criteria, and pass the asset test, do not qualify for the MWI program.
3. A working disabled individual who meets the income and asset criteria for the 100% FPL program does not qualify for MWI. When the individual is married, use the rules for a married couple to decide if income is under 100% FPL.
4. If both members of a married couple are aged or disabled, but only one is working and disabled, decide if they both want Medicaid coverage.
a. If both want coverage, decide if they qualify for the 100% FPL group.
b. If they do not qualify for the 100% FPL group, determine eligibility for the medically needy spenddown group as a couple.
i. If eligible, they will need to meet the spenddown amount to receive coverage for both of them.
ii. If they choose not to meet the spenddown to qualify both of them, the working disabled spouse may qualify for the MWI program.
iii. If the couple fails the asset test for medically needy coverage, determine if the working disabled spouse qualifies for MWI.
5. If both members of a married couple are disabled and both are working, they can be on MWI as a couple.
B. Disability
The individual must meet the requirements for disability in section 303-2.
1. If the person is age 65 or older, have the State Medicaid Disability Office (SMDO) complete continuing disability reviews because Social Security stops doing disability reviews once a person turns age 65.
2. For someone turning age 65 and receiving MWI, complete a disability review within 12 months after they reach age 65. [NOTE: Do not refer a individual to the SMDO if the SMDO previously decided someone was disabled and decided no further redeterminations are needed.]
C. Earned Income
The individual must have earned income, or be self-employed and working with the expectation of future earnings. Individuals do not have to earn a certain amount of income or work a minimum number of hours each month.
1. Verify the income is earned. Verification may include check stubs with FICA deductions or a statement from an employer
2. A self-employed individual may provide self-employment quarterly or annual tax returns, self-employment income and expense ledgers or contracts for work, or a written business plan.
a. The individual may not realize a net profit immediately; however, the individual may still qualify for MWI if actively engaged in self-employment.
b. Request income and expenses records as needed to determine a best estimate.
3. A business license may show a individual intends to do self-employment, but they may need to provide other documents indicating hours worked and expected earnings.
4. If an individual has started a new job, MWI eligibility can begin the month they start working. They do not have receive any earnings in that month.
5. Someone working on commission or doing contract work may not receive any earnings for some time. If they confirm they're working, MWI eligibility can begin the month they start working.
6. Income received from a college work-study qualifies as earned income.
D. Asset Exemptions and Special Circumstances
1. The asset limit for the MWI program is $15,000. (503)
2. Special Asset Lifetime exemptions:
· Vehicles 521-4
· Retirement/Pension plans 521-13