DHHS - Medicaid Policy Manual
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All Medicaid Programs

Obsolete Policy

 

Obsolete 0714 - 314-7 MWI Premium

Policy Effective August 1, 2010 - June 30, 2014

Contact DWS Program Specialist for previous policy

MWI Premium Calculation

An individual who meets the criteria for the Medicaid Work Incentive (MWI) program may be required to pay a MWI premium to be eligible.    The MWI premium has three tiers based on the level of countable income of the individual or couple.   If a premium is owed, it must be paid before issuing a Medicaid card to the individual.

Countable income is calculated the same as it would be for the 100% A&D poverty group.   The three tiers for calculating a MWI Premium are as follows:

Countable Income Is:

Multiply Income By

More than 100% but not over 110% of FPL

5%

More than 110% but not over 120% of FPL  

10%

Over 120% of FPL

15%

  1. A Work Incentive eligible individual or eligible couple whose countable income does not exceed 100% of the applicable poverty level when following policy in Section 305 for 100% of poverty A & D Medicaid group will not pay a MWI premium.   This applies even if the individual’s resources exceed the regular Medicaid limit for 100% of poverty group.

  2. A Work Incentive eligible individual or eligible couple whose countable income exceeds 100% of poverty when following the policy of Section 305 will have to pay a MWI premium.   The amount of income to be multiplied by the premium percentage is calculated as follows.

    1. Count the income that is not excluded income under D-Medicaid policy.  See Sec. 314-1.  Count all the income of  the eligible individual.  If a spouse is also eligible for the MWI Program, combine their income before making the following deductions.  If the spouse is not eligible do not count the spouse’s income.  If the client is a minor child, count only the child’s income; do not count parents’ income to calculate the MWI Premium.

    2. Deduct $20 from unearned income except VA needs-based income.  The remainder of the $20 disregard can be deducted from earned income.

    3. Deduct only from earned income any impairment-related work expense not covered by Medicaid or a third part, and not paid by someone other than the client.  

    1. Deduct from earned income, the rest of the $20 general disregard, if any, and then $65 and ½ of the remaining earned income. Countable income after these calculations could be under 100% of poverty because income of an ineligible spouse or a minor client’s parents is not counted.  Even if countable income in this calculation is under 100% of poverty, the individual must pay a MWI premium because countable income when following policy in Sec. 305 is over 100% of poverty.

    2. Before multiplying the income determined in 2. A-D by the appropriate premium percentage, deduct payments for health insurance the eligible client pays to cover the client’s, the client’s spouse or the dependent children of the client and spouse.   Deduct the whole premium amount in the month payment is due.  Do not pro-rate the deduction over the months the insurance is intended to cover.   For instance, if the full premium is due the first month of each quarter, then deduct the premium only in that month; do not allow one-third each month of the quarter.  Do Not Deduct the premium in any month except the month it is due.  Do not deduct a Medicare Part B premium for the client’s Medicare coverage because if the client becomes eligible for Medicaid, the State will pay the Part B premium.

    3. To determine the MWI premium amount, multiply the countable income remaining after step 2-E by the appropriate percentage.


  1. The client must meet the MWI premium with cash, check, credit or debit card, or money order only.   Do not use incurred expenses and medical deductions to pay the premium.   Follow the rules in section 415-17 for the time limits on paying the premium.  The MWI premium paid may be used to reduce a spenddown of another household member.   The deduction will show as a cash payment after the premium is paid.  Other family members can use cash or medical deductions to meet the rest of their spenddown. DO NOT enter the MWI premium as a health insurance expense.

  1. The individual is not required to pay the MWI premium for months when the client does not want Medicaid coverage.  Close the case in the second month after a MWI premium is not met and send proper notice of closure.  If the client never meets the MWI premium and has not been eligible for the MWI program in at least one previous month,  the client is not eligible for the lifetime asset exclusion if they reapply for Disability Medicaid in the future.

    1. If the individual contacts the worker requesting the case stay open or meets the current month’s premium before the closure date, keep the case open.  However if the third month’s premium is not met, again schedule the case to close and send proper notice of the closure.   Set alerts as needed to see if premiums are met.

    2. If the individual contacts the agency after the effective date of the closure, the individual needs to reapply for benefits.

  2. Individuals eligible for the MWI program may not choose to be on the Disability Medicaid spenddown program instead.  However, an MWI client who lives with an unemployed, disabled or aged spouse must be on a spenddown case if both need medical coverage. See section 412-2.