Federal link: www.cm s.hhs.gov/twwiia/eligible.asp
What is it: Section 4733 of the Balanced Budget Act of 1997 (BBA) allows States to provide Medicaid coverage to working individuals with disabilities who, because of their earnings, cannot qualify for Medicaid under other Statutory provisions. Section 4733 allows States to provide Medicaid coverage to these individuals by creating a new optional categorically needy eligibility group.
In response to BBA, many States implemented more liberal income and resource methodologies than are used by SSI and have premium payments and cost sharing charges set on a sliding scale based on income.
Who qualifies: In most cases, if you are blind or disabled, regardless of age, and you have Medicaid before you go to work, your Medicaid will continue while you are working as long as your disabling condition still exists. If your earnings are higher than approved amount, but you have special work expenses or medical expenses, you may still qualify for Medicaid.
- 16-64 years of age.
- Individual assets less than $15,000.
- Meet the SSI or SSDI eligibility standard, whether or not you have received either.
- Verified earned income from competitive employment.
Similar to the BBA Group, the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA), created two new optional categorically needy Medicaid eligibility groups: (1) the Basic Coverage Group; and (2) the Medical Improvement Group.
A. Rules that Apply to All States Implementing Basic Coverage Group
- Individuals covered must be at least 16 but not more than 64 years of age.
- Individuals covered must be disabled as SSI defines the term.
- Earned income is not automatically disregarded.
- No federally required income and resource standards.
- If States establish income and resource standards, SSI income and resource methodologies are used to determine eligibility.
B. Rules that Apply to All States Implementing Medical Improvement Group
- Individuals covered must be 16 but not more than 64 years of age.
- Individual covered must have a medically improved disability.
- Individual covered must have been eligible under the Basic Coverage Group but lost that eligibility because his or her medical condition has improved to the point where it is determined at the time of a regularly scheduled continuing disability review that he or she is no longer disabled as SSI defines the term.
- Earned income is not automatically disregarded.
- No federally required income and resource standards.
- If States establish income and resource standards, SSI income and resource methodologies are used to determine eligibility.
- States are free to establish their own income and resource standards, or have no income and resource standards if they choose.
- Use of more liberal income and resource criteria than used by SSI (Section 1902(r)(2) of the Act).
- Use of more restrictive eligibility criteria than are used by SSI (209(b) States).
- States can require payment of such premiums or other cost-sharing charges, on a sliding scale based on income, as the State may determine.
What it covers:
BASIC COVERAGE GROUP - (Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act)
States have the option to cover individuals with disabilities (aged 16-64) who, except for earnings, would be eligible for SSI. States are allowed to permit working individuals with disabilities to:
- Buy-into the Medicaid program by paying premiums and other cost-sharing charges on a sliding-fee scale based on income.
MEDICALLY IMPROVED GROUP - (Section 1902(a)(10)(A)(ii)(XVI) of the Social Security Act)
If and only if a state provides Medicaid coverage to individuals under the Basic Coverage Group, the state would also have the option of:
- Providing coverage to employed persons with disabilities (aged 16-64) whose medical condition has improved (and as a result are no longer eligible for SSDI or SSI and therefore are no longer eligible for Medicaid) but who continue to have a severe medically determinable impairment as defined in regulations issued by the Secretary of HHS.
Under this option, individuals would be considered employed if they earn at least the Federal minimum wage and work at least 40 hours per month or are engaged in work that meets criteria for work, hours, or other measures established by the state and approved by the Secretary of HHS.
What it costs: Participants pay premiums and other cost-sharing charges on a sliding-fee scale based on income.
- TWWIIA extends to 8 ½ years premium free Medicare Part A coverage to SSDI beneficiaries who lose cash assistance because they return to work.
- For people 250% to 450% FPL, premium cannot exceed 7.5% of annual income
- For people with incomes above $75,000, premium can equal 100% the cost of Medicaid coverage
Impact for YOUTH: The “Ticket to Work and Medicaid Buy-In” program opens the door for young adults who earn good salaries to have access to an excellent health insurance program. Many private insurance policies may not cover the needed services that a person with complex health needs requires such as personal care attendants. Having this access to Medicaid addresses the complex health services needed and provides incentive to pursue life dreams of a well paying job and adequate health insurance.
SSA - The Ticket to Work Program and Youth in Transition
www.ssa.go v/work/Youth/youth.html
Today there are almost one million youth under the age of 18 that are receiving Supplemental Security Income benefits from the Social Security Administration. Approximately seventy percent of these individuals will be future Ticket recipients once they reach 18 years of age. The Ticket To Work Program can help to ensure the successful transition of youth with disabilities from school to work and adulthood through the provision of employability services, supports and incentives.
How to Apply: Contact Medicaid office
www.cms.hhs.gov/medicaid/consumer.asp
SOCIAL SECURITY ADMINISTRATION
Medicaid Buy-in State Map
www.ssa.gov/work/ResourcesToolkit/Health/states.html
Listing of states who currently implement program and status of other states efforts to create a Medicaid Buy-in for working people who are disabled.
Resources:
TWWIIA - Ticket to Work Program
www.yourticke ttowork.org/
The Ticket to Work and Self-Sufficiency Program is the centerpiece of new legislation under the Ticket to Work and Work Incentives Improvement Act of 1999. This comprehensive national initiative is also designed to assist people with the training and support they need to go to work by increasing their choices. SSA beneficiaries with disabilities can find employment, vocational rehabilitation (VR) and other support services from public and private providers.
TWWIIA - Ticket to Work Program
State Chart of Work Incentives Activities
www.ssa.gov/work/Beneficiaries/activity.html
The chart below contains links to information on initiatives, activities, and programs that can help people with disabilities who want to work. This includes information on the Ticket-to-Work Program, demonstration projects, cooperative agreements, and grants.
TWWIIA FACT SHEET: Youth In Transition and the Ticket to Work Program
 www.yourtickettowork.org/selftrai ning/Fact%20Sheet%20Final.doc
TWWIIA FAQ - Questions Frequently Asked by Transition Professionals regarding Beneficiaries in Transition That Receive Tickets
www.yourtickettowork.org/selftraining/FAQ%20Final.doc
CMS - Medicaid Infrastructure Grants - Medicaid Buy-In
www.cms.gov/twwiia/grant use. asp
Twenty-five (25) States were awarded Medicaid Infrastructure Grants during this first grant cycle. All 25 of these States plan to use a portion of their grant award in the study, implementation, or improvement of a Medicaid Buy-in program.
In addition, 19 of the States will use a portion of their grant award to study or improve Medicaid services designed to support the competitive employment of persons with disabilities. In order to highlight what States are doing with Infrastructure Grant funds in each of these two critical areas, the following examples are provided.
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