Effective: June 1, 2011
21.40 - MA-EPD Income Calculation
MA-EPD Medical Assistance for Employed Persons with Disabilities. Program which provides MA coverage to certain employed disabled people who would not otherwise be eligible. does not calculate income for the same purpose as other MA programs. There is no income limit for MA-EPD. The gross monthly income is used to calculate the MA-EPD premium amount. All MA-EPD enrollees are required to pay a monthly premium of at least $35.
Exception: An American Indian who has provided verification of American Indian status is exempt from paying a premium for MA-EPD.
MA vs. MA-EPD.
Calculating the MA-EPD Premium Amount.
MA-EPD Calculation Examples.
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MA vs. MA-EPD
A determination of regular MA eligibility is essential in order to determine if MA-EPD is the better alternative to regular MA.
Situations when regular MA may be a better alternative include:
l MA without a spenddown.
l MA with a monthly spenddown amount lower than the MA-EPD premium amount.
l MA with a spenddown greater than the MA-EPD premium, when the spenddown is satisfied with existing unpaid medical bills.
To compare regular MA to MA-EPD you must:
1. Determine the regular MA eligibility and whether or not the client has a spenddown. See MA Method B Income Calculation.
2. Determine the MA-EPD premium amount.
3. Compare the monthly premium amount to the client’s spenddown obligation amount to determine which has a lower cost to the client.
Note: Use the premium calculator on the MA-EPD webpage of Disability Benefits 101 website to determine an approximate MA-EPD premium amount.
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Calculating the MA-EPD Premium Amount
Average the income when calculating the premium amount to get a consistent MA-EPD premium amount throughout the certification period (except for retroactive months).
To determine the premium amount for a MA-EPD client, follow these steps:
1. The premium amount is based on the client’s gross earned and unearned income. Determine what income to consider in the premium calculation.
l Do not count excluded or unavailable income.
l Exclude the spouse’s income.
l Count the income of biological or adoptive parents who live with a 16 or 17 year old client.
l Use actual income received in retroactive months.
l Use average anticipated income for the current and future months of a certification period.
For current and future months calculate the average anticipated monthly income for clients with varying income in one of the following ways:
a. Total the varying income amounts for the certification period and divide by the number of months in the certification period.
b. Total the varying income received. Divide by the number of checks used in the total to find the average check amount. Then multiply the average check amount by how often the client is paid. If paid:
m Every two weeks (biweekly) multiply by 2.16.
m Weekly multiply by 4.3.
c. FIAT the income on the MAXIS EBUD panel.
Note: When people perform work every month and are paid once per month, there is no need to average the income over the six-month certification period.
2. Total all monthly gross earned income.
Note: Gross earned income is the total of gross wages and countable (net) self-employment income.
Rebecca applies for MA-EPD in October and requests eligibility be determined back to July. She is paid every two weeks and verifies the following income:
l July paycheck totals of $820 and $790.
l August paycheck totals of $770 and $790.
l September paycheck totals of $780 and $800.
Use actual income for July ($1,610), August ($1,560) and September ($1,580).
Determine the average monthly income by totaling the verified paychecks ($4,750) and dividing by the number of checks (6). The average check amount is $791. Multiply the average check amount by 2.16 because Rebecca is paid bi-weekly. Her monthly average income is $1,708 which is the amount of earned income budgeted for October, November and December.
Rebecca’s premium will fluctuate for the first three months of the certification period but will be consistent for the remainder of the months of the certification period.
John works part time at a convenience store and is paid weekly. He is also a member of his town's council, for which he receives payment quarterly, or twice in a six-month period.
Average the council income over the six-month certification period and combine it with the convenience store income to arrive at a consistent monthly premium.
If John's only employment was attending quarterly council meetings, he would only be considered employed in the months he attends meetings, and the entire payment would be counted in the month received.
3. Total the unearned income of the client.
MAXIS calculates the Unearned Income Obligation (UIO) An amount added to premiums for MA-EPD clients who have unearned income. The UIO is .005 (one-half of one percent) of the unearned income. of 1/2 of 1% of the gross unearned income. This amount is automatically added to the monthly premium amount.
Yvonne has a premium of $42 based on her earnings. Her gross unearned income is $800.
MAXIS determines her UIO is $4 ($800 x .005 = $4) each month and adds this amount to her premium invoice. Her total premium is $46.
4. Determine the MA household size. See MA Household Size Exceptions.
5. Enter client’s income amounts in MAXIS to determine the premium amount.
l For instructions on how to code MAXIS, see POLI/TEMP TE04.01 and TE4.02.
l The minimum monthly premium for all enrollees is $35.
6. See Premiums, for information regarding the process of billing MA-EPD premiums and changes to premiums.
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MA-EPD Calculation Examples
Amanda is certified disabled by SMRT and lives with her husband Dave, who is not disabled. She receives earned income of $2,500 per month. Dave has earned income of $1,000 per month.
To determine the MA-EPD premium amount, use only Amanda’s income of $2,500. Use a household size of two because Dave is not requesting or receiving MA-EPD. Enter Amanda’s income in MAXIS to determine the actual premium amount.
Ben has earned income of $900 per month and is receiving RSDI of $800 per month based on a disability. He is also receiving services through the BI waiver. Ben lives with his wife Dena who has earned income of $3,500 a month.
To determine the MA-EPD premium amount use only Ben’s income and a household size of two. Enter Ben’s income in MAXIS to determine the actual premium amount.
Note: If Ben is not eligible for MA-EPD but is still eligible for the BI waiver, use a household size of one when determining eligibility for regular MA.
Shannon and Matt, a married couple, apply for MA-EPD. Shannon is self-employed as an in-home day care provider with net income of $625 per month. She receives RSDI of $800 per month based on disability. Matt has earned income of $3,000 per month and is certified disabled by SMRT. They have joint assets of $25,000, or $12,500 each, which is within the $20,000 asset limit for each spouse.
Shannon and Matt will have their premium amounts calculated separately.
To determine the MA-EPD premium amount for Shannon use only Shannon’s income and a household size of one.
To determine the MA-EPD premium amount for Matt, use only Matt’s income and a household size of one.
Enter the information for each person separately into MAXIS which will determine the premium amount.
Note: If Shannon and Matt had a mutual child in the home, eligibility would be continue to be determined separately for Shannon and Matt using only their own income but with a household size of two.
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