Medical Assistance for Employed Persons with Disabilities

2.3.5.1.3 Work Requirements

A person must be employed to be eligible for Medical Assistance for Employed Persons with Disabilities (MA-EPD). This policy describes specific employment requirements for MA-EPD.

Employment Income

A person must have earned income greater than $65 per month on average for the six-month period used at application and renewal from wages or self-employment earnings to be eligible. For wages, earned income is monthly average gross income. For self-employment income, earned income is net earnings from self-employment, which is the gross income minus all expenses the Internal Revenue Service (IRS) allows as a self-employment expense.

Seasonal self-employment is counted only in the months in which the person is engaged in work activity.

Social Security and Medicare taxes must be withheld from wages. State and federal income taxes need only be paid or withheld if the person earns enough to be required to pay those taxes. A person with self-employment earnings must pay Social Security and Medicare taxes at least annually. Quarterly estimated state and federal income taxes must be paid if the person earns enough to be required to pay those taxes.

A person cannot retain MA-EPD eligibility or become eligible for MA-EPD simply by filing self-employment taxes. Self-employed people generally must:

work for themselves rather than for an employer
be responsible for their own work schedule
not be covered under an employer's liability insurance or Workers' Compensation
pay Social Security and Medicare taxes

The following are not considered employment income for MA-EPD:

Gratuitous money allowances
Honoraria or stipends that only reimburse expenses or do not have Medicare and Social Security taxes withheld or paid annually
Payments for participation in a clinical trial
Payments for the sale of blood or blood plasma

Individuals with two sources of employment income, one source that has taxes withheld and one source that does not, are eligible for MA-EPD. The gross monthly earnings from which taxes are withheld must exceed $65.

Verification of Employment Income

Employment income must be verified at application, at six months, and at renewal. See MA-EPD Mandatory Verifications for more information

Only verification of employment income is required when the premium is recalculated at six months. Verification of assets is not required unless the enrollee reports a change in assets. See MHCP Change in Circumstances for more information

Medical Leave or Job Loss Extension

MA-EPD enrollees must receive employment income or must engage in self-employment activities each month unless they meet specific medical leave or job loss criteria. However, medical leave and job loss provisions do not pertain to the month of application or in any retroactive month. An MA-EPD applicant must be employed at application and during any retroactive months.

MA-EPD enrollees are still considered employed if they change jobs and receive no paychecks for one month because of different pay periods in each job.

Four-Month Medical Leave

An MA-EPD enrollee may maintain eligibility, without earnings, for up to four calendar months due to a verified medical condition.

A physician’s statement is necessary to verify the need for medical leave before continuing coverage under MA-EPD.
The four-month medical leave begins the month after the enrollee is unable to work.
The four-month medical leave ends the last day of the fourth month in which the enrollee is unable to work, even if the physician's statement states the enrollee is expected to be unable to work for more than four calendar months.

Four-Month Job Loss

An MA-EPD enrollee may maintain eligibility, without earnings, for up to four months due to job loss that was not caused by or attributed to the enrollee. Situations that would allow a four-month extension include, but are not limited to, layoffs due to lack of work or business closing.

Verification of the reason the enrollee became unemployed is required before continuing coverage under MA-EPD.
The four-month job loss leave begins after the enrollee stops working or receives the last paycheck, whichever is later.

MA-EPD enrollees who become unemployed for reasons attributable to them, such as poor work performance, discharge for misconduct, or resignation for reasons other than medical leave, are not eligible for the four-month extension.

Employees who become unemployed while on medical leave from their jobs may remain enrolled for four additional months following the month in which they are terminated or laid off.

There is no annual limit on the number of times the MA-EPD medical leave or job loss extensions can be used. The enrollee must return to work between leaves and meet all requirements. Enrollees who remain eligible for MA-EPD due to the four-month job loss extension may not extend eligibility with a medical leave without returning to work between leaves.

Enrollees must continue to pay MA-EPD premiums during the four-month medical leave or job loss extension.

Legal Citations

Minnesota Statutes, section 256B.057, subdivision 9