*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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03.30.20 - MA for Employed Persons With Disabilities (MA-EPD) |
Archived: June 1, 2016 (Previous Versions) |
Medical Assistance for Employed Persons with Disabilities (MA-EPD) is a work incentive health care program that provides MA coverage to employed people with disabilities between the ages of 16 and 64. People eligible for MA with a spenddown who are certified disabled by SSA or SMRT may qualify for MA-EPD if they go to work. People on MA-EPD may also be on a home and community-based (CAC, CADI, BI or DD) waiver program.
Note: For MA-EPD, consider people to be age 16 beginning with the month of their 16th birthday, and under age 65 through the month of their 65th birthday.
For a client-friendly overview of MA-EPD eligibility requirements, see the MA-EPD flier (DHS-3532).
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow the disabled guidelines.
The earliest possible date of eligibility is the first day of the month three months before the month of application.
l Eligibility cannot be approved until the initial premium is paid.
l Applicants who request retroactive coverage must pay the premium for a retroactive month before coverage can be approved for that month.
l Applicants can choose which month(s) they pay for. Eligibility can only be granted for months that are paid.
Example:
Nina applies for MA-EPD in June and requests retroactive coverage back to March. When she receives the initial premium notice, which includes March, April, May, June, and July, she does not want to pay all five months. Since she did not have medical bills in April or May, she chooses only to pay for March, June and July. Her eligibility is opened and closed for April and a new span is entered for June ongoing.
l Applicants who are American Indians and have provided verification of American Indian status are not required to pay a premium for MA-EPD and can be approved effective the month of application and for any retroactive months they request when all other eligibility criteria have been meet. See MA-EPD Premium exemption for American Indians.
Renewals (standard guidelines)
Follow standard MA guidelines.
Note: Do not require monthly reports of income. MA-EPD enrollees must report changes in income and employment status within ten days.
For MA-EPD, people must be certified disabled by the Social Security Administration (SSA), the State Medical Review Team (SMRT), or by the county case manager as eligible to receive services through the DD waiver.
Refer people to SMRT who have no current disability certification. Indicate on the Determination of Disability form (DHS-1467A) that the person is applying for MA-EPD. This includes:
l People whose Supplemental Security Income (SSI) or Retirement, Survivors, and Disability Insurance (RSDI) application is pending or being appealed.
l People who are not eligible for RSDI because they earn more than the substantial gainful activity (SGA) level.
l People whose Supplemental Security Income (SSI), Retirement, Survivors, and Disability Insurance (RSDI), or 1619(a) or 1619(b) benefits are terminated.
Note: Do not refer people who are in non-pay status for RSDI; they continue to be certified disabled by SSA during the period of non-pay status.
l People who have extended Medicare but who are no longer receiving RSDI. Some people may remain disabled but lose RSDI because they earn more than the substantial gainful activity (SGA) level. These people are eligible for a Medicare extension for up to 93 months. Because SSA considers them to remain disabled, they continue to meet a disabled basis of eligibility for MA. Do not refer them to SMRT until two months before the Medicare extension ends.
l For MA-EPD only, SMRT will determine disability without regard to the person’s earnings level.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Follow standard MA guidelines.
People who are eligible for Medicare must enroll as a condition of MA-EPD eligibility, regardless of their income level and the amount of the Part B premium.
l Approve MA-EPD for Medicare eligibles who failed to enroll. Require them to enroll during the next general enrollment period (January-March of each year) as a condition of continued eligibility.
l Reimburse Part B premiums retroactive to the date of MA-EPD eligibility for enrollees who meet both of the following:
n Have income no greater than 200% FPG. Do not deem spousal income when calculating income for Part B premium reimbursement.
n Are not eligible for the Qualified Medicare Beneficiary (QMB) or Service Limited Medicare Beneficiary (SLMB) programs. Deem spousal income for QMB and SLMB eligibility.
See MA-EPD and Medicare.
Household Composition (standard guidelines)
Determine the household size as you would for any MA applicant or enrollee.
Exceptions:
l For married couples who both apply for MA-EPD, use a household size of one, plus children, for each spouse.
l For people receiving services through a home and community-based waiver program (CAC, CADI, BI, or DD) use the standard MA household size instead of the waiver household size.
See MA-EPD Premiums for more information.
Count only the MA-EPD applicant or enrollee’s income.
Exception: If a child ages 16 or 17 lives with one or both biological or adoptive parents, deem parental income.
Use the regular MA household size and income to determine eligibility for the Medicare Savings Programs for MA-EPD enrollees.
Eligibility Method (standard guidelines)
Generally, use Method B for income and assets, unless noted otherwise in this section.
The asset limit is $20,000.
l Follow standard MA asset guidelines.
l In addition to all other Method B asset exclusions, exclude:
n Retirement accounts.
n Medical expense accounts set up through an employer, including Health Savings Accounts (HSA).
n Spousal assets, including the spouse’s share of jointly held assets.
Note: There is no asset limit for children under 21, regardless of their basis of eligibility.
When an MA-EPD enrollee stops working for any reason, continue to apply the MA-EPD asset rules and $20,000 asset limit when determining regular MA eligibility for up to 12 months after the person loses MA-EPD status.
Note: This does not apply to MA-EPD enrollees who reach age 65 and lose MA-EPD eligibility. Apply the standard Method B asset guidelines with 10-day notice in those cases.
Income Guidelines (standard guidelines)
There is no upper income limit for MA-EPD. MA-EPD enrollees must receive earned income from employment or self-employment. To be considered employment for MA-EPD:
l Average monthly earned income must be above $65.
l Medicare, Social Security and applicable state or federal income taxes must be paid or withheld from earnings.
See MA-EPD Employment Definition for further information.
Computing varying income for MA-EPD differs slightly from the usual MA guidelines in order to maintain consistent premiums.
None.
Spenddowns/Premiums (standard guidelines)
All MA-EPD enrollees have monthly premiums based on a sliding scale or a minimum of $35, whichever is greater.
Exception: An American Indian who has provided verification of American Indian status is exempt from paying a premium for MA-EPD. See MA-EPD Premium Exemption for American Indians.
MA-EPD enrollees with unearned income also have an unearned income obligation of one-half of one percent of the unearned income, in addition to the monthly premium.
Clients who work and are on MA with a spenddown who have a disabled (DX) or blind (BX) basis of eligibility may be eligible for MA-EPD and have a premium that is lower than their spenddown.
To see approximate premium amounts, go to www.dhs.state.mn.us/id_052165.
Follow standard MA guidelines.
Follow the disabled guidelines. MA-EPD enrollees are excluded from managed care but may voluntarily enroll in a Special Needs Basic Care (SNBC) plan, if eligible.
The following groups are not eligible for MA-EPD:
l SSI recipients.
l People with 1619a or 1619b status.
Note: People who are terminated from SSI, RSDI or 1619(a) or 1619(b) benefits because of excess income, assets or other non-disability factors may be eligible for MA-EPD if they meet all other eligibility factors.
l People who reside in a Group Residential Housing (GRH) facility, are ineligible for GRH, and have their MA spenddown fully met with remedial care costs.
l People who reside in a long-term care facility and are expected to remain for at least 30 consecutive days.
Send a SIR webmail message to dhs.made@state.mn.us when MA-EPD eligibility ends so the premium billing will be stopped.
Do not interrupt the six-month certification period if eligibility changes from MA-EPD to MA under another basis.
Relationship to Other Groups/Bases (standard guidelines)
People may not be eligible for MA-EPD concurrently with the following:
l Elderly Waiver (EW) and Alternative Care (AC). These waivers are limited to people age 65 or older.
Exception: QI and MA-EPD may overlap only when a QI enrollee requests retroactive coverage for MA-EPD. If MA-EPD eligibility will continue, close QI for the first month for which you can give 10-day notice.
Exception: MA-EPD may overlap with non-federally funded MinnesotaCare when a MinnesotaCare enrollee has MA-EPD eligibility approved.
m Close MinnesotaCare for the first available month after approving MA-EPD.
m Do not charge MA-EPD premiums for the months of overlap.
l Refugee Medical Assistance (RMA).
l Qualified Working Disabled Adult (QWD).
People who are otherwise eligible for MA-EPD while residing in an Institution for Mental Diseases (IMD) may be eligible for program IM.
MA-EPD may not be the right choice for all employed people with disabilities. Determine eligibility under another MA basis first, keeping in mind:
l People with net countable incomes equal to or less than 100% FPG qualify for MA without a spenddown if they meet all other eligibility requirements.
l All MA-EPD enrollees must pay premiums.
Allow people who qualify for another MA basis and MA-EPD to choose between them.
People may be eligible for MA-EPD concurrently with QMB and SLMB. To be eligible for QMB or SLMB, MA-EPD enrollees must meet all the eligibility requirements of those programs, including deeming of spousal income and assets.