Medical Assistance for Employed Persons with Disabilities: An Important Work Incentive

Since 1999, through federal legislation called the Ticket to Work and Work Incentives Improvement Act, Minnesota has offered a work incentive for individuals with disabilities who are employed. This optional Medicaid buy-in program is called Medical Assistance for Employed Persons with Disabilities (MA-EPD). MA-EPD promotes competitive employment and the economic self-sufficiency of people with disabilities. It does this by assuring continued access to Medical Assistance (MA) for necessary health care services when people with disabilities go to work. MA-EPD allows working people with disabilities to qualify for MA under higher income and asset limits than regular MA.

To qualify for MA-EPD, a person must be:

1. certified disabled by either the Social Security Administration (SSA) or the State Medical Review Team (SMRT). To request a SMRT review, a person may contact their local county human service agency.

2. at least 16 but less than 65 years of age.

3. employed and have Medicare and Social Security taxes withheld or paid from earned income.

4. have average monthly earnings of more than $65.

5. meet the asset limit of $20,000. Some assets that do not count towards the limit include homestead property, personal items, spouse’s assets, one motor vehicle if used by enrollee, retirement accounts, and medical expense accounts set up through an employer.

Participants in the program must pay a monthly premium to be on MA-EPD. Premiums are based on a sliding fee scale or a minimum of $35, whichever is greater. Income and household size are used to calculate the premium. There is no maximum income limit or maximum premium amount for MA-EPD. In addition to the monthly MA-EPD premium, people who have unearned income, such as Social Security Disability (SSDI), must pay one-half percent of their unearned income. The Department of Human Services (DHS) has developed a web site that will assist in estimating MA-EPD premium costs. The web site is located at http://www.nasmd.org/disabilities/minnesota/Premium_Estimator.htm

The 2003 Minnesota Legislature made several policy changes to the MA-EPD program. They included the following:

Changes in Payment of Medicare Part B Premium (Effective November 1, 2003): The Medicare Part B premium is paid or reimbursed only for enrollees whose gross income is not more than 200 percent of the federal poverty guideline, currently $1,552 for an individual, and $2,082 for a 2-person household.

Unearned Income Obligation (Effective January 1, 2004): In addition to the MA-EPD premium, enrollees with unearned income, such as Social Security Disability (SSDI or RSDI) must pay a monthly “unearned income obligation” equal to one half percent of their gross unearned income. To calculate the monthly unearned income obligation, multiply the total unearned income amount by .005. For example, a person with $400 of unearned income per month would have a monthly unearned income obligation of $2, in addition to the monthly premium.

Minimum $35 Premium (Effective January 1, 2004): Everyone enrolled in MA-EPD must pay a minimum premium of $35 or a sliding fee premium, whichever is greater, based on their income and household size.

Job Loss Grace Period (Effective January 1, 2004): Enrollees are allowed to remain enrolled in MA-EPD for up to four months after losing their job, if the job loss is not related to their work performance.

$65 Earned Income Disregard (Effective with six-month or annual renewals after July 1, 2004): To be considered employed, an individual must work and have earned income each month. For every enrollee, the first $65 of earned income is not counted to meet the earned income requirement for the program. To be eligible for MA-EPD, a person must have average monthly wages of more than $65. A self-employed person must have average, monthly countable self-employment income (gross receipts minus business expenses) of more than $65 to be eligible.

Medicare and Social Security Taxes (Effective with six-month or annual renewals after July 1, 2004): To be considered employment for MA-EPD, Medicare and Social Security taxes must be withheld from wages or paid from self-employment income. Enrollees who are self-employed and have not yet filed taxes may be given additional time to provide tax information. State and federal income taxes must be withheld or paid only if required by the Internal Revenue Service (IRS).

Local county human service agencies review income, employment, asset and other household information to determine eligibility for MA-EPD. Applications for MA-EPD are available at all local county human service agencies and may be downloaded from the internet at http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3417-ENG.

For more information about MA-EPD, please contact your local county human service agency or the Department of Human Services at 651-297-7139 or email: beth.grube@state.mn.us.

How is MA-EPD working for the more than 6000 people currently on the program? Pathways to Employment, funded by Minnesota’s Infrastructure Grant at the Department of Human Services, is doing an evaluation of the MA-EPD program. As part of this evaluation, DHS contracted with Wilder Research Center to conduct a telephone survey of MA-EPD enrollees to find out about their experiences with the MA-EPD program and further explore barriers to employment. Next month we will highlight the MA-EPD survey results.

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