Page 6
5
1610.25.00 RCAP ELIGIBLE INDIVIDUALS (MED 1) This category is identified in IEDSS as MA R.
To be eligible for Residential Care Assistance Program-related Medicaid, an individual must:
• Be approved for Room and Board Assistance (RBA). • Be aged, blind, or disabled. The aged, blind, and disabled requirements for RCAP- related Medicaid are the same as those for RCAP.4 • The full range of Medicaid covered services is available to recipients in the MA R category. 1610.26.00 EMPLOYEES WITH DISABILITIES (MED 1) MEDWorks – Medicaid for Employees with Disabilities – consists of two categories identified in IEDSS as MADW and MADI.
A federal law known as the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIA) added two new optional Medicaid categories designed to remove barriers to employment for persons with disabilities by providing access to health care. Effective July 1, 2002, Indiana’s Medicaid Program was expanded to cover these categories with the enactment of P.L. 287-2001.
MADW is the basic MEDWorks category for individuals who meet the Medicaid definition of disability without regard to the person’s employment. MADI is the medically improved category for persons who lose eligibility in the basic category because of an improvement in their medical condition which although is not a medical recovery, is improved to the extent that the Disability definition for the basic category is no longer met.5
To be eligible, individuals must be aged 16-64. Depending on their income, some MEDWorks members must pay premiums. All members pay the regular Medicaid co-payments. 1610.30.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) This category is identified in IEDSS as MA L. To be eligible in this category an individual must be entitled to Medicare Part A.6 There is no other blindness or disability requirement for the QMB category. Medicaid coverage under QMB is limited to payment of the following:7
• The monthly premium for Medicare Part B • The monthly premium for Premium Hospital Insurance under Medicare Part A for individuals not entitled to free Part A • Medicare Parts A and B deductibles and co-insurance.