2664 Working Healthy (WH)

Medical coverage is available to persons with disabilities who have earned income and who meet the requirements of this section. Coverage for this group is provided under authority of the Ticket to Work and the Work Incentives Improvement Act of 1999 (TW-WIIA) and is available beginning July 1, 2002.

Persons eligible for Working Healthy do not have a spenddown, however a premium may be required as noted below. The full Medicaid benefit package is available to those eligible and persons are not subject to managed care. A referral to the HIPPS program per 2912 is required for all program participants.

Persons must also meet Social Security’s disability criteria. Because of this, all persons potentially eligible for Working Healthy also meet categorical criteria for other Medicaid programs (Medically Needy/spenddown, SI, QMB, etc.). It is most often in the client’s best interest to be found eligible under the Working Healthy program as opposed to the regular medically needy (or spenddown) group. When processing a medical application for an employed person, coverage must first be considered under Working Healthy. However, if the Medically Needy determination results in no spenddown, the client is placed in Medically Needy/spenddown, not Working Healthy. If a premium would be required, the individual must agree to pay the premium prior to enrolling in Working Healthy including premiums for prior months.

Coverage under the limited Medicare Savings Programs (QMB and LMB) must be considered as well and would not be impacted by the decision to enroll in Working Healthy. Persons eligible for coverage as an SSI recipient, including deemed recipients such as those eligible under the 1619(b) provisions, are not eligible for Working Healthy as they shall remain covered under the SI program.

Working Healthy recipients are not eligible for HCBS per 8200 , however, personal services may be available through the WORK program (see 8400 ). Persons entering a nursing facility for a period exceeding the temporary stay criteria of 8113 are not eligible for Working Healthy coverage. Ongoing eligibility for a current Working Healthy recipient entering one of these living arrangements must be determined using the provisions applicable. A new application is not required.

To support persons with disabilities currently working or wishing to work, regional Benefits Specialists are located throughout the state. Because increased income or assets can result in the loss or reduction of other benefits (e.g., Section 8 housing), persons must understand the impact increased earnings will have on these other benefits. Benefits Specialists are available to provide this type of service and planning. They have been trained in the various state and federal programs and are a key piece to successful employment. The Benefits Specialists will also be able to discuss any personal care services (attendant care) available to the individual and make appropriate referrals for such services. To ensure that all Working Healthy eligibles are aware of the service, a referral to the regional Benefits Specialist shall be made for every person working or expressing interest in employment. The decision to cooperate with the Benefits Specialist shall not impact eligibility under the Working Healthy group.