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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2180

HEALTH COVERAGE FOR WORKERS WITH DISABILITIES

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REVISED 4/30/26 – CHANGE NOTICE 05-26 I. Introduction to Health Coverage for Workers with Disabilities

The federal Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 offers states the option to protect Medicaid coverage for workers with disabilities. People with disabilities are often discouraged from working for fear that their earnings would make them ineligible for Medicaid. TWWIIA offers state Medicaid programs options to expand Medicaid eligibility criteria for workers with disabilities.

II. Background

North Carolina is authorized to provide Medicaid for disabled/blind workers under the Health Coverage for Workers with Disabilities Act (G.S. 108A-54.1). Health Coverage for Workers with Disabilities (HCWD) provides an incentive for people with disabilities to go to work or to increase their hours of work while protecting their Medicaid eligibility.

HCWD covers blind or disabled workers age 16 through 64 regardless of total countable income or CAP status. However, there is a limit on unearned income of 150% of the federal poverty level. The resource limit is the minimum community spouse resource allowance. Refer to MA-2231, Community Spouse Resource Protection policy. HCWD beneficiaries are entitled to full Medicaid coverage under Medicaid for the Blind or Visually Impaired (MAB) or Medicaid Disabled (MAD). Beneficiaries aged 16 through 20 are also entitled to additional services provided under Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Refer to MA-2905, Medicaid Covered Services policy. HCWD consists of two groups, the Basic Coverage Group and the Medically Improved Coverage Group.

III. COVERAGE GROUPS

A. Basic Coverage Group The Basic Coverage Group consists of beneficiaries aged 16 through 64 who, except for engaging in substantial gainful activity, would meet the Social Security/ Supplemental Security Income (SSI) disability criteria, or who do not engage in substantial gainful activity but are over income and/or reserve for regular MAD. Refer to MA-2525, Disability policy.

B. Medically Improved Coverage Group

1. The Medically Improved Group consists of beneficiaries aged 16 Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4