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If the beneficiary would only be eligible as MAD/MAB/HCWD, a referral to DDS is required. Use the DDS referral form, DHB-4037 form for HCWD referrals.

2. MAB Cases When the local agency discovers that the beneficiary is no longer considered blind, refer to instructions in C.1. above.

E. Employment

1. Basic Coverage Group

Employment means being engaged in a substantial and reasonable work effort which is defined as the following:

a. Working in a competitive and inclusive work setting for a wage or salary, or being self-employed,

(1) Competitive means that the job was held open to the general public.

For example, a handyman who is hired by a neighbor to do a chore is not engaged in competitive employment. They may be self-employed if they meet that criteria.

(2) Inclusive means that the job is not in a sheltered workshop setting. Generally, those who work as staff in a sheltered workshop are not working in a “sheltered workshop setting.” Evaluate the beneficiary’s responsibilities to determine if their position is “sheltered.”

(3) Self-Employed has the same meaning as it is defined in MA- 2250, Income policy.

b. Being able to provide proof of payment of payroll taxes through FICA, or the equivalent.

For example, self-employed individuals who have not filed tax forms may submit alternative proof such as a business ledger, or similar documentation that shows that the business is operational.

2. Medically Improved Coverage Group

a. Employment

For a beneficiary to be considered “employed” for purposes of Medically Improved Group eligibility they must meet the Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4