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requirements:

(4) Have gross earnings at least equivalent to those of an individual who is working 40 hours per month at minimum wage.

or

(5) Be actively engaged in a self-employment activity and have earnings after operational expenses at least equivalent to those of an individual who is working 40 hours per month at minimum wage.

b. Voluntary Loss of Employment

If a beneficiary in the Medically Improved Group voluntarily stops their employment, evaluate for eligibility in all other programs. If MAD is the only program in which they may be eligible, a disability determination by DDS is necessary. See section VII below for involuntary loss of employment.

F. Income

HCWD has varying income limits that determine eligibility and/or cost sharing. These limits are:

• Those who have unearned incomes greater than 150% of Federal Poverty Level (FPL) are not eligible for HCWD. • Those whose total countable income is equal to or less than 150% of FPL have no cost sharing (other than applicable co-payments).

• Those whose total countable income is greater than 150% of FPL must pay a $50 annual enrollment fee.

• Those whose total countable monthly income exceeds 200% of FPL must pay a monthly premium in addition to the enrollment fee. The monthly premium increases as income increases until countable income exceeds 450% of FPL, at which point the applicant/ beneficiary (a/b) must pay a full premium. The countable income determines whether the a/b is subject to cost-sharing and the amount thereof, countable income must be determined and all applicable exclusions applied.

Refer to MA-2252, Non- MAGI Medicaid Income/Reserve Limits chart.

Note: The a/b is to have work expense exclusions for the blind and impairment-related work expense exclusions for the disabled. Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4