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If the individual is self-employed, net earnings from self-employment (NESE) must be demonstrated through documentation of Internal Revenue Service (IRS) filings, quarterly estimated taxes, business records, and/or business plans. The individual’s signed allegation of self-employment is acceptable if no other evidence of NESE can be obtained. Follow the policy in M0820.220 to determine NESE.

2) The income limit for unearned income remains less than or equal to 138% of the FPL. The policy for determining countable unearned income is contained in subchapter M0830.

3) Any increase in an enrollee’s Social Security Disability benefits resulting from employment as a MEDICAID WORKS participant OR because of a COLA adjustment to the Social Security Disability benefits will not be counted as long as the increase is regularly deposited upon receipt into the individual’s WIN account.

4. Income Exceeds 138% FPL at Eligibility Determination Spenddown does not apply to the Medicaid Works covered group. Therefore, admission into MEDICAID WORKS is not available to individuals whose income exceeds 138% of the FPL. Evaluate the individual’s eligibility in all other Medicaid covered groups.

G. Safety Net Resources held in the WIN Account that are accumulated from the enrollee’s earnings while in MEDICAID WORKS will be disregarded up to the 1619(b) threshold amount for this eligibility determination.

If found eligible and enrolled in another Medicaid covered group, the individual shall have a “safety-net” period of up to one year from MEDICAID WORKS termination and enrollment in another group to dispose of these excess resources before they are counted toward ongoing eligibility. If the individual resumes working within the safety-net period, he may be re-enrolled in MEDICAID WORKS provided that all eligibility requirements are met, except that the resources in the WIN Account are disregarded up to the 1619(b) threshold amount. If the individual wishes to be re-enrolled in MEDICAID WORKS after the one-year safety net period, any resources retained in the WIN Account remain exempt. Resources accumulated while in MEDICAID WORKS and retained in an IRS approved account described in M0320.400 D. 2. b. 2) that has been designated as a WIN Account are excluded in all future Medicaid determinations for former MEDICAID WORKS enrollees.

H. Benefit Package

Individuals enrolled in MEDICAID WORKS are entitled to the standard benefits available to full-benefit Medicaid enrollees (see Chapter M18). Medicaid Works members cannot be enrolled in Developmental Disabilities (DD) waivers or CCC Plus waivers, but the waiver slot will be held for up to six months if a DD Waiver recipient wants to try transitioning to Medicaid Works. Waiver slots are not held for CCC Plus recipients since there is no waiting list for CCC Plus waiver services. Participants can receive personal care services as a service provided by the assigned MCO plan. No medical screening is required, and MEDICAID WORKS enrollees do not have a patient pay responsibility. Intensive Behavioral Dietary Counseling is also covered for MEDICAID WORKS enrollees when a physician determines that the service is medically necessary.