Purpose: This section will assist in determining eligibility for Employed Individuals with Disabilities (EID).

Current Policy Effective Date: January 1, 2022

Date Last Reviewed:

Previous Policy: October 1, 2013

POL M1003: DETERMINING ELIGIBILITY FOR EMPLOYED INDIVIDUALS WITH DISABILITIES (EID)

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Be Age 16 Through 64

3. Applicants Must Be Disabled

Individuals are considered disabled if they are receiving disability benefits from SSA or are determined disabled by WDH.

4. Applicants Must Be Employed

Applicants must have documented proof of employment. This verification should include a current statement indicating hours worked, amount earned, and contain an employer signature or a signed employer statement specifying applicant is on medical leave. Refer to Medicaid Table 5B .

Employment must be verified every year, or more often when changes occur.

5. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard. Refer to Medicaid Table 1A for the income standards. Refer to Section M901 to determine if income is countable.

Earned income is exempt when determining eligibility for this program. Earned income is used when calculating the premium.

6. Benefits Begin First Day Of The Application Month If Determined Eligible

7. Clients May Receive Retroactive Medicaid

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.

Premiums for retroactive months must be paid prior to approving retroactive benefits.

8. Applicants Do Not Have Resource Test

9. Waiver Clients May Be Eligible For EID

Clients of Comprehensive and Support or ABI Waiver programs, losing eligibility due to increased earned income or excess resources, may be eligible under EID. These clients will retain their waiver benefits.

10. Clients Pay Premium Based On Gross Monthly Income

Clients will pay a monthly premium based on 7.5% of gross monthly income. Allow a $50 deduction from monthly unearned income.

11. Applicants Under Age 19 May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility or for 12 months from the last periodic review.

12. Clients Must Be Reviewed

Clients must be reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

13. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client does not pay premium, except clients under age 19. Client is no longer employed. Client dies. Client determined no longer eligible. Client fails to pay premium. Client turns age 65. Client does not complete review.