§ 108A-54.1. Medicaid buy-in for workers with disabilities.
§ 108A‑54.1. Medicaidbuy‑in for workers with disabilities.
(a) Title. This actmay be cited as the Health Coverage for Workers With Disabilities Act. TheDepartment shall implement a Medicaid buy‑in eligibility category aspermitted under P.L. 106‑170, Ticket to Work and Work IncentivesImprovement Act of 1999. The Department shall establish rules, policies, andprocedures to implement this act in accordance with this section.
(b) Definitions. Asused in this section, unless the context clearly requires otherwise:
(1) "FPG"means the federal poverty guidelines.
(2) "HCWD"means Health Coverage for Workers With Disabilities.
(3) "SSI"means Supplemental Security Income.
(4) "Ticket toWork" means the Ticket to Work and Work Incentives Improvement Act of1999.
(c) Eligibility. Anindividual is eligible for HCWD if:
(1) The individual is atleast 16 years of age and is less than 65 years of age;
(2) The individual meetsSocial Security Disability criteria, or the individual has been enrolled inHCWD and then becomes medically improved as defined in Ticket to Work and asfurther specified by the Department. An individual shall be determined to beeligible under this section without regard to the individual's ability toengage in, or actual engagement in, substantial gainful activity as defined insection 223 of the Social Security Act (42 U.S.C. § 423(d)(4)). In conductingannual redetermination of eligibility, the Department may not determine that anindividual participating in HCWD is no longer disabled based solely on theindividual's participation in employment or earned income;
(3) The individual'sunearned income does not exceed one hundred fifty percent (150%) of FPG, andcountable resources for the individual do not exceed the resource limit for theminimum community spouse resource standard under 42 U.S.C. § 1396r, and asfurther determined by the Department. In determining an individual's countableincome and resources, the Department may not consider income or resources thatare disregarded under the State Medical Assistance Plan's financialmethodology, including the sixty‑five‑dollar ($65.00) disregard,impairment‑related work expenses, student earned‑income exclusions,and other SSI program work incentive income disregards; and
(4) The individual isengaged in a substantial and reasonable work effort (employed) as provided inthis subdivision and as further defined by the Department and allowable underfederal law. For purposes of this subsection, "engaged in substantial andreasonable work effort" means all of the following:
a. Working in acompetitive, inclusive work setting, or self‑employed.
b. Earning at least theapplicable minimum wage.
c. Having monthlyearnings above the SSI basic sixty‑five‑dollar ($65.00) earned‑incomedisregard.
d. Being able toprovide evidence of paying applicable Medicare, Social Security, and State andfederal income taxes.
TheDepartment may impose additional earnings requirements in defining"engaged in substantial and reasonable work effort" for individualswho are eligible for HCWD based on medical improvement.
Individualswho participate in HCWD but thereafter become unemployed for involuntaryreasons, including health reasons, shall have continued eligibility in HCWD forup to 12 months from the time of involuntary unemployment, so long as theindividual (i) maintains a connection with the workforce, as determined by theDepartment, (ii) meets all other eligibility criteria for HCWD during theperiod, and (iii) pays applicable fees, premiums, and co‑payments.
(d) Fees, Premiums, andCo‑Payments. Individuals who participate in HCWD and have countableincome greater than one hundred fifty percent (150%) of FPG shall pay an annualenrollment fee of fifty dollars ($50.00) to their county department of socialservices. Individuals who participate in HCWD and have countable income greaterthan or equal to two hundred percent (200%) of FPG shall pay a monthly premiumin addition to the annual fee. The Department shall set a sliding scale forpremiums, which is consistent with applicable federal law. An individual withcountable income equal to or greater than four hundred fifty percent (450%) ofFPG shall pay not less than one hundred percent (100%) of the cost of thepremium, as determined by the Department. The premium shall be based on theexperience of all individuals participating in the Medical Assistance Program.Individuals who participate in HCWD are subject to co‑payments equal tothose required under the Medical Assistance Program. (2005‑276, s.10.18(a); 2006‑66, s. 10.9(a); 2007‑144, s. 2; 2009‑451, s.10.69.)