Income eligibility will be determined in a two-step process. Only the income of the disabled individual will be used to determine eligibility. Any income of the spouse or children will be disregarded.

Step 1 –

First determine the amount of unearned income for the individual. Only individuals with unearned income under the SSI/SPA will be eligible in this category. SSI exclusions and disregards (Re: [MS 3348]-3348.1) will be allowed. Total all unearned income for the individual and subtract the $20.00 general exclusion. If the resulting amount is under the SSI/SPA for an individual, proceed to the second step. If the resulting amount is over the SSI/SPA, deny the application.

Step 2 –

Determine the individual’s gross monthly earnings. If there was no unearned income, subtract the $20.00 general exclusion from the earned income. Deduct $65.00 plus ½ of the remaining gross earnings. Add the net unearned income, if any, and remaining net earnings to determine countable income. Compare the total to 250% of the federal poverty level for the individual’s family size. If the income falls below the 250% level, the individual is eligible. (Refer to the [FPL chart at Appendix F] for current amounts.)

Family, in this category, is defined as the applicant, his/her spouse, and the minor children, natural or adoptive, of either spouse. To be included in the family unit, children must be under 18 years of age and reside in the home of the disabled individual.

Countable resources are determined according to LTC guidelines (Re. [MS 3330]-3333) with certain exceptions. A second car can be disregarded as a resource if it is used by the spouse to maintain employment. There will be no penalty imposed for the transfer of resources; and all funds held in retirement accounts, including private retirement accounts such as IRAs and other individual accounts and employer-sponsored retirement plans such as 401(K) plans, Keogh Plans and employer pension plans will be disregarded as resources.

Only the resources of the individuals and the spouse will be counted. Although children are included in the standard, their resources are not counted. Countable resources are compared to twice the MNRL for the family size.

An "approved account" can be established by the disabled individual and be used to enhance independence and increase employment opportunities. Funds in the approved account, up to an established maximum, are disregarded in the resource calculation (Re. [MS 28040]).

Household Size             Resource Limit

1 (Individual)                   $4000

2 (Individual & Spouse) $6000

3                                       $6200

4                                       $6400

5                                       $6600

6                                       $6800

NOTE:  Add $200 for each additional family member.

An approved account may be used to save for any expense that will enhance an individual’s independence and/or increase employment opportunities. The account must be kept separate from all non-exempt accounts such as regular savings and checking accounts. Up to $10,000.00 of an approved account can be disregarded as a countable resource. Interest generated on an approved account will not be counted as income. If the interest generated causes the approved account to exceed $10,000.00, or the approved account otherwise exceeds $10,000.00, the amount in excess of $10,000.00 will be counted toward the resource limit for the individual’s family size.

If an individual declares a checking account, savings account, or cash at the time of application, he/she will be given the opportunity to designate all or part of the funds as an approved account. If the individual designates only a portion of the funds as an approved account, he/she should be given a written notice via the DCO-700 with instructions to separate the account and provide verification of the new account within 10 days. If the funds designated for the approved account are not deposited into a separate account, they will be counted as a resource.

Some approved expenditures follow:

Educational Expenses-Expenditures for training to enhance employment and independent living skills which include tuition, fees, books and other related expenses.

Work–Related Expenses-Expenditures for job accommodations, equipment, service animals, computer software and hardware, business capital, tools and other related expenses.

Home Purchase/Modification-Costs of acquiring, constructing, modifying or reconstructing a residence to meet the needs of the disabled individual.

Transportation-Cost of acquiring, modifying, maintaining or repairing a motor vehicle to be used by the disabled individual, or an immediate family member, on his/her behalf. The cost of insurance for the vehicle is also included.

Medical Expenses-Medically related expenditures, including dental bills, not covered by Medicaid or other insurance, and Medicaid co-pays.

Assistive Technology and Related Services-Expenditures for assistive technology devices, which include any item, piece of equipment, product system, or assistive technology service that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. The term "assistive technology service" means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. These services include:

1. The evaluation of the assistive technology needs of an individual with a disability, including a functional evaluation of the impact of providing the appropriate assistive technology and services to the individual in his/her customary environment.
2. Services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices, and services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices.
3. Coordination and use of necessary therapies, interventions, or services associated with education and rehabilitation plans and programs.
4. Training or technical assistance for the disabled individual, or where appropriate, the family members, guardian or authorized representative of the individual.

When establishing the approved account, the individual must state in writing the intended purpose of the account. The signed statement must include the projected cost of the item(s) or services for which they are saving. If at any time the individual has no intended use for the money in the account, or the intended use is for items that do not meet the definition of an approved item, the account will become a countable resource.

At each re-evaluation, the County will review the approved account history for the past year. The individual must provide receipts for any expenditure from the account. If the individual has accessed the account and used the money for a non-approved reason, the amount withdrawn will be considered unearned income in the month withdrawn. A new signed statement of intended use must be provided at each re-evaluation.

In the case of qualified emergencies, funds may be withdrawn and used for living expenses if there is a hardship on the family caused by such instances as extended illness, loss of employment, natural disasters, or similar events beyond the control of the individual.

Recipients of Medicaid for the Working Disabled with gross income under 100 percent of the Federal Poverty Level for their family size (Re. [FPL chart at Appendix F] for current amounts) will be subject to the usual Medicaid co-pays. Recipients with gross income equal to or greater than 100 percent of the FPL will be assessed co-payments at the point of service for medical visits and prescription drugs according to the following schedule:

1. Physician’s visits - $10.00;
2. Prescription drugs - $10.00 for generic, $15.00 for brand name;
3. Inpatient Hospital – 25% of the first day’s Medicaid per diem rate;
4. Orthotic appliances, prosthetic devices, durable medical equipment & augmentative communication devices – 10% of the Medicaid maximum allowable reimbursement rate;
5. Occupational, physical and speech therapy, & private duty nursing - $10.00 per visit, with a cap of $10.00 per day.

After certification, any increases in income that cause the individual to exceed 100% of the FPL, will not be processed until the next reevaluation. If the individual reports a decrease in income that puts him under the 100% FPL, his income will be adjusted when reported to reflect the lower co-payment amounts. Any increase in co-payments determined at reevaluation will require a 10-day advance notice. A DCO-700 will be sent and the changes keyed after the notice is up.

Applications for the Working Disabled will be made on form DCO-777, "Application for Assistance, Long Term Care and Other AABD Categories", by the individual requesting assistance, or his/her authorized representative, at the DHS County Office located in the individual’s county of residence.

In instances where disability is already established, the County Office will have 45 days to dispose of the application by approval, denial, or withdrawal. When eligibility must be established by MRT, 90 days will be allowed for processing.

If an applicant does not meet all of the eligibility requirements for Working Disabled, the application will be denied.

The caseworker will record the pertinent information stating the reason for denial; complete the denial data on the application form and notify the applicant of the denial by DCO-700 or DCO-55 (system generated notice).

If an individual wishes to withdraw the application, the caseworker should obtain a signed statement from the applicant stating that he/she wishes to withdraw the application. The procedures for denying an application will then be followed.

Eligibility will begin on the date of application unless retroactive coverage is needed. If retroactive coverage is needed, and eligibility is established for a retroactive period, eligibility can begin up to 3 months prior to the date of application; but in no case can coverage be authorized before February 1, 2001.

Medicaid eligibility for the Working Disabled will be re-evaluated annually by the County Office. The application form and all other forms required at initial application will be completed. If the individual has an approved account, the County will review the account history for the past year, and a new statement of intended purpose for the account will be obtained.

An MRT disability re-determination may or may not be necessary at re-evaluation. If a re-examination by MRT is necessary, it will be indicated on the DCO-109. Individuals that did not require an MRT decision initially due to loss of SSA or SSI in the previous year will require an MRT determination at the first re-evaluation.

When a change occurs that affects eligibility, or an increase in the cost sharing (Re: [28045]), a ten day advance notice of action will be given unless advance notice is not required (Re. [MS 3633]). Case closure will be effective the date the notice expires.