316.1 General Policy for MAWD and MAWD/HCBS

Medical Assistance (MA) Recipients Who Become Eligible for Medical Assistance for Workers with Disabilities (MAWD) During the COVID-19 Emergency Must Not Owe a Monthly Premium, PMW20508316 (February 27, 2021)

Medical Assistance for Workers with Disabilities (MAWD) Premiums Must Not Be Increased During the COVID-19 Emergency Beginning January 1, 2020, PMW20084316 (July 30, 2020)

Medical Assistance for Workers with Disabilities (MAWD) Reinstatement for Individuals Who Self-Attest to Paying Premium During the COVID-19 Emergency,PMW19919316 (May 5, 2020)

Medical Assistance for Workers with Disabilities (MAWD) Premium Payments during the COVID-19 Emergency PMW19831316 (March 26, 2020)

 

Medical Assistance for Workers with Disabilities (MAWD) helps individuals with disabilities work while receiving MA coverage. Each individual receiving MAWD must pay a monthly premium to the Department of Human Services  (DHS).             

Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170)

Act 2001-77 of June 26, 2001 (P.L. 755)

MAWD gives benefits to individuals who meet the eligibility rules in the following groups:

      20 CFR Part 411

 

NOTE: Any Individual who is age 16 through 64, is disabled (or presumptively disabled), employed, and over the income and/or resource limits for other MA categories, including Home and Community Based Services (HCBS) must be reviewed for MAWD. The individual does not have to apply specifically for MAWD to be considered for the program.

 

 

         NOTE:  The individual must continue to have a severe impairment, as determined by medical professionals.

 

NOTE:  Begin eligibility the month after coverage ends under the worker with a disability group. There cannot be a break in coverage.

316.11 MAWD and Home and Community Based Services (HCBS)

HCBS is in-home, Long-Term Care services designed to help individuals with disabilities live independently in their homes and communities.

 

Individuals enrolled in MAWD can apply for HCBS, and those in HCBS programs can apply for MAWD. Individuals not enrolled in either MAWD or HCBS can apply for both.

 

NOTE: This applies to all HCBS for which individuals receiving MAWD can qualify. This does not include the Infants, Toddlers, and Families Waiver (for children birth through age 2).

 

Individuals must meet the functional eligibility requirements to be eligible for HCBS. The CAO will use category PW for individuals who are eligible for MAWD and HCBS.

 

The CAO must let individuals enrolled in MAWD know that they can apply for HCBS and that there are pros and cons to enrolling in MAWD, HCBS, or both. For instance:

 

 

To be eligible for MAWD, an individual must:

 

 

When an individual is functionally eligible for HCBS, the CAO must consider all other MA categories before authorizing MAWD because of the monthly premium that comes with MAWD.  If the functionally eligible individual is not financially eligible for a waiver category or other categories of MA but does meet the non-financial MAWD criteria the CAO will send the applicant the Supplement to the PA 600L which explains MAWD premiums and lets the applicant verify whether, if MAWD eligible, they want MA coverage and the monthly premium to begin the first day of the month in which the application was received or the first day of the following month.

 

MAWD recipients who are interested in receiving HCBS should be directed to contact the Intellectual Disabilities Services Customer Service Line at 1-888-565-9435 or by contacting their local County Mental Health/Intellectual Disabilities (MH/ID) Program Office or their local Area Agency on Aging.

 

When looking at resource and income limits for combined MAWD and HCBS eligibility, the CAO must use the MAWD resource and income limits to determine eligibility. (See Appendix A.)

Use the following guidelines in 316.111 when looking at disability for combined MAWD and HCBS eligibility.

316.111 Nonfinancial Eligibility

316.112 Resource Eligibility

HCBS participants enrolled in MAWD have a higher resource limit than HCBS participants enrolled in other MA groups. The CAO must tell HCBS program participants about this when they apply for MAWD.

 

See Chapter 340.82 for Excluded Resources – SSI-Related.  

316.113 Income Eligibility

HCBS participants enrolled in MAWD benefit from higher income limits than HCBS participants in other MA groups. The CAO must let HCBS individuals applying for MAWD know of the different limits.

316.114 MA Estate Recovery Requirements

Individuals age 55 and older are subject to the MA estate recovery requirements for the following types of services received:

 

See the Long Term Care Handbook Chapter 403.11 Medical Assistance Estate Recovery Program for more information.

316.115 Case Maintenance

Individuals who are eligible for both MAWD and HCBS must meet MAWD rules for the following:

316.116 E-CIS

316.12 How to Refer Individuals

Tell current HCBS enrollees who expect to be employed  about MAWD. HCBS program offices will let current HCBS individuals know about MAWD and refer them to the CAO when the HCBS individual or his or her representative would like to have a MAWD determination made by the CAO. HCBS program offices will have MAWD outreach information for individuals enrolled in the program, their families, and advocates
.

The Work Incentives Planning and Assistance (WIPA) program is another resource available to individuals interested in applying for MAWD. It is funded by the SSA. The WIPA program provides technical assistance to individuals with disabilities receiving SSI or RSDI who need assistance in understanding how earned income from employment affects benefits and how to access and manage work incentives.

The CAO must refer eligibility information for individuals who are already enrolled in MAWD or taking part in HCBS to the correct office (either the CAO, the Independent Enrollment Broker (IEB), or the HCBS provider). Individuals who are already enrolled in MAWD must fill out the supplement to the PA 600WD to apply for HCBS services. Individuals who are already in HCBS must complete the supplement to the PA 600L to apply for MAWD.

The IEB or HCBS provider will also make MAWD/HCBS referrals, and MAWD/HCBS applications will be generated by COMPASS.

316.13 How to Handle MAWD/HCBS Applications

The CAO must use the following procedures when handling MAWD/HCBS applications and referrals. The CAO will use category PW for individuals who are eligible for MAWD and HCBS.

316.131 Individual Enrolled in MAWD and Applying for HCBS

   When an individual applies for HCBS at the CAO, the CAO must follow these steps:

1. Explain the differences between MAWD requirements and HCBS requirements and review the information page.

2. Refer the individual to the right HCBS provider.

3. The HCBS provider will determine the individual’s functional eligibility and let the CAO know the decision. If the individual is functionally eligible, enter the correct HCBS code.

4. Update the case narrative to show combined MAWD/HCBS eligibility.

5. Send HCBS eligibility notices to the individual and the HCBS agencies.

When an individual uses COMPASS to apply for HCBS, the CAO must follow these steps:

1. Give the application to a CAO worker who handles HCBS to make sure that the HCBS provider received the information from the Health Care Services Information System.

2. Contact the applicant to explain the differences between MAWD requirements and HCBS requirements and to review the information page.

3. The HCBS provider will determine the individual’s functional eligibility and let the CAO know the decision. If the individual is functionally eligible, refer the individual to a CAO staff worker who handles HCBS.

4. Enter the appropriate HCBS code.

5. Update the case record to show that the individual has applied for combined MAWD/HCBS eligibility.

6. Send HCBS eligibility notices to the individual and the HCBS provider agencies.

When an individual applies for HCBS through the HCBS provider, the CAO must follow these steps:

1. After the HCBS provider contacts the CAO, review the information page with the applicant and explain the differences between MAWD requirements and HCBS requirements.

2. The HCBS provider will determine the individual's functional eligibility and let the CAO know the decision. If the individual is eligible, enter the correct waiver code, and update the case notes to show combined MAWD/HCBS eligibility.

3. Send HCBS eligibility notices to the individual and the HCBS provider agencies.

316.132 Individual Participating in HCBS and Applying for MAWD

The CAO must take the following steps whether the individual uses a CAO application, a COMPASS application, or an HCBS program office application:

           NOTE:  When an application is made through the HCBS provider, the provider will contact the CAO.

1. Refer the individual to the CAO worker who handles HCBS.

2. Follow existing HCBS steps to let the program office know about the MAWD application.

3. Review the information page with the applicant and explain the differences between MAWD requirements and HCBS requirements.

4. Explain that individuals receiving MAWD have to pay a premium.

5. Review MA eligibility to determine whether the individual is still eligible for the current category or for another MA category. If the individual is eligible for HCBS under MAWD only, proceed  to step 6.

6. Authorize the MAWD category without entering any waiver information.  If the waiver code is entered during authorization then eCIS will fail the waiver category due to excess income or resources.  

7. Send the system generated notice of MAWD eligibility.

8. Through case maintenance enter the appropriate waiver information on the Waiver and Long-Term Living screens.

9. Run eligibility. After running eligibility in maintenance, the case should remain open in the MAWD category.

10. Send a notice of eligibility for payment of HCBS to the individual; the Independent Enrollment Broker or assessing agency listed on the HCBS Eligibility/Ineligibility/Change form, PA 1768; and to the Power of Attorney or other representative.

11.Update the narrative to show combined MAWD/HCBS eligibility.

 

316.133 New Applications

The CAO must take the following steps whether the individual uses a PA 600 WD MAWD application, a COMPASS application, or a PA 600 L Long-Term Services and Supports application:

 

1. Determine the individual’s eligibility for MA. If the individual is eligible, open the case in the correct MA category.

 

NOTE: An individual applying for HCBS must be authorized in a waiver category if eligible. Only when the individual is not eligible in a waiver category should MAWD eligibility be reviewed.

 

2. Follow existing CAO HCBS steps to let the program office know about the application. If the individual’s case is open in MAWD, proceed to step 3. If not, follow existing HCBS steps.

3. Review the information page with the applicant and explain the differences between MAWD requirements and HCBS requirements.

 

 NOTE: Explain that individuals receiving MAWD have to pay a premium.

 

4. The HCBS provider will determine the individual’s functional eligibility and let the CAO know the decision. If the individual is eligible, enter the correct HCBS code.

5. Update the notes in the case record to show combined MAWD/HCBS eligibility.

6. Send MA eligibility notices to the individual and the HCBS provider agencies.

7. Send HCBS eligibility notices to the individual and the HCBS provider agencies.

316.14 Benefits

Each individual who is enrolled in MAWD receives a PA ACCESS card to show providers when obtaining medical services. MAWD includes the following benefits:

 

 

 

Payment of the Medicare Part A and Part B premiums, if the individual is also eligible for Healthy Horizons Cost Sharing Benefits.

 

NOTE:  Healthy Horizons is also known as Qualified Medicare Beneficiaries (QMBs).

 

Payment of the Medicare Part B premium, if the individual is also eligible for Specified Low Income Medicare Beneficiaries (SLMB). (Chapter 319, Healthy Horizons.)

 

NOTE:  Individuals who are eligible for MAWD and also meet the income and resource limits for Qualifying Individuals Group 1 (QI-1) cannot receive both MA services under MAWD and payment of the Medicare Part B monthly premium. The CAO must ask the individual which MA program they would prefer to receive.  

Payment of group health insurance benefits provided by employers by the Health Insurance Premium Payment Program (HIPP), if DHS decides it is cost-effective. ( Section 338.22 for information about HIPP.)

Reminder: Individuals are automatically referred to HIPP based on answers to insurance and employment questions in e-CIS.

 

NOTE:  MAWD eligible individuals who need accessible public transit beyond the terms of the Americans with Disabilities Act may be eligible for  transportation at a reduced rate. This service is provided under the People with Disabilities (PwD) program.

316.15 Verification

The CAO must verify the following:

NOTE:  Documentation of date of birth is not required if it has been proven and noted before. If there is a problem with information provided, proof of age is required within 30 days.

 

 

The CAO will not deny eligibility if proof is not received as long as the individual cooperates in providing the information needed.

20 CFR Part 411

Act 2001-77 of June 26, 2001 (P.L. 755)

Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170)

 

Updated March 10, 2021, Replacing August 30, 2018