Medical Assistance for Workers with Disabilities (MAWD) Workers with Job Success (WJS) Cost-of-Living-Adjustment (COLA) Adjusted Gross Income Maximum Amount Changes for 2023, PMW-21198-316 (Published January 27, 2023)
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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:
Worker with a disability (category PW). Individuals in this group must:
Be at least age 16 but under age 65.
Be employed and getting paid.
Be disabled according to the Social Security Administration (SSA) or the DHS rules (except for earnings).
Have countable monthly income, after allowable deductions, below 250% of the Federal Poverty Income Guidelines (FPIGs).
Have countable resources of $10,000 or less.
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.
For an individual who appears to be eligible for MAWD and who did not apply specifically for MAWD or was not given MAWD information in the COMPASS application, the CAO will contact the individual, explain the program and premium requirement, and obtain their verbal consent prior to authorizing MAWD and narrate that consent was received.
For an individual who did apply for MAWD or was already given MAWD information in the COMPASS application, the individual is already aware of the program and its premium requirement. The CAO does not need to contact the individual prior to authorizing MAWD.
When in doubt as to whether the individual is aware of the MAWD program, the CAO will contact the individual prior to authorizing MAWD.
Worker with a medically improved disability (category PI). Individuals in this group must:
Meet the age, income and resource requirements of the worker with a disability group.
Work at least 40 hours a month and earn at least minimum wage.
Have a medically improved disability that no longer meets the SSA’s disability rules.
NOTE: The individual must continue to have a severe impairment, as determined by medical professionals.
Have received ongoing MA coverage in the workers with a disability group in the past and have had benefits discontinued because of medical improvement.
NOTE: Begin eligibility the month after coverage ends under the worker with a disability group. There cannot be a break in coverage.
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:
Individuals ages 55 and older who receive HCBS are subject to MA estate recovery requirements. The benefit of HCBS to MAWD enrollees is access to HCBS.
Resource limits are higher for MAWD than for other MA eligibility groups.
Individuals enrolled in MAWD with HCBS can earn more income and keep their HCBS services.
There may be a premium with MAWD and not with HCBS.
To be eligible for MAWD, an individual must:
Meet MAWD age and disability requirements.
Be employed.
Pay a premium.
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.
Age: The individual must meet the MAWD age requirement (age 16 through 64), as well as the age requirement for the appropriate HCBS program.
Disability: The individual must meet the disability criteria for MAWD and be functionally eligible for HCBS.
Employment: Individuals enrolled in MAWD must be employed (See Employment 316.22).
Premium: Individuals enrolled in MAWD must pay a monthly premium. The CAO must tell them about this rule.
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.
Resource limits: The CAO must use the MAWD resource eligibility limit of $10,000. Resources must still be counted if there are children under age 21 in the household.
Spousal resources: Spousal resources are counted under MAWD unless the spouse is receiving HCBS in a HCBS category. If the spouse is eligible for HCBS under the Special Income Limit (300 percent of the Federal Benefit Rate), the CAO will not count the spouse's resources.
Fair Consideration: Fair Consideration requirements do not apply for MAWD.
See Chapter 340.82 for Excluded Resources – SSI-Related.
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.
Income: Use the MAWD income eligibility guideline of 250 percent of the Federal Poverty Income Guidelines.
Spousal income: Spousal income is counted under MAWD unless the spouse is receiving HCBS in an HCBS category. If the spouse is eligible for HCBS under the Special Income Limit (300 percent of the Federal Benefit Rate), the CAO will not count the spouse's income.
Individuals age 55 and older are subject to the MA estate recovery requirements for the following types of services received:
Nursing Facility Care.
Home and Community-Based Services.
Any related hospital care and prescription drug services provided while receiving nursing facility care or care at home or in a community setting.
See the Long Term Care Handbook Chapter 403.11 Medical Assistance Estate Recovery Program for more information.
Individuals who are eligible for both MAWD and HCBS must meet MAWD rules for the following:
Eligibility period: The CAO must use a calendar month when determining the eligibility period. MAWD benefits are opened on the first day of the month and are closed on the last day of the month.
Renewal: Renewals are required every 12 months. The applicant must use the PA 600WD form for the yearly renewal for MAWD and HCBS services. Functional eligibility for HCBS does not need verified at each renewal.
MAWD or HCBS closure: When an individual’s eligibility for MAWD or HCBS ends (by choice or by eligibility requirements), review the case for continued MA eligibility under other categories.
MAWD and HCBS applications can be processed in e-CIS using the current PW and PI categories with the entry of the waiver code on the Waiver screen in e-CIS, identifying the individual's appropriate HCBS eligibility.
MA benefits: Adult and Children's health care benefit packages 1, 2, and 8 apply. HCBS services for the appropriate HCBS program is based on the entry of the waiver code.
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.
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.
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.
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.
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.
Each individual who is enrolled in MAWD receives a PA ACCESS card to show providers when obtaining medical services. MAWD includes the following benefits:
MA benefits provided by a managed care organization.
HealthCare Benefits Package (HCBP) coverage:
The Children’s HCBP is for individuals under age 21.
The Adult HCBP is for individuals ages 21 to 65 who do not have Medicare coverage.
Individuals ages 21 and over who have Medicare coverage are enrolled in Community HealthChoices (CHC) managed care.
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.
The CAO must verify the following:
Age: This can be verified through SDX.
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.
Disability: An individual's disability is verified if he or she gets SSI or Social Security Disability Insurance (SSDI) or is certified disabled by DHS’s Medical Review Team (MRT).
Employment
The CAO will not deny eligibility if proof is not received as long as the individual cooperates in providing the information needed.
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