February 7, 2007 The Medicaid Buy-In Program: MEDICAID WORKS dmas.virginia

1. February 7, 2007The Medicaid Buy-In Program:MEDICAID WORKShttp://www.dmas.virginia.gov

2. Medicaid Buy-In and Medicaid Infrastructure Grant • Authorized under the Balanced Budget Act of 1997 and the Ticket to Work and Work Incentives Improvement Act of 1999 • Purpose of the Medicaid Infrastructure Grant (MIG) is to support people with disabilities in securing and sustaining competitive employment in an integrated setting by targeting improvements to the State’s Medicaid program

3. Medicaid Buy-In Program • 2006-2008 biennial budget amendment authorized DMAS to establish a Medicaid Buy-In through a State plan amendment

4. Legislative Requirementsfor the Medicaid Buy-In At time of enrollment: • Current Medicaid recipient, or • Meet the income, asset and eligibility requirements for the Medicaid-covered group for individuals who are blind or disabled and have incomes that do not exceed 80% of the Federal Poverty Level ($681/mo. in 2007) Buy-In shall: • Include cost sharing provisions • Implement on January 1, 2007

5. Overview MEDICAID WORKS(Medicaid Buy-In Program) Eligibility Requirements: • Disabled • Employed or have letter from employer • 16 through 64 years of age • Current or new Medicaid recipient who meets the income, asset and eligibility requirements for the Blind and Disabled 80% Federal Poverty Level (FPL) covered groups • Does not apply to Medically Needy or LTC

6. “Disabled” Requirement • Current enrollment in SSI or SS programs • A previous finding of disability by the Disability Determination Services (DDS) unit at Department of Rehabilitative Services for Medicaid purposes • Applicants without SSA or DDS documentation of disability must be evaluated by DDS

7. Must be “Employed” or “Working” • Applicant/enrollee must be engaged in competitive employment in an integrated setting and receive compensation at or above the minimum wage from which payroll taxes are withheld (documentation required). • If self-employed, earnings must be demonstrated through documentation of IRS filings, quarterly estimated taxes, business records and/or business plan.

8. Eligibility Requirements • Complete the MEDICAID WORKS Agreement • Establish “Work Incentive” (WIN) accounts at a bank or other financial institution to deposit earned income and keep financial resources in order to remain eligible for Medicaid • Submit payment of a premium, if required

9. MEDICAID WORKS Agreement I, print enrollee name , want to enroll in MEDICAID WORKS, the work incentive plan for individuals with disabilities through the Virginia Medicaid program. I understand that this is a voluntary option and that I may leave the plan at any time and return to regular Medicaid coverage if I continue to meet the eligibility requirements for another Medicaid covered group. I know that I must be employed to be enrolled in MEDICAID WORKS and that a monthly premium payment may be required to continue to participate in this plan. I understand that I must establish at least one Work Incentive (WIN) account at a bank or other financial institution to be eligible for this work incentive plan and that I must deposit all earned income into a WIN account. Through the WIN account, I can have earnings of up to $40,905 (in 2007). If I am going to save some of my earnings, I must keep it in a WIN account, where I can save up to $27,577 (in 2007). I agree to the above requirements for MEDICAID WORKS and to inform my eligibility worker about changes that may affect my coverage, including but not limited to, change of address, change in employment or loss of employment. I further agree to provide any required documentation regarding my employer, employment status, earned income and WIN account(s). _______________________ _____- -______ Print Full Name Social Security Number _______________________ ________________ Signature Date

10. Enrollment in MEDICAID WORKS Prospective enrollment only – no retro

11. Upon Enrollment • Earned income in WIN account of up to 200% of Federal Poverty Level ($20,420 in 2007) • Medicaid methodology for determining countable income • Assistance unit of one • Gross earnings up to $40,905 • Resources from earnings in WIN account up to annual SSI threshold ($27,577 in 2007) for Virginia • Exclude amounts in IRS-approved accounts

12. Upon Enrollment • Monthly premium payment waived for first six months of program (1/1/07-6/30/07) • When implemented, premiums on a sliding scale • Safety net • Allow 6 months continued coverage if unemployed due to unavoidable employment interruptions

13. Upon Enrollment • Safety net continued • Resources in WIN account disregarded in evaluation for other covered groups • If eligible and enrolled in another group, enrollee has one year to dispose of excess resources • Amounts in IRS-approved accounts established as WIN accounts disregarded in all future Medicaid determinations

14. MEDICAID WORKSProgram Status Program implemented 1/1/07 with local Departments of Social Services accepting applications. http://www.dmas.virginia.gov