Intro 0:00 [musical interlude] Joe Murphy 0:17 Welcome to Networks for Training and Development's Employment for All podcast. I am your host, Joe Murphy. This podcast is dedicated to real work and real pay for all citizens. Welcome back to Episode Three of the Benefits Planning podcast. If you have missed any previous episodes, please feel free to go back and listen at your convenience. We are again being joined by Suzanne Erb of Networks for Training and Development and Martine DeLorenzo from Disability Rights PA. Suzanne Erb 0:52 Hi Martine, Suzanne Erb here. Glad to see you again. This week we're going to be talking about Medicaid or medical assistance. So what is Medicaid? And what do I need to know about it? Martine DeLorenzo (Disability Rights Pennsylvania) 1:10 Hi, Suzanne. So Pennsylvania's Medicaid program, also known as medical assistance, provides comprehensive health coverage for vulnerable populations and people with limited income. In addition to providing health coverage, Medicaid is the only program that covers long term services and supports at home, in a nursing facility or in a group home. Suzanne Erb 1:36 So who exactly can get Medicaid? Martine DeLorenzo (Disability Rights Pennsylvania) 1:41 So Medicaid is... used to only be available to narrow groups like low income children, adults with disabilities, but in 2015, Pennsylvania adopted the Medicaid expansion under the Affordable Care Act. So children and adults can also qualify for coverage based solely on having limited income, you don't have to have a disability. So the coverage ensures access to care. So people of all ages and abilities can live healthy and full lives. Suzanne Erb 2:13 So that means that a lot of people with disabilities really should be paying attention to Medicaid, right? Martine DeLorenzo (Disability Rights Pennsylvania) 2:21 Absolutely. Absolutely. It is usually the first insurance that you would have. Children are covered by it through a loophole in Pennsylvania, luckily. All states don't do that. Medicaid is is a federal program, but it is delivered by the states. So different states have different rules. And Pennsylvania does cover children with disabilities, right? And then when they are become 18, there's a redetermination for those services and then they could possibly still get Medicaid as adults, but it is the go to insurance for people with disabilities in the state. Suzanne Erb 3:00 Well, that's great to know. So who who administers it? And who should I contact if I'm having a problem? Martine DeLorenzo (Disability Rights Pennsylvania) 3:08 Hmm. So the state administers the Medicaid. We call it medical assistance here. You are going to contact DHS. You can go on the DHS website, which is the Department of Human Services at www.dhs.pa.gov. You can get information there. You can also call the county assistance office. There's a Change Center phone number, which is the number for the state. It is 1-877-395-8930 you can contact those that number and they will explain to you how to apply for Medicaid. But you can also call those numbers for other benefits such as SNAP, but that is the go to place for the county assistance office question. The offices are closed to the public right now because of the pandemic, but they're available by telephone. If you have a problem, you can also call the Change Center. If you're having a problem with your Medicaid uh, aside from that, you can also call the Health Law Project. The phone number for Health Law Project is 800-274-3258. They're there on Monday, Wednesday and Friday from 8am to 8pm if you have problems with your Medicaid or your application. Suzanne Erb 4:53 Oh, that's good. What, I've heard this batted around a little bit what is 1619(b)? Martine DeLorenzo (Disability Rights Pennsylvania) 5:02 So I'm glad you asked 1619(b) is a work support offered by Social Security. After you return to work, your Medicaid coverage can continue, even if your earnings, either alone or in combination with your other income become too high for your SSI cash payment. So you qualify if you meet all of the following requirements: you were eligible for an SSI cash payment for at least one month, you would be eligible for the cash payment except for your earnings, you are still disabled, you still meet all the other eligibility rules including the resource tab, you need Medicaid in order to work and then you have gross earned income that is insufficient to replace your SSI, your Medicaid, and any publicly funded attendant care. That means like waivers you might have, okay. So if you cannot replace those things, your replace your insurance, replace your SSI payment and replace your attendant care, there's a threshold that they use. And if you're underneath that, you get the Medicaid, once you hit that threshold number, you can apply for an individual threshold so that you can maintain your Medicaid. But 1619(b) allows you to work and still continue to have insurance. The biggest fear that people have is not really losing their SSI check if they're making enough money to replace that check. So if you're making enough money, and you don't need the check anymore, you won't have the check, but you will maintain your Medicaid. If you are working, and you get a letter saying, that you're going to lose your Medicaid, I encourage you to contact your CWIC, because we can help you navigate that issue because you should not be losing your Medicaid because you aren't working. Suzanne Erb 7:20 Hmm. Is Is there a specific threshold amount that I should know about? Martine DeLorenzo (Disability Rights Pennsylvania) 7:29 Yes. Every state has a different threshold amount. In Pennsylvania, that is $38,719 annually. So if you are earning less than that, you can maintain your Medicaid. They get the threshold amount by multiplying twice the annual State supplementation rate, they multiply that by the Federal benefit rate plus 85 times 12. Then they average the per capita Medicaid expenses by state. And then it's a very complicated way to get to this, but that's where they come up with the threshold amount. But every state is different. And you don't need to know how they come up with that amount, you really just need to know that that is the amount in Pennsylvania that you can earn before you lose your Medicaid. However, if you are earning that much, you might be able to still keep your free Medicaid. Because you might have things called Impairment Related Work Expenses. Or if you're blind, you might have what they call Blind Work Expenses. They're also known as IRWEs or BWEs. So these things are items that maybe you need to be working. Right. Like maybe you pay extra money for transportation, or you have medical expenses that aren't covered by your insurance, things that you have to pay for out of pocket in order to work can be used to lower your countable income. Remember that they don't use your full income. They subtract work incentives from that, you automatically get to work incentives that add up to $85 of which they don't count your earnings. And then there may be other things like IRWEs or BWEs that they can also not count, which could lower your countable income so that you still are eligible for free Medicaid. Suzanne Erb 9:51 Wow, okay, that that's really good to know. But what if I reached the point where I'm I'm really making significantly more than that and I've included even with including my IRWEs or BWEs, I'm still above that threshold. Is there anything I can do? I've heard a little bit about MAWD, but I don't really know much about it. Martine DeLorenzo (Disability Rights Pennsylvania) 10:24 Okay, so there are two things you could do. The first thing I'm going to tell you about is the individual thresholds. So suppose you have a waiver (and a lot of people have waivers in the state and are working) that individual threshold can subtract the cost of your waiver from your earnings so that you can continue to keep your waiver and to keep your earnings and to keep your Medicaid. So you want to talk to your CWIC about requesting an individual threshold if you have a waiver, because you can earn more than that $38,000. Right. But suppose you don't have a waiver, and you really are earning a significant amount of money. That's where the Medical Assistance for Workers with Disabilities, also known as MAWD, M-A-W-D, enters the picture. Medical Assistance for Workers with Disabilities, lets Pennsylvanians with a disability take a job, earn more money, still keep their Medicare medical coverage, and home and community based services, which are waiver services. So MAWD allows you to earn more and still be eligible for your medical assistance benefits, including your waiver. Suzanne Erb 11:56 And what how do I go about getting this? Martine DeLorenzo (Disability Rights Pennsylvania) 11:59 So, you will have to apply for it. In order to be eligible, you have to be at least 16 and under 65 years old, you're employed, you're getting paid, you have a disability that meets Social Security Administration standards, you have countable and earned and unearned income below 250% of the federal poverty level (that changes every year), you can have up to $10,000 in countable resources... you're going to put this application in with the Department of Human Services, which is DHS, which is the state. Okay. You might get an application for this, if you start working, and you are getting SSI. But again, if you are not earning more than $38,000, please contact your CWIC. We can help you with this because you don't need to apply for MAWD. You might need to apply for MAWD later on though. Right? So you would also apply for MAWD through the State's website. Your, your payment for MAWD is based on 5% of your countable income. So that's 5% of your countable income. So again, they do exclusion. And then they base your payment on that. So your payments are typically not terribly high. It is a reasonable amount of money in order for you to pay to have medical assistance, if you want to continue that. Suzanne Erb 13:44 Wow, that's really good to know. Is there anything else you think I need to know that we haven't covered today? Martine DeLorenzo (Disability Rights Pennsylvania) 13:54 There might be. I think we should talk more about are IRWEs and BWEs and other work incentives that might help you lower your countable income so that you can keep your benefits intact if you need them. Suzanne Erb 14:08 How about if we talk about that next week? Martine DeLorenzo (Disability Rights Pennsylvania) 14:12 That sounds like a great idea. Suzanne Erb 14:15 Thank you guys so much for dropping by and look forward to our next podcast, when we'll be discussing IRWEs and BWEs. Martine DeLorenzo (Disability Rights Pennsylvania) 14:26 You're welcome. Joe Murphy 14:32 Thank you for listening. We hope the information we provided was useful. If it was please subscribe to our podcast channel. You can find all information about Networks for Training and Development at our website www.networksfortraining.org Transcribed by https://otter.ai