WWD and Private Health Insurance—Scenario

John is a gainfully-employed individual with a disability, and he has healthcare coverage under Worker with Disabilities (WWD), North Dakota’s Medicaid buy-in program. He pays a premium of $80 per month for the WWD coverage. John’s employer recently told John that John has worked for the business long enough, and is working enough hours, to qualify for coverage under the employer’s health insurance plan. John’s share of the premium for this coverage would be just $40.00 per month.

Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.

The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.

Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.

John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.

Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.



Any questions may be directed to: rsi5@srt.com

WWD Income Limits

Workers with Disabilities Coverage

My colleague Mark Mehlhoff wrote a nice synopses regarding calculating income when applying for the WWD. What follows is a condensed version. Please email either Mark or I for the full document complete with examples, alternate thresholds and POMS references.

Terry Peterson

Income Limit for Workers with Disabilities Coverage

Workers with Disabilities (WWD) coverage is a work incentive available in North Dakota for individuals with disabilities. It allows eligible individuals with disabilities who are gainfully employed to “buy into” Medicaid health care coverage by paying a monthly premium.

To be financially eligible for WWD, the income of an individual and of his/her family must be less than 225 percent of the federal poverty level. This converts to a current income level of $1,914 per month for a unit of one person. The income level will be $1,950 per month for a one-person unit effective April 1, 2008.

Certain disregards and deductions are subtracted from gross income to arrive at net income for WWD purposes. The income deductions that are allowed in determining eligibility for WWD include the following:

A deduction of $20 per month subtracted from any income, but first from unearned income.
Deductions of $65, plus one-half of the remaining monthly earned income, both subtracted from gross earned income.

Example

Earl is a single person, and he resides alone in his house. He receives Social Security Disability Insurance benefits in the amount of $1,100 per month. Earl is currently employed and earns $935 per month. His gross income is therefore $2,035 per month. After applying the income deductions, his net income is just $1,515 per month, and he is therefore eligible for WWD.

Any questions may be directed to: rsi5@srt.com

Workers With Disabilities Coverage....KNOW IT!!

Workers With Disabilities (WWD) coverage (also referred to as the Medicaid Buy-In) could be the most powerful work incentive for people with disabilities in the state.

This work incentive - for individuals - could mean access to hundreds of dollars per month and Medicaid coverage.

For professionals that work with individuals with disabilities that may qualify for this program - not being familiar with it and its impact is a significant and detrimental oversight both professionally and ethically.

In short, WWD allows workers with disabilities who currently pay a Recipient Liability, an option of buying into the Medicaid system at a fraction of the cost.

Here is some more detailed info: WWD

Any questions may be directed to: rsi5@srt.com