What is MED
Works:
MED Works
is a work incentive
that went into
effect in July 2001.
For individuals who
have more income
than the
SSI federal benefit
rate,
such as
SSDI beneficiaries, or
individuals on SSI
whose earnings
exceed the Indiana
threshold for
1619b
protection, MED
Works allows these
individuals to keep
their
Medicaid
coverage and
continue to work.
Many people on MED
Works will pay a
small
premium
(depending on their
income), which is
much less than
a
spend-down
would have been had
the individual
remained on
traditional Medicaid. With MED Works,
individuals may
accumulate more
resources
to work towards
self-sufficiency.
MED
WORKS PROGRAM RULES
On July 1, 2002,
Indiana implemented
MED Works
(this is Indiana’s
Medicaid Buy-In
program for working
people with
disabilities). As a
result, persons with
disabilities no
longer face
automatic
termination of their
health care benefits
under
Medicaid
or have a Medicaid
spend-down
just because they
obtain employment or
their employment
income increases
over the
Substantial Gainful
Activity (SGA)
limit of $1000 (this
is the 2011 SGA
level) .
To be eligible for
MED Works,
individuals must:
-
be age 16-64,
-
meet Indiana’s
income
and
resource
guidelines,
-
meet Indiana’s
Medicaid
definition of
disability
regardless of
their employment
status
Most MED Works
members will be
those currently on
Medicaid. However,
new applicants can
be found eligible as
well. Based on an
individual’s income,
they may pay a
Medicaid
premium
to receive coverage.
The premiums are
generally much lower
than the Disability
spend-down
amount. Individuals
enrolled in MED
Works have the same
coverage for
services and
co-payments
as individuals
enrolled in regular
Medicaid.
Section 1619b of the
Social Security Act:
For people who are
Supplemental
Security Income (SSI)
beneficiaries who go
to work, there is a
part of the Social
Security Act called
section
1619b
that mandates
Indiana to continue
providing Medicaid
coverage (without a
spend-down)
to individuals who
were receiving SSI
and because of their
earnings, their SSI
cash payments have
stopped. To qualify
for Medicaid under
section 1619b,
individuals must:
-
Meet or fall
below
established
resource
levels
($1,500-individual
or
$2,250-couple),
-
Have been
eligible for
Medicaid
coverage the
month prior to
becoming
employed,
-
Need Medicaid in
order to
continue
working. This
means they will
still have unmet
medical needs in
spite of their
earnings.
Section 1619b is a
Social Security law.
When an individual
reports their
earnings to the
Social Security
Administration, and
because of their
earnings their SSI
check has stopped,
the Social Security
Administration (SSA)
office will record
1619b into the
recipient’s Social
Security record.
Social Security will
transfer information
about eligibility
for 1619b
electronically into
the Indiana Medicaid
computer system. A
working SSI/Medicaid
recipient should go
to the local
Division of Family
Resources (DFR)
office to also
report their
earnings and ensure
that the 1619b
designation has been
recorded with the
DFR office to
protect their
Medicaid when their
SSI check stops due
to earnings.
Indiana has a
maximum amount of
money that a person
can make and still
fit in 1619b status.
In 2010, that amount
is $32,930. If
gross earnings are
above this amount,
the individual is no
longer eligible for
1619b Medicaid
protection. The
individual may be
eligible for another
work incentive
called
MED Works.
