October 2006 Newsletter
Volume 6, Number 2
Personal Assistance Services Available Soon for Working
Healthy Participants
By May Ellen O'Brien Wright, Working Healthy Program Director
The Kansas Health Policy Authority (KHPA) is excited to announce that it has
received approval for a State Plan Amendment that will provide personal assistance
services
for Working Healthy enrollees who need those services to live and work independently.
As part of the Ticket-to-Work and Work Incentives Improvement Act (TWWIIA), states
receiving Medicaid Infrastructure Grants awarded by the Centers for Medicare
and Medicaid Services (CMS) are required to “offer personal assistance
services statewide inside and outside the home to the extent necessary to enable
an individual to be engaged in full-time employment.” Kansas meets this
requirement through Home and Community Based Services (HCBS) Waivers with one
exception: Working Healthy enrollees cannot receive services through an HCBS
Waiver.
Following effort on the part of SRS, and later KHPA, including the submission
of a Medicaid State Plan Amendment in August 2002, the submission of an 1115
Independence Plus Demonstration application in August 2003, nearly three years
of negotiation with CMS, and the submission of a second Medicaid State Plan Amendment
in June 2006, KHPA was finally able to obtain CMS approval utilizing a new option
available under the Deficit Reduction Act of 2005 (DRA).
Using this new option, KHPA submitted a third Medicaid State Plan Amendment in
August 2006. Via the “Flexibility in Benefits – Benchmark Package” available
under Section 6044 of the Deficit Reduction Act, KHPA has created a benefit plan
that includes all of the state’s regular state plan services plus personal
assistance services for employed adults with developmental disabilities, physical
disabilities, and traumatic brain injuries who are eligible to enroll in Working
Healthy. The “benchmark benefit package” also includes assessment,
independent living counseling, and assistive services.
There are several unique features to the new package of services. Personal assistance
services will be offered using a “cash model,” allowing participants
to handle funds and purchase their services directly. Those wanting to manage
their funds will be expected to take a web-based course and assessment prior
to assuming responsibility for their funds. Participants also have the option
to use a more traditional approach to fiscal management and employ a fiscal agent
to manage their funds. Moreover, participants will also be given the flexibility
to purchase services in an alternative and cost-effective way, e.g., send laundry
our rather than pay an attendant to do the laundry. Individuals have the option
to choose to use an Independent Living Counselor to direct their services or
assist them in directing their services. If they feel capable of directing their
services without the help of an Independent Living Counselor, they may do so.
Finally, participants who choose to use fiscal management and/or independent
living counseling services are free to designate the agency of their choice.
KHPA is hoping to implement the program, titled WORK (Work Opportunities Reward
Kansans), in the spring of 2007. For more information or questions about
WORK, please contact the Working Healthy program.
Benefits Specialist Corner
This issue features Working Healthy Benefits Specialist Steve Curtis from
the Topeka Service Center. Steve’s coverage area includes the counties
of Atchison, Brown, Doniphan, Jackson, Jefferson and Shawnee. He can be reached
by phone at (785) 296-5816 or by E-mail at SXXC@srs.ks.gov.
Childhood Disability Benefits, Working Healthy and Benefits Planning
Adults with disabilities who do not have enough work quarters to qualify for
Social Security Disability Insurance (SSDI) benefits on their own may receive
benefits based on their parents’ employment record. This program is called
the Childhood Disability Benefit (CDB). For Medicaid purposes, it is known as
the Adult Disabled Child Benefit. To be eligible in this manner the individual
must be 18 years of age or older, be disabled per Social Security standards prior
to age 22, and be the child of an insured worker who is disabled, retired, or
deceased. Marriage usually results in loss of CDB eligibility, unless the marriage
is to another Social Security beneficiary.
For employment purposes, receiving SSDI under the CDB is just like regular SSDI.
The trial work period, grace period, substantial gainful activity limit, and
other SSDI work incentives are applicable.
Sometimes, individuals receiving benefits through the CDB continue to qualify
for Medicaid. If the individual was receiving Supplemental Security Income (SSI)
or Section 1619 and lost it because they became newly eligible for CDB, or due
to an increase in CDB, Medicaid may continue if the individual would otherwise
be eligible for SSI if the amount of CDB is disregarded.
When an individual receiving CDB goes to work, the earnings may affect Medicaid
eligibility.
For example, let’s say Lucy receives SSI and marries Ricky, an SSDI beneficiary
based on his own insured status. Ricky gets $800 in SSDI. For 2006, the SSI benefit
for an individual and spouse is $904. Lucy’s SSI is $62 and Ricardo also
receives $62 in SSI, which brings their total SSDI and SSI to $924 (allowing
for the $20 general income exclusion on the SSDI).
A few months pass and Lucy’s father dies from a sudden illness. Lucy’s
impairment is such that she met Social Security disability criteria at age 19
and she now qualifies for CDB through her deceased father’s insured earnings.
Her CDB benefit is $800. Because her and her spouse’s combined SSDI is
$1600, they no longer qualify for any SSI. However, Lucy continues to be eligible
for Medicaid because she receives CDB; it was the receipt of CDB which caused
her to lose SSI, and if it were not for the CDB she would still be SSI eligible.
Another few months pass and Lucy begins to work and earns $600 per month. Her
countable earnings after disregards (assuming no IRWE, subsidy, or special condition)
equals $267.50. Medicaid eligibility as an Adult Disabled Child ends because
her spouse’s SSDI of $800 plus her countable earnings of $267.50 exceeds
the $904 SSI federal benefit rate for a couple.
She could be eligible for Medicaid through Working Healthy with a $112 premium.
Since it is no longer the CDB income alone that causes ineligibility for SSI,
her connection to Medicaid as a CDB recipient may be forever lost. Fortunately,
Lucy has discussed this with her Benefits Specialist and, with her goal being
full-time employment, she was willing to risk the connection to Medicaid in return
for the work experience. -Steve Curtis, Working Healthy Benefits Specialist
New Requirements for Medical Coverage
By Jeanine Schiefercke, Medicaid Eligibility Manager, Kansas Health Policy
Authority
In July, 2006 the Kansas Health Policy Authority (KHPA) and SRS implemented
new requirements for the Medicaid, MediKan and HealthWave programs. The new
rules require verification of U.S. citizenship and identity for most new applicants
and current recipients. These requirements will impact some Working Healthy
participants.
People who have received Supplemental Security Income (SSI) payments or are
covered under Medicare are exempt from the requirement and do not have to provide
documentation.
The new rules are based on a federal law, the Deficit Reduction Act. The law
requires the eligibility worker to get proof of citizenship and identity for
all new applicants before coverage is approved. For current recipients, proof
is required at the annual review. SRS and KHPA will give extra time for people
who have trouble getting the documents.
Many different documents can be used to meet the requirement. A passport is
considered a primary document and will verify both citizenship and identity.
If a passport isn’t available, two documents must be provided – one
for identity and one for citizenship.
Examples of citizenship documents include a birth certificate, certain military
records and records issued by the State Department. If these aren’t available,
hospital/medical records or insurance policies may be used.
Examples of identity documents include a driver’s license, Kansas ID
card, certain Native American tribal documents, government ID cards and school
ID cards. Certain employment ID cards are also acceptable. For children under
16, school, daycare or medical records may also be used.
Both KHPA and SRS stress the importance of communication in dealing with the
new requirements. If a person is having a hard time finding documentation the
SRS case worker will give extra time to submit the needed documents.
This newsletter and other Working Healthy information can be found online
at: http://www.workinghealthy.org
Working Healthy is published quarterly by the University of Kansas CRL, Division
of Adult Studies and the Kansas Health Policy Authority. Additional copies
and copies in alternate formats are available upon request by writing the University
of
Kansas
Division
of
Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence,
KS 66045, by phone (785) 864-7085, by emailing: pixie@ku.edu
KU Research Team:
Jean Hall, Principal Investigator
Noelle Kurth, Project Coordinator and Editor
Michelle Crick, Graduate Research Assistant
Kansas Health Policy Authority:
Mary Ellen O'Brien Wright, Program Director
Nancy Scott, Benefits Specialist Team Leader