New York Makes Work Pay

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2 New York Makes Work Pay Title: 1619b (Best Kept Secret) Presenter: Edwin J. Lopez-Soto New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure Grant (Contract No. #1QACMS030318) from the U.S. Department of Health and Human Services, Center for Medicaid and Medicare Services to the Office of Mental Health on behalf of New York State. It is a joint effort of the Burton Blatt Institute at Syracuse University and the Employment and Disability Institute at Cornell University with the collaborative support of the Employment Committee of the New York State Most Integrated Setting Coordinating Council to remove barriers to employment and develop pathways to work for New Yorkers with disabilities. 2

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5 The Importance of Medicaid Medicaid vs. Medicare Medicaid is a publicly funded health insurance program Medicare is a federal insurance program 5

6 Medicaid vs. Medicare Con t In NYS: Medicaid covers a wide variety of services including, but not limited to: Inpatient and outpatient hospital care Physician services Mental Health counseling Home health care, personal care, private duty nursing PT, OT, speech and language therapy Prescription drugs Durable Medical Equipment Additional services under Medicaid Waiver programs 6

7 Basic Medicaid Eligibility In NYS, people on Supplemental Security Income (SSI) get Medicaid automatically Some former SSI recipients continue to qualify for automatic Medicaid (e.g., Disabled Adult Child) In NYS, people on Temporary Assistance (TA) get Medicaid if requested on the TA application Others can be eligible for Medicaid if income, resource, age and/or disability requirements are met 7

8 Section 1619(b) - Review Powerful work incentive If a person on SSI loses eligibility for cash benefits due to wages, get to keep Medicaid Permanent part of SSI program since 1987 As long as otherwise eligible for SSI Wages below $43,421 a year. Or meets an individualized threshold if medical costs extremely high 8

9 How 1619(b) Works Part I SSI will disregard $65 and 50% of what remains from wages Person living alone (no other income) will lose SSI if gross wage is $1,607 or higher in 2009 Person Living with others (no other income) will lose SSI if gross wage is $1,479 or higher in

10 How 1619(b) Works Part II Medicaid Use Test (expect to use) Annual Earned Income below $43,421 in 2009 Or must be under individualized threshold limit Resources must be within SSI limits Unearned Income must be within SSI limits Individual Must Continue To Be Disabled If individual Does Not Meet The Above, Will Not Qualify For 1619(b) 10

11 Medicaid Use Test A person is considered to depend on Medicaid if he/she: Used Medicaid within past 12 months; or Expects to use Medicaid in next 12 months; or Would be unable to pay unexpected medical bills in next 12 months without Medicaid. As a practical matter everyone should meet the Medicaid use test, as it would be rare to have a private health insurance plan that would pay any and all unexpected medical bills no matter what intervening events occurred. 11

12 Earned Income: The Case of Charlie Charlie lives alone and receives SSI benefits of $761 per month. He goes to work and earns $2,200 gross per month or $26,400 per year. Will he lose his Medicaid benefits? (Polling Question 2) 12

13 The Case of Charlie Using SSI s formula for budgeting income, Charlie s monthly countable income will be $ ($2, = 1,935 /2 = $967.50). Since this is more than the $761 SSI rate, he will lose his SSI check. Charlie retains Medicaid under 1619(b), since his annual income of $26, 400 is less than New York s threshold of eligibility (i.e., $43,421 in 2009). 13

14 Excess Resources: The Case of Charlie Charlie continues to work at the same level but his bank account continues to grow. He deposits $200 a month. Eventually, it hits $2000. The next month he deposits another $100. Will Charlie lose his Medicaid benefits? (Polling Question 3) 14

15 Earned & Unearned Income: The Case of Peggy Peggy resides with her two young children and receives $610 in SSDI benefits and $107 in SSI benefits. She goes to work part time and earns $465 per month in gross wages. Will she lose her Medicaid benefits? (Polling Question ) 15

16 The Case of Peggy Using SSI s formula for budgeting income, Peggy will lose her SSI benefits as she has $790 monthly countable income. $590 of her SSDI and $200 ($ = $400/2 = $200) of her wages, which will be counted against New York s 2009 SSI living with others rate of $697. Peggy retains Medicaid under 1619(b) since she lost her SSI due to wages and her annual income from wages ($5,580) is less than the (b) threshold for eligibility ($43,421). 16

17 Unearned Income: The Case of Peggy II Due to Peggy s work record, SSA informs Peggy that her SSDI will be increasing from $610 a month to $810 a month. Will she lose her Medicaid benefits? (Polling Question 4) 17

18 What s the Problem with 1619(b) Not available to everyone Only available to former SSI recipients Not available if former SSI person lets income or resources go over SSI limits 18

19 MBI-WPD In NYS, became effective July 1, 2003 Only about 7400 individuals enrolled as of August 30, 2009 Two groups: Basic Coverage Group and the Medical Improvement Group Note: Everyone applying now in Basic Eligibility Group 19

20 The Basic Eligibility Group Disability certified disabled under SSI medical criteria No SGA test can earn over $980 or $1640 SGA limits Age Be at least 16 but not yet 65 years old Work engage in some paid work Income at or below 250% of FPL (i.e., wages if single individual and sole income is earned = $55,188/yr max) Countable Income under 250% of FPL ($2257 in 2009) Resources at or below $13,800 20

21 Conclusion The Medicaid Buy-In program for Working People with Disabilities addresses the medical health needs of many New Yorkers who work despite severe disabilities For more information on Medicaid and MBI-WPD, visit our website at 21

22 Questions / Answers 22

23 New York Makes Work Pay Partnering Organizations New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure Grant (Contract No. #1QACMS030318) from the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services to the Office of Mental Health on behalf of New York State. It is a joint effort of the Burton Blatt Institute at Syracuse University and the Employment and Disability Institute at Cornell University with the collaborative support of the Employment Committee of the New York State Most Integrated Setting Coordinating Council to develop pathways and remove obstacles to employment for New Yorkers with disabilities. 23