2665 Working Healthy Medically Improved - Gainfully employed persons receiving medical coverage under Working Healthy who are determined to no longer meet Social Security disability criteria because of a medical improvement are eligible for extended coverage under the Medically Improved group if the requirements of this section are met. Like standard Working Healthy coverage, authority for this group is provided under TWIAAW. Coverage begins January 1, 2005.

 

2665.1 General Requirements/Working Healthy Recipient - All general eligibility criteria of the Working Healthy program as per 2664.1) must be met. In addition, only those persons actually receiving coverage under the Working Healthy program at the time the disability terminates may receive extended eligibility. However, persons who were enrolled in another eligibility group as 2664 who were other eligible for Working Healthy, may elect to change eligibility to Working Healthy in the last month of coverage. This is only necessary if it will permit the individual to access ongoing coverage. Annual redeterminations are required (9373).

 

2665.2 Medical Improvement - Loss of disability status must be based on a medically improved disability. Loss of disability status for other reasons will not qualify an individual for extended coverage. Medical improvement must be documented through contact with Social Security or DDS.

 

2665.3 Financial Eligibility/ Premium Requirement - The financial eligibility criteria of 2664.4 are applicable, including the resource and income limits except that eligibility is denoted with a unique Special Medical Indicator. Cases are established with a program of MS, a program subtype of WH and a Special Medical Indicator (PICK code) of:

WM - Working Healthy Medical

The premium requirements of 2664.5 and subsections are also applicable.

 

2665.4 Employment Status - Persons must meet the earned income requirement as per 2664.3 requiring payment for FICA or SECA taxes. In addition, the individual must be earning at least the federal minimum wage and working a minimum of 40 hours per month. Persons earning below these levels are not eligible for extended coverage. The extended coverage provisions of 2664.7 are also applicable. To find the current minimum wage click this link, http://www.dol.gov/dol/topic/wages/minimumwage.htm , then scroll down and click on ‘What is the Minimum Wage?’

 

2665.5 Medically Determinable Severe Impairment - Once the individual is determined to have lost disability due to medical improvement, the agency must also document the individual continues to have a medically determinable severe impairment.

 

This is determined to exist if a medical professional (doctor, nurse practitioner, or psychologist) documents one or more of the following health conditions:

 

  1. The individual's disability continues to substantially limit the ability to work or conduct daily life activities;
     
  2. The individual has a mental or physical health problem that has been stabilized by assistive technology, medication, treatment, monitoring by medical professionals, or a combination of all of these, and loss of medical services may result in a deterioration of the condition;
     
  3. The loss of medical care could result in the individual's not being able to continue in the workforce or the the health problems would regress to the point where the individual would meet the SSA definition of disability, and become eligible for Social Security Disability Insurance (SSDI) payments. The Benefit Specialist is responsible for establishing the level of impairment is met. The level of impairment is reviewed annually.
     

 

2665.6 Referral to Benefits Specialist - Upon discovery of a suspected case involving a medical improvement, the individual must be referred to the local Working Healthy Benefits Specialist. The Benefit Specialist will verify the reason for loss of disability status and inform the EES Specialist. The Benefit Specialist will also determine if the individual meets the necessary level of impairment initially and at annual review.

 

 

2666 Child in an Institution (CI) - Medical assistance is available to a child who is residing in a Medicaid approved institution for long term care. See also 8183. This includes persons currently residing in a Medicaid accredited psychiatric hospital, including Level VI treatments facilities, or intermediate care facility if under the age of 21 or under 22 if receiving inpatient psychiatric care on their 21st birthday (see 8112.4). See 8142 (2) and 8143 (3) regarding the obligation of legally responsible relatives.

 

Institutional personnel are responsible for determining parental obligation to be paid to a state institution. Staff are responsible for providing state institutional staff with any requested income information available in the individual case record for the purpose of establishing this obligation.