1 THE EMPLOYED INDIVIDUALS WITH DISABILITIES (EID) PROGRAM Medical Assistance for Workers with Disabilities Michael Dalto, Work Incentives Project Director

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THE EMPLOYED INDIVIDUALS WITH DISABILITIES (EID) PROGRAM

Medical Assistance for Workers with Disabilities

Michael Dalto, Work Incentives Project Director

Maryland Department of Disabilities

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Employed Individuals with Disabilities (EID)

Also known as the Medicaid Buy-In, EID is a work incentive that provides Medicaid, for a limited premium, to people who:

Meet Social Security’s disability criteria after reaching age 18

Are U.S. citizens or qualified aliens aged 18 – 64

Are working for pay Meet income limits Meet resource limits

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Disability

You may be eligible for EID if you:

Currently receive SSDI Formerly received SSDI or

SSI as an adult and lost the benefit for reasons other than medical improvement (i.e., earnings, other income or resources)

Meet Social Security’s medical disability standard, but are not eligible for SSDI or SSI due to non-disability criteria.

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Countable Income

“Countable” income must be below 300% of federal poverty level (FPL)

$32,670/yr. ($2,722/mo.) for an individual (in 2011)

$44,130/yr. ($3,677/mo.) for a married couple (in 2011)

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Employed Individuals with Disabilities (EID) Only income from individual

and spouse is counted

Not all income is counted, and certain disregards (subtractions) apply:

$20/month subtracted from unearned or earned income

$65/month and half the remainder subtracted from earnings

Disability-related expenses needed for work and paid by the worker

Any work-related expenses paid by blind workers

Premiums paid by the worker for employer-sponsored health insurance

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Countable Resources

Countable resources for individual or couple must be below:

$10,000

Not all resources count. The following are excluded:

The home in which the applicant (and spouse) live

Vehicles owned by the applicant and spouse

401(k), 403(b), Keogh and pension plans

Certain burial funds Discretionary or “special needs”

trusts Others

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Premiums

Monthly premiums on a sliding scale

Countable income up to 100% federal poverty level (FPL) – premium = $0/mo.

Countable income = 101% - 200% FPL – premium = $25/mo.

Countable income = 201% - 250% FPL - premium = $40/mo.

Countable income = 251% - 300% FPL – premium = $55/mo.

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Premiums

Premium may be waived temporarily in cases of extreme hardship (i.e., paying premium would leave the applicant unable to afford food, shelter, clothing)

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Once You’re Enrolled

If found eligible, Medicaid is retroactive to the 1st day of the month the application is received

EID provides “fee for service” Medicaid – don’t join a managed care organization

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Provides full coverage for people with no other insurance; “wrap-around” (supplemental) coverage for those with private insurance or Medicare

If private insurance denies a service, Medical Assistance may cover it

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Medical Assistance covers premiums, deductibles and co-insurance for Medicare. May save individual up to thousands of dollars per year.

EID Medical Assistance a good alternative for people enrolled in Qualified Medicare Benefi-ciary (QMB) or Specified Low Income Medicare Beneficiary (SLMB). EID has higher income and resource limits and covers some items Medicare, QMB and SLMB don’t.

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HOW TO APPLY

Contact the EID Outreach Program at:

443-514-5034 1-800-637-4113 [email protected]

A staff member will contact you to list the EID eligibility criteria, answer questions, take your application, and tell you which documents you need to include with your application.

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ELIGIBILITY QUESTIONS

Contact the Division of Eligibility and Waiver Services (DEWS) at 410-767-7090.

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Success Stories

Vicki

Received Qualified Medicare Beneficiary (QMB), had to limit wages to $60/month

Switched to EID – began to earn $900/month

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Success Stories

Edward

Was “spending down” to get Medical Assistance, which cost him $8,000 every six months.

Quickly found a job and enrolled in EID.

Saved almost $16,000 per year.

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Success Stories

Edward

Was “spending down” to get Medical Assistance, which cost him $8,000 every six months.

Quickly found a job and enrolled in EID.

Saved almost $16,000 per year.

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Success Stories

Kim

Enrolled in EID and saved over $1,000 a month on Medicare premiums, deductibles and co-insurance.

With savings, he and his wife were able to buy a house.

Documents

1 THE EMPLOYED INDIVIDUALS WITH DISABILITIES (EID) PROGRAM Medical Assistance for Workers with Disabilities Michael Dalto, Work Incentives Project Director