Eligibility

Life is complicated; systems supporting people with developmental disabilities are even more complex. This guidebook is intended to help understand the many systems that may be encountered as a self advocate or someone involved in the life of an individual with a developmental disability. Like a car manual; some of this information may never be needed but if something happens the information is available. Other state programs can use this guidebook as a template to create a similar manual.

The author focuses on Medicaid and Medicare in offering healthcare reform suggestions. Both legislative and administrative actions are proposed regarding eligibility and enrollment, access to services, program management and delivery systems issues, and financing. Several options relate to HCBS, such as protecting spouses of the medically needy, expanding eligibility for SSI-related groups, and issuing further guidance on waiver waiting lists.

This report provides a summary of how long-term services and supports (LTSS) are financed and describes factors that contribute to uncertainty of the future costs for LTSS, including changes in how LTSS will be delivered. Three projections of future LTSS spending for senior populations under different scenarios are offered. These scenarios differ based on projecting the number of people with varying functional limitations and the resulting need for varying degrees of LTSS.

The Medicaid Buy-In (MBI), Social Security Disability Income (SSDI), and Supplemental Security Income (SSI) programs all provide workers with disabilities options to maintain health coverage if they earn too much for Medicaid or Medicare benefits. The first issue brief explains how these programs compare and interact in terms of eligibility, coverage, populations, and enrollment. The second examines how MBI participants that collect SSDI utilize SSDI work incentives.

Medicaid waivers funds can be used to support self-employment, but may not be used directly to fund the development of a business. This factsheet provides answers to questions about how to leverage waivers supports for self-employment while complying with these regulations. It also outlines eligibility requirements and presents short case studies.

MAPP is the Wisconsin Medicaid Buy-In program, allowing qualified workers with disabilities to purchase Medicaid healthcare coverage. Find here several reports outlining enrollment and expenditure data, policies and activities. Also available is a report that evaluates the effectiveness of WI’s return-to-work programs.

M-WIN is West Virginia’s Buy-In program, enabling workers with disabilities to buy Medicaid benefits in exchange premium payments based on a sliding scale. The flyer directs potential consumers to a 1-800 number for more information and to begin participation. The spec sheet gives detailed eligibility information.

Here is an example of a tool used to educate service providers and consumers about how SSI recipients can keep Medicaid through 1619(b) even if the earn too much to continue receiving an SSI check. The presentation covers eligibility requirements and the application process. In addition, it points people towards resources for further help and information if needed.

Support workers use this tool as a preliminary eligibility test for clients that wish to apply for Medical Assistance for Workers with Disabilities (MAWD). Once initial screening is passed, clients receive an application and the questionnaire is sent for eligibility verification.

NASHP produced this report and webinar to help states provide Medicaid and SCHIP coverage to youth involved with or exiting foster care and juvenile justice systems. The report focuses on simplifying enrollment, enhancing retention through transitions, and integrating services with partners. The webinar slides present the report findings in brief and highlight programs in New Mexico and Washington that focus on the juvenile justice system and youths released from incarceration.