health benefits.” Those benefits include ambulatory patient “essential services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorders, prescription drugs, rehabilitation and habilitation services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services. States have the option to propose alternate benefits packages for the adult group, which could include Medicaid State Plan benefits. Example of the eligibility group: Luther receives $1,270 of SSDI. He doesn’t have Medicare yet. Given his household size, the income limit for this Medicaid eligibility group is $1,387 per month (138% of 2017 FPL). His MAGI-based income is below that limit and, as a result, he can access Medicaid this way. When counseling beneficiaries who use this it’s important to recognize returning to work could make them ineligible. Example of what happens to Luther when he begins working: Luther gets a job making $500 per month, plus he will continue to receive $1,270 of SSDI. His MAGI-based income is $1,770 per month, which is over the income limit for this group. As a result, the state would need to find Luther eligible under a different Medicaid eligibility group in order for him to maintain Medicaid. shouldn’t only identify those who could be eligible for this group, but should also be familiar with other Medicaid eligibility groups in their state that could benefit workers with disabilities, such as the Medicaid Buy-in group (if available). Home and Services (HCBS) Waivers Historically, Medicaid only funded long-term care services in an institutional setting. Long-term care (LTC) services include support with activities of daily living (ADLs), such as bathing, dressing, and eating. LTC services have also included support with instrumental activities of daily living (IADLs), such as taking medications as prescribed, managing
“essential health benefits.” Those benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorders, prescription drugs, rehabilitation and habilitation services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services. States have the option to propose alternate benefits packages for the adult group, which could include Medicaid State Plan benefits. Example of the eligibility group: Luther receives $1,270 of SSDI. He doesn’t have Medicare yet. Given his household size, the income limit for this Medicaid eligibility group is $1,387 per month (138% of 2017 FPL). His MAGI-based income is below that limit and, as a result, he can access Medicaid this way. When counseling beneficiaries who use this it’s important to recognize returning to work could make them ineligible. Example of what happens to Luther when he begins working: Luther gets a job making $500 per month, plus he will continue to receive $1,270 of SSDI. His MAGI-based income is $1,770 per month, which is over the income limit for this group. As a result, the state would need to find Luther eligible under a different Medicaid eligibility group in order for him to maintain Medicaid. shouldn’t only identify those who could be eligible for this group, but should also be familiar with other Medicaid eligibility groups in their state that could benefit workers with disabilities, such as the Medicaid Buy-in group (if available). Home and Services (HCBS) Waivers Historically, Medicaid only funded long-term care services in an institutional setting. Long-term care (LTC) services include support with activities of daily living (ADLs), such as bathing, dressing, and eating. LTC services have also included support with instrumental activities of daily living (IADLs), such as taking medications as prescribed, managing
2018_WIPA_Manual_Module_4_S.docx