How Might Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waiver Programs?

Issue Brief
  1. In addition to the work requirement, Kentucky’s waiver includes coverage lockouts for failing to pay premiums, timely renew eligibility, and timely report changes affecting eligibility, among other provisions.

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  2. The ACS questions used to classify an individual as having a disability include:  (1) Is this person deaf, or does he/she have serious difficulty hearing? (2) Is this person blind, or does he/she have serious difficulty seeing, even when wearing glasses? (3) Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? (4) Does this person have serious difficulty walking or climbing stairs? (5) Does this person have difficulty dressing or bathing? (6) Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone, such as visiting a doctor’s office or shopping?  U.S. Census Bureau, How Disability Data are Collected from the American Community Survey, (Oct. 17, 2017), https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html.

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  3. The maximum SSI benefit is about 74 percent of the federal poverty level (FPL, $9,000/year for an individual in 2018), and the asset limit is $2,000.  The ACA Medicaid expansion covers individuals up to 138% FPL ($16,735/year for an individual in 2018) without an asset test.  States have the option to extend financial eligibility for many disability-related Medicaid coverage pathways up to 300% of SSI ($27,000/year in 2018).

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  4. People who qualify for Medicaid both as an expansion adult and based on a disability can choose the group through which they enroll in coverage; benefit packages may differ by coverage group.  42 C.F.R. § 435.911 (c) (2), (d).

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  5. In addition, people who are medically frail will be exempt from the six-month healthy behavior incentive account suspension and account point deduction (for those at or below 100% FPL who choose to pay premiums but stop paying) and will not have to wait for the 60-day premium payment period to expire before coverage begins (for those who do not pay premiums).

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