[Hpn] Fw: buy-in information

Thomas Cagle nh-adapt@juno.com
Tue, 30 Oct 2001 01:06:16 -0500


Thanks Mary Ellen,

It is my hope this will spark more questions, so bear with them as they
come. I think this will be acutely questioned among the walking disabled
populations, especially Blind PWD who are now mostly covered under VR.

Tom Cagle
First NH-ADAPT

--------- Forwarded message ----------
From: "MaryEllen Fortini" <MaryEllen@mds-nh.org>

Here is the buy-in information included in the text.  The rules are still
being tweaked and will be submitted soon.  They won't change the
substance at all, but we have to include all the proper legalese and
bureaucratese or they won't be accepted.  Note the name has been changed
to MEAD - Medicaid for Employed Adults with Disabilities.    Let me know
if you have any problems with this.  I will get you the full rules as
soon as all the i's are dotted and the t's crossed properly. 

Medicaid for Employed Adults with Disabilities
(MEAD)

The Medicaid for Employed Adults with Disabilities (MEAD) coverage group
was authorized under federal law in Public Law 106-170 The Ticket to Work
and Work Incentives Improvement Act.  Its projected implementation date
is February 4, 2002.  This program will allow persons with a disability
to engage in employment without jeopardizing their Medicaid eligibility. 
In general the program makes a person with a disability who is employed
eligible for Medicaid by removing the eligibility criteria relative to
earnings and substantial gainful activity.
ELIGIBILITY REQUIREMENTS
Participants in MEAD must meet the eligibility requirements in each of
the three categories described below:

1.	General Eligibility Requirements
The individual must:
			be age 18 * 64 inclusive
	 meet general  and technical eligibility requirements such as NH
residency, citizenship, providing a social security number
	be employed or self-employed
	meet income and resource criteria
	pay a premium, if required to do so (see premium schedule below)

2.	Medical Eligibility Requirements
The individual must:
			have been determined eligible for APTD or ANB within 12 months prior
to application, regardless of whether or not that individual has used
Medicaid services in the past 12 months; and not have been terminated
from APTD or ANB due to medical improvement during the previous 12
months; or
	be employed or self-employed for pay and have a documented medical
impairment that meets or exceeds the SSI criteria and the medical
impairment has persisted or is expected to persist for a minimum of 48
months.

3.	Financial Eligibility Requirements
			The net income limit is 450% of the federal poverty guideline: 
currently $3,222 for a household of one and $4,353 for a household of
two.  The income of non-applicant spouses are counted in determining the
individual's eligibility.
	The resource limit is $20,000 for a household of one and $30,000 for a
household of two.
	The following resources are excluded:
		o	Retirement plans
o	Medical savings accounts;
o	Accounts specifically designated and set aside by the individual for
the purpose of purchasing certain goods or services that will enhance the
individual's employability and which are not covered by the Medicaid
program; and
o	Individual development accounts.
			Liquid resources, including interest earned by the resources,
accumulated from earnings by a MEAD-eligible individual on or after the
date that MEAD eligibility was established and kept in a separate account
from other liquid resources will be excluded when determining future
eligibility for non-MEAD adult category medical assistance.
	Individuals who have been determined eligible for MEAD who subsequently
become unemployed but who intend to return to work will continue to meet
the employment requirement for a period of up to 12 months from the date
the individual becomes unemployed if the individual meets specific good
cause reasons.

Premium Schedule

Participants may be required to pay a premium.  Premiums are based on net
income relative to the federal poverty level.  Net income is determined
calculated using the treatment, disregards and exclusions used for APTD*.


Summary:
Premium Bands Based on 7.5% of NET INCOME for FY 2001

FPL % RANGE	ANNUAL NET INCOME RANGE	MONTHLY PREMIUM	ANNUAL PREMIUM	
Less than 150% 	Up to $12,884	$0	$0	
150-200%	$12,885- $17,180	$80	$960	
More than 200-up to and including 250%	$17,181-$21,475	$105	$1,260	
More than 250-up to and including 300%	$21,476-$25,770	$130	$1,560	
More than 300-up to and including 350%	$25,771-$30,065	$160	$1,920	
More than 350-up to and including 400%	$30,066-$34,360	$185	$2,220	
More than 400-up to and including 450%**	$34,361-$38,655	$210	$2,520	
	


*  Net income is approximately  of gross income.  For details for a
specific individual, please contact a benefits specialist.

** When a participant's and their spouse's annual adjusted gross income
as defined by the IRS exceeds $75,000, that participant shall pay the
full premium identified which is calculated annually as 7.5% of the
participant's and their spouse's adjusted gross income.  



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