Healthcare for Workers with Disabilities

Healthcare for Workers with Disabilities – HWD (S08)

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Healthcare for Workers with Disabilities – HWD (S08)

Revised March 7, 2008

Who is eligible to receive S08 medical?

How long is the S08 certification period?

How is S08 opened?

How do I screen S08 medical?

How do I process a pending S08 AU?

What happens if the S08 premium is not paid?

Who is eligible to receive S08 medical?

Individuals who meet the conditions in the following WAC/EAZ manual sections may be eligible for S08 medical coverage:

EA-Z Manual – WAC 388-475-1000 Healthcare for workers with disabilities (HWD) – Program description

WAC 388-475-1050 Healthcare for workers with disabilities (HWD) – Program requirements

Once eligibility for S08 medical has been established, recipients must pay a monthly premium to maintain eligibility for this program.

S08 eligible clients also meet Medically Needy SSI-related eligibility requirements and have a choice between receiving coverage under the MN program or the S08 program. See EA-Z Manual SSI-Related Medical/HWD – Clarifying Information – Program Choice - HWD Or Other Medical Programs

How long is the S08 certification period?

The S08 medical program is certified for 12 months.

A person who experiences a job loss can choose to continue S08 coverage through the original twelve months of eligibility, if both the following requirements are met:

The job loss results from an involuntary dismissal or health crisis.

The person continues to pay the monthly premium.

For information on retroactive S08 coverage, see EA-Z Manual WAC 388-475-1100 - Healthcare for workers with disabilities (HWD) - Retroactive coverage.

How is S08 opened?

Designated staff in HCS and Regional CSD offices are responsible for the administration of the S08 (HWD) program. These are the only workers who can process S08 cases.

How do I screen S08 medical?

To screen an S08 AU, take the following steps:

From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

On the Applicant page, enter the head of household’s Name, Residential and Mailing Addresses. Continue with the screening process until you reach the Programs page.

On the Programs page:

Click the checkbox next to Medical in the Programs section.

Click the checkbox next to Disabled in the Program Determination Criteria section.

Continue with the screening process until you reach the Finalize page.

The system defaults to the S02 program in this situation.

On the Finalize page, click the Specify Program button.

On the Finalize – Program Details page:

From the Program drop-down list, select Medical Assistance (MA).

From the Medical Coverage Group drop-down list, select Healthcare for Workers with Disabilities (S08).

Based on the client’s situation, select either Disabled (D) or Blind (B) from the Program Type drop-down list.

Click the Next button to return to the Finalize page and complete the screening process. See Screening a Client.

How do I process a pending S08 AU?

To process a pending S08 AU, take the following steps:

From the AMEN, access the pending AU via Option O – Interview.

Complete the interview following the steps in the Interview chapter.

From AMEN, access the AU via Option P – Process Application Months.

Complete processing following steps in the Process Application Month chapter.

Calculate the premium amount off-line before finalizing the application. See EA-Z Manual WAC 388-475-1250 Healthcare for workers with disabilities (HWD) - Premium payments

From AMEN, access the AU via Option Q – Finalize Application.

On the Eligibility for Special Programs SPEC screen, enter [Y] in the Confirm field and [the premium amount] in the Premium Amount field.

See EA-Z Manual Worker Responsibilities – Initial Premium Amount under WAC 388-475-1250 for information on entering the initial premium amount.

What happens if the S08 premium is not paid?

If the premium is not paid for four consecutive months an interface from the Office of Financial Recovery communicates this information to ACES.

ACES generates Alert 235 - PREMIUM PAYMENT 120 DAYS OVERDUE. When this alert is received, the worker will close S08 and redetermine eligibility for other medical programs.

If a client does not pay four consecutive monthly premiums, that person is not eligible for S08 coverage for the next four months, and must pay all premium amounts owed before S08 coverage can be approved again.

Healthcare for Workers with Disabilities – HWD (S08)
Revised March 7, 2008

Who is eligible to receive S08 medical? How long is the S08 certification period? How is S08 opened? How do I screen S08 medical? How do I process a pending S08 AU? What happens if the S08 premium is not paid?
Who is eligible to receive S08 medical? Individuals who meet the conditions in the following WAC/EAZ manual sections may be eligible for S08 medical coverage: EA-Z Manual – WAC 388-475-1000 Healthcare for workers with disabilities (HWD) – Program description WAC 388-475-1050 Healthcare for workers with disabilities (HWD) – Program requirements Once eligibility for S08 medical has been established, recipients must pay a monthly premium to maintain eligibility for this program. S08 eligible clients also meet Medically Needy SSI-related eligibility requirements and have a choice between receiving coverage under the MN program or the S08 program. See EA-Z Manual SSI-Related Medical/HWD – Clarifying Information – Program Choice - HWD Or Other Medical Programs How long is the S08 certification period? The S08 medical program is certified for 12 months. A person who experiences a job loss can choose to continue S08 coverage through the original twelve months of eligibility, if both the following requirements are met: The job loss results from an involuntary dismissal or health crisis. The person continues to pay the monthly premium. For information on retroactive S08 coverage, see EA-Z Manual WAC 388-475-1100 - Healthcare for workers with disabilities (HWD) - Retroactive coverage. How is S08 opened? Designated staff in HCS and Regional CSD offices are responsible for the administration of the S08 (HWD) program. These are the only workers who can process S08 cases. How do I screen S08 medical? To screen an S08 AU, take the following steps: From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window. On the Applicant page, enter the head of household’s `Name`, Residential and Mailing Addresses. Continue with the screening process until you reach the Programs page. On the Programs page: Click the checkbox next to Medical in the `Programs` section. Click the checkbox next to `Disabled` in the Program Determination Criteria section. Continue with the screening process until you reach the Finalize page. The system defaults to the S02 program in this situation. On the Finalize page, click the Specify Program button. On the Finalize – Program Details page: From the Program drop-down list, select `Medical Assistance (MA)`. From the Medical Coverage Group drop-down list, select `Healthcare for Workers with Disabilities (S08)`. Based on the client’s situation, select either `Disabled (D)` or `Blind (B)` from the Program Type drop-down list. Click the Next button to return to the Finalize page and complete the screening process. See Screening a Client. How do I process a pending S08 AU? To process a pending S08 AU, take the following steps: From the AMEN, access the pending AU via Option O – Interview. Complete the interview following the steps in the Interview chapter. From AMEN, access the AU via Option P – Process Application Months. Complete processing following steps in the Process Application Month chapter. Calculate the premium amount off-line before finalizing the application. See EA-Z Manual WAC 388-475-1250 Healthcare for workers with disabilities (HWD) - Premium payments From AMEN, access the AU via Option Q – Finalize Application. On the Eligibility for Special Programs SPEC screen, enter [Y] in the `Confirm` field and [the premium amount] in the `Premium Amount` field. See EA-Z Manual Worker Responsibilities – Initial Premium Amount under WAC 388-475-1250 for information on entering the initial premium amount. What happens if the S08 premium is not paid? If the premium is not paid for four consecutive months an interface from the Office of Financial Recovery communicates this information to ACES. ACES generates Alert 235 - PREMIUM PAYMENT 120 DAYS OVERDUE. When this alert is received, the worker will close S08 and redetermine eligibility for other medical programs. If a client does not pay four consecutive monthly premiums, that person is not eligible for S08 coverage for the next four months, and must pay all premium amounts owed before S08 coverage can be approved again.