Working clients on long-term care programs (Waiver, residing in a medical institution or MPC)

Revised December 28, 2011

Working clients on COPES (or any HCB service) or MPC

• SSI clients that no longer receive a SSI check due to earnings but Social Security still considers an active SSI client.   (1619B status).
• Healthcare for Workers with Disabilities  (HWD).  HWD may be more beneficial to a working clients who have earnings. 
  HWD provides categorically needy (CN) scope of care, including Medicaid Personal Care (MPC) services. Effective 4/1/2009 eligibility for HWD has been included in the HCB CN Waivers  authorized by Home and Community Services (HCS). Either MPC or HCB CN Waivers can be considered for HWD eligible clients. Use MPC as a priority if needs can be met under MPC.
• HCB CN Waivers are authorized by either HCS or DDD. 

When is HWD (S08 in ACES) better than using HCS CN (COPES) rules (L22 in ACES).

• No asset test for HWD.
• May have gross income over the SIL with HWD. 
• No participation toward personal care.  There is a monthly HWD premium.  HWD clients in residential settings are responsible to pay the ADSA room and board standard.
• Earned income can be over the social security substantial gainful activity (SGA).  SGA is not a factor for HWD because it is waived for the HWD program.  It is a factor in determining disability for most SSI related medicaid including HCS Waivers

When can HCB Waiver (COPES or DDD Waiver) be better than HWD

• Client's income is low enough where there is no participation toward personal care and there is already -0- out of pocket cost under the COPES program. 
• Spousal impoverishment rules do not apply to HWD.  Spousal income follows SSI related rule for the HWD program.  The non applying spouse's income is counted in the initial HWD eligibility but not counted in the premium determination of HWD. 
•  Many individuals with a community spouse may be better off using the rules under the L22/Waiver program because of the benefit of the spousal impoverishment rules.

How is HWD similar to other SSI-related medical (CN)?

• Same application form
• SSI related rules when determining eligibility. 
• NGMA is needed if no current disability determination.
• Categorically Needy scope of care

How is HWD different from other SSI-related medical (CN)?

• No asset test
•  Higher income standard - clients pay monthly premiums instead of meeting spenddown liability or pay participation liability  HWD Website determines eligibility and premium amount
• Only designated HWD staff determine eligibility
• The substantial gainful activity (SGA) is not a factor for HWD.  For all other SSI related Medicaid programs, the SGA IS a factor regarding disability criteria and earnings cannot equal or exceed the SGA amount . For HWD disability, this test does not apply.  For a under age 65 client earning over the SGA standard, HWD is the only SSI related program that should be considered if the client is not receiving a payment from SSA based on disability.   Detailed information on the SGA is in the HWD section of the manual.   

Working Clients and HCB Waiver programs

ACES supports the 65 and 1/2 earned income exclusion in post eligibility for the CN Waivers.  Do not code an additional earnings deduction on the LTCX screen. 

Expenses for self employment are based on actual costs per SSI related rule

Impairment related work expenses (IRWE) are not allowed as a deduction in both initial and post eligibility for HCB Waivers.  IRWE deductions ARE allowed for HWD.   Individuals with IRWEs should have a comparison of HCB Waiver vs HWD rules

Working clients in a Medical Institution

Working clients in a medical institution do not receive the 65 and 1/2 earned income disregard in initial or post eligibility. 

WAC 388-513-1380 (4)  allows a post eligibility deduction for:

1.  mandatory taxes out of wages. 
2. department-approved training or rehabilitative program designed to prepare the client for a less restrictive placement. When determining this deduction employment expenses are not deducted.

The client PNA, mandatory taxes, department approved wage deduction and guardianship fee deduction cannot exceed the MNIL. 

HWD does not cover nursing facility payment when an individual is institutionalized 30 days or more in a medical facility.  See short stays  for using HWD for nursing facility admissions under 30 days.

Coding Department Approved Training or Rehabilitative Program Earnings for individuals in Medical Institutions. 

Individuals with earnings in medical facilities must have their employment approved by DSHS staff in order to receive an allowance for the earnings.  ACES is programmed to do the calculation correctly as long as the earnings are coded as "RH" on the EARN screen. 

RH - Department-Approved Training or Rehabilitative Program

Clients receiving services through DDD in a RHC or ICF-MR are approved automatically through their care plan with DDD.

Clients receiving services in a Nursing Facility must have an approval with the HCS Social Worker in order to receive an allowance for the earnings.  The financial worker will need to request an approval as part of the care plan from the HCS SW.  If the employment is not approved, the earnings are coded as EI in ACES. 

HWD specialists in the CSO and HCS

When routing HWD applications or case records, the following contact information applies:

CSD - Forward to the Specialized Medical Unit (SMU) via DMS under @HWD CSO 157.

SMU contact information:

        Address: DSHS CSD - Customer Service Center, PO Box 11699,
        Tacoma, WA 98411-6699
        Phone: (206) 272-2169 or 1-800-871-9275. 

The CSO HWD contact is:   Bryan Thai.  This includes DDD Waiver clients on HWD. 

How to request an active HWD case from the CSO:

Set a “Same Day” barcode Tickle under @HWD for CSO 157  requesting the transfer.  

The financial record is requested from the CSO HWD specialty unit when HCS services are opened unless there is a TANF or children/family medical case attached to the household

HCS maintains their own HWD financial cases for clients receiving services with HCS (and no TANF or children/family related medical attached).

An application for HWD and HCS services goes to the HCS Regional specialist. 

An application for HWD and no HCS services goes to the CSO HWD specialty unit.  This includes HWD clients on DDD MPC or Waiver services. 

DSHS has 3 Regions.  Click on the Map  to determine what region your county is in.

HCS HWD Specialists:

Region 1 North -Stevens, Pend Oreille, Grant, Adams, Lincoln, Okanogan, Ferry, Douglas, Whitman, Spokane.   

Attn: Rob O'Dowd, Sharon Howe, Dan Rees HWD specialists.

1330 N. Washington Street, Suite 3000
Spokane WA 99201
(509) 323-9400 or 1-800-459-0421
FAX# (509) 458-3558
TTY# (509) 456-2827

Region 1 South- Klickitat, Yakima, Walla Walla, Franklin, Benton, Garfield, Columbia, Asotin, Kittitas.

Attn:  Diane Storms or Harvey Cardwell HWD specialists

1002 N. 16th Ave (Office)
Yakima WA 98902
(509) 225-4400 or 1-800-822-2097
Fax: (509) 575-2286

Region 2 South-King County 

Attn:  Mathew Sipes, Shelly Bradford-Johnson, Clark Thompson or Graham Zuch HWD specialists

1737 Airport Way S, Suite 130 (Office)
Seattle, WA 98134
P. O. Box 24847 (Mail)
Seattle, WA 98124-0847
206-341-7750 or 1-800-346-9257
TTY: 1-800-833-6384

Region 2 North-Snohomish, Whatcom, Skagit, Island

Attn: Rob Murphy or Jyl Phipps HWD Specialists

Mt Vernon HCS
900 E College Way, Suite 210
Mt. Vernon, WA 98273-5682
Phone: (360) 416-7289 or 1-866-608-0836

Region 3  HCS, Pierce, Kitsap, Clallam, Jefferson, Thurston, Mason, Lewis, Cowlitz, Clark, Pacific, Grays Harbor,  Skamania, Wahkiakum. 

Attn:  John Hanrahan

HCS Olympia-Lacey-Tumwater
PO Box 45610
Olympia WA  98504--5610

1-800-462-4957

For questions regarding HWD and assistance in choosing the most beneficial program for HCS clients contact: 

HCS Headquarters:  

Lori Rolley or Peggy Rezac

Worker Responsibilities for HWD receiving HCS services

• The HWD computation is not supported by ACES,see complete HWD program information. The HWD section in EAZ gives detailed information on the HWD program and SGA information. 
• The calculation is done by a calculator located on the Financial Services Administration (FSA) website at:  http://fsa.dshs.wa.gov/hwd/.  (Click on the Entry Form Tab) 
• Only designated financial staff receives a User name for the HWD calculator.
• Changes in ACES on a S08 case must be done by an HWD specialist. (Changes made by a non HWD specialist can result in incorrect eligibility including notification issues). 
• HCS service eligibility is indicated on the INST screen of the S08. The HWD premium amount is indicated in ACES on the SPEC screen by the HWD specialist.  This is sent over to FSA so the correct premium notice is sent to the client.    
• HWD letters are hand done using letter templates.  The information is cut and pasted info into an ACES general correspondence letters.  Notify the case manager of HWD eligibility via e-mail as HWD letter assignments are not supported in ACES/Barcode. 
• HWD receiving Waiver services are subject to transfer of asset, annuity declaration and excess home equity provisions that are specific to institutional programs (L22).  (MPC services are not subject to these provisions). 
• HWD specialists must inform the social worker or case manager that the room and board standard is the only cost for an HWD client in an ALF along with the HWD monthly premium.
•  ACES does not support the room and board calculation for HWD on HCS CN Waiver.  The award letter for HCS CN Waiver must be hand-done indicating the room and board amount plus the HWD award letter indicating the premium amount.
• MPC is the preferable program if needs can be met under the MPC program.  This determination is made by the social worker/case manager.
• The medical coverage group S08 must be used for HWD clients in order for the premium bill to go out to the client from FSA.  (Waiver or MPC service information is indicated on the INST screen under the HCB service field).
• The L22 program is not used in ACES for HWD, but a client can still get services under the HCB Waiver under the S08 program.   A separate letter will need to be created for the HCB Waiver services. 
• It is important for the client, financial worker and the client case manager/social worker to know that it is very important for the client and/or their representative to pay the HWD premium to FSA timely.  There are penalties described in the HWD chapter when premium payments are overdue.  This penalty could result in no HWD coverage for 4 months which could affect the client's eligibility for continued services. 
• When a NGMA is needed for HWD, make sure the following language is added to the NGMA cover sheet to DDDS:
  • Disability determination is needed for Healthcare for Workers with Disabilities (HWD). SGA is waived for this program. 
• Follow NSA/Equal Access for individuals needing assistance. 
• HWD and ACES coding
• SPEC screen in ACES