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


Revised September 26, 2014



Purpose: This section explains how to choose the correct program when a client is working and needing HCB services. This section also describes how to code ACES. This section gives additional information on the healthcare for workers with disability program (HWD). Eligibility for HWD is used for both the DDA and HCS CN Waiver programs as well as medicaid personal care (MPC).

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


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 (applies to DDA Waivers)
  • 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 DDA 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 (CN) 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.   

NOTE:

HWD covers short stays (29 days or less) in nursing homes.  HWD does not cover medical institutionalization (Nursing Facility or RHC) projected 30 days more more.  A redetermination under the L track program is needed for HWD clients in a NF or RHC 30 days or more. 

 


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 182-513-1380 (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 DDA in a RHC or ICF-MR are approved automatically through their care plan with DDA.

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 DDA LTC Specialty Unit and HCS

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

DDA LTC specialty unit HWD Phone:  1-800-871-9275 

To request an active HWD case from DDA LTC specialty unit, set a same day barcode tickler to @HWD for CSO 157 requesting the transfer.  Indicate the HCS office. 

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

An application for HWD and HCS services goes to the HCS regional specialist

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

HCS HWD Specialists:

 

Region 1 - Pend Oreille, Grant, Adams, Lincoln, Okanogan, Ferry, Douglas, Whitman, Spokane, Klickitat, Yakima, Walla Walla, Franklin, Benton, Garfield, Columbia, Asotin, Kittitas.

Attn: Jeannie Valdez

1620 S. Pioneer Way Moses Lake WA  98837

509-764-5667 or 1-800-671-8902

TTY: 509-886-6223

 

Region 2 King, Snohomish, Whatcom, Skagit, Island 

Attn: Javier Gonzales1737 Airport Way S, Suite 130 Seattle

Mail:  PO Box 24847 Seattle WA  98124-0847

206-341-7827, 206-341-7750 or 1-800-346-9257

TTY:  1-800-833-6384

 

 

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

Attn:  Brandy Rhodes

5411 E Mill Plain Blvd Ste 203 Vancouver,  WA 98661-7046

Mailing: PO Box 45610
Olympia WA  98504-5610

360-397-9512 or 1-800-280-0586

360-992-7949 FAX

360-750-4079 (TTY)

 


Worker Responsibilities for HWD receiving HCS services

  • See complete HWD program information. The HWD section in EAZ gives detailed instructions on the HWD program.   
  • 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).   
  • 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). 
  • 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.
  • 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.  
  • HWD specialists inform the client and the client case manager/social worker  that it is 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. 
  • If an HWD client's job ends and HWD continues to be the preferable program, it is continued through the certification period as long as the premium continues to be paid.  
  • Premium adjustments based on income changes occurs on the first of the following month
  • Follow NSA/Equal Access for individuals needing assistance
  • HWD and ACES coding
  • SPEC screen in ACES
Modification Date: September 26, 2014