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EAZ
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Working clients on long-term care programs (Waiver, residing in a medical institution or MPC) |
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Revised July 22, 2009 |
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Healthcare for Workers with Disability, Substantial Gainful Employment (SGA) and SSI clients with 1619B status |
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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 DDD and HCS CN Waiver programs as well as medicaid personal care (MPC). |
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Working clients on COPES (or any HCB service) or MPC
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When is HWD (S08 in ACES) better than using HCS CN (COPES) rules (C01 in ACES).
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When can HCB Waiver (COPES) be better than HWD
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Adding HWD to the HCS CN waiver effective 4/1/09.
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How is HWD similar to other SSI-related medical (CN)?
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How is HWD different from other SSI-related medical (CN)?
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What is substantial gainful activity (SGA) and why is it important?
See: >http://www.ssa.gov/OACT/COLA/sga.html Why is SGA important for SSI related medicaid programs? SGA criteria is waived for the HWD program. SGA criteria is not waived other SSI related medicaid programs. If a client has income at or above the SGA amount and is not in 1619B status for continued SSI eligibility, HWD is the only SSI related program that can be considered. The client no longer fits the SSI related disability criteria for eligibility except the HWD program. (SGA note: there is a special consideration such as IRWE, work modification, productivity percentage of like work that is deducted before reaching the countable SGA by Social Security, consult the Social Security office if there are questions regarding the SGA criteria and disability). In other words, the client would still be considered disabled for the purposes of HWD when income is over the SGA amount, but not considered disabled for any other SSI related medicaid program. It is important to consider SGA when closing the HWD program and considering another SSI related Medicaid program including rules under the C01 (Waiver) program. | ||
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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:
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. | ||
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HWD specialists in the CSO and HCS CSO specialty unit 132, HWD and HCS cases. CSO 132, Region 4 medical call center uses a specialty unit for the HWD program for the state. All HWD cases not on HCS services are maintained by CSO 132 as a specialty program. The financial record is requested from CSO 132 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 132 specialty unit. This includes HWD clients on DDD MPC or Waiver services. The CSO HWD specialist contact is: Joshua Smay 132 call center number- 1 (800) 337-1835 HWD Message line (206) 272-2169 How to request an active HWD case from CSO 132: Set a “Same Day” barcode Tickle under @HWD for CSO 132 requesting the transfer. In addition to the tickle, a direct e-mail to Joshua Smay fast tracks the case transfer . For questions regarding HWD and assistance in choosing the most beneficial program for HCS clients contact: HCS Headquarters : Lori Rolley, Financial Policy Analyst Peggy Rezac, Financial Policy Analyst
HCS HWD Specialists: Region 1: Robert O’Dowd, Gary Olson, Theresa Zavala Region 2: Diane Storms, Harvey Cardwell Region 3: Rob Murphy, Jyl Phipps Region 4: Mathew Sipes, Shelly Bradford-Johnson, Michelle Joseph, Graham Zuch Region 5: Roberta Blocker Region 6: Frankie Sokso, Crystal Boling, Colleen Bouldin, John Hanrahan | ||
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Worker Responsibilities.
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