Healthcare for Workers with Disabilities – HWD (S08)

Created on: 
Nov 02 2015

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the Healthcare for Workers with Disabilities - HWD (S08) medical program?

The HWD medical program recognizes the employment potential of people with disabilities. The enactment of the federal Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 enables many people with disabilities to work and keep their health care.

As a Categorically Needy (CN) Medicaid program, HWD provides access to Medicaid Personal Care services (MPC) and Home and Community Based (HCB) waiver programs administered by the Developmental Disabilities Administration (DDA) and Home and Communities Services (HCS).

Who is eligible to receive Healthcare for Workers with Disabilities - HWD (S08) medical?

Individuals who meet the criteria in the following WACs may be eligible for S08 medical coverage:

S08 eligible clients may also meet Medically Needy SSI Related (MN) eligibility requirements and can choose between receiving coverage under the MN program or the S08 program. See Worker Responsibilities in the Apple Health (Medicaid) Manual - WAC 182-511-1100 Health care for workers with disabilities (HWD) -- Retroactive coverage for more information.

Once eligibility for S08 medical has been established, recipients must pay a monthly premium to maintain eligibility for this program. See the Apple Health eligibility manual - WAC 182-511-1250 Healthcare for workers with disabilities (HWD) -- Premium payments for more information.

How long is the Healthcare for Workers with Disabilities - HWD (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; and,
  • The person continues to pay the monthly premium.

For information on retroactive S08 coverage, see  WAC 182-511-1100 - Health care for workers with disabilities (HWD) -- Retroactive coverage.

How is Healthcare for Workers with Disabilities - HWD (S08) opened?

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

Online Processing

How do I screen a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

To screen an S08 medical AU, take the following steps:

  1. From the Welcome Back page in aces.online, click the Screen New Application link at the top left of the page. The Applicant page displays in a new window.
  2. On the Applicant page:
  • In the Applicant Name field enter the [applicant's name]
  • In the Residential Address field enter the [applicant's residential address].
    • If the applicant's mailing address is different than the residential address, click the box next to Mailing Address same as above to remove the checkmark and enter the applicant's mailing address.
  • To add an Authorized Representative, follow the steps in Screening - Add/Edit/Delete Authorized Representation (AREP).
  • Click the Next button and the Address Validation page displays.
  1. On the Address Validation page:
  • Take the necessary steps to complete the address validation process. See Screening - Address Validation for additional information.
  • Click the Next button and the Programs page displays.
  1. On the Programs page:
  • Click the checkbox next to Healthcare/Workers with Disabilities(HWD) in the Programs section.
    • If appropriate, click the checkbox next to Disabled or Blind in the Programs Determination Criteria section. If no box is checked the default Program Type is Disabled (D).
  1. Continue screening following the steps in the Screening an Application chapter.
  2. On the Finalize page, click the checkbox next to Medical Assistance (MA).
  3. Enter the Application Date in [mmddyyyy] format.
  4. Click the Commit button.

How do I process a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

To process an S08 medical AU, take the following steps:

  1. From the Case Actions page, select Start Interview.
  2. On the Assistance Unit page: 
  • In the AU ID section, enter [a date] in the Client Chosen HWD Begin Date field:
    • If the client has not chosen a begin date leave this field blank.
NOTE: The S08 AU remains in pending status until a date is entered in the Client Chosen HWD Begin Date field, even when the AU is finalized. 
  • In the Clients section, update the Financial Responsibility with the appropriate program codes from the drop down menu:
    • Applicant (PN) (for only one member of the AU)
    • ABD Parent (AP)
    • Alien Sponsor (AL)
    • Child - SSI/Of SSI-related Parent/Used for HH Size (SC)
    • Ineligible Person (IP)
    • Ineligible Spouse (SP)
    • Non-Member (NM)
  1. To complete the interview following the steps in Interview - Online Processing.
  2. After committing the interview data, follow the steps in How do I complete Process Application Months?.
NOTE: Barcode Tickler HW06-HWD PENDING, NEED CLIENT CHOSEN START DATE generates to the user of record when an S08 AU is finalized without a date in the Client Chosen HWD Begin Date field.

How do I finalize a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

If the client has not chosen an HWD begin date, follow the steps in How do I complete Finalize Application?

NOTE: ACES will generate Letter 0023-02 (Request for Information) asking the client to choose a month for Ongoing Coverage.

If the client has chosen an HWD begin date, take the following steps:

  1. From the Case Actions page, select Start Interview.
  2. On the Assistance Unit page:
  • In the AU ID section, enter [a date] in the Client Chosen HWD Begin Date field.
  1. To complete the interview following the steps in Interview - Online Processing.
  2. To process pending application months, follow the steps in How do I complete Process Application Months?
  3. To finalize the AU, follow the steps in How do I complete Finalize Application?

How do I process Retro Medical for a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

This function is not available in ACES 3G.  See Mainframe Processing - How do I process Retro Medical for a Healthcare for Workers with Disabilities - HWD (S08) Assistance Unit (AU)? for steps on processing a retro medical request.

What happens if the Healthcare for Workers with Disabilities - HWD (S08) premium is not paid for an active S08 Assistance Unit (AU)?

Barcode Tickler HW02-90 DAYS NON-PAYMENT OF PREMIUM FEES generates when a client has not paid their premiums for 90 days. This tickler advises the user of record that the client is nearing HWD termination and sanction for non-payment of premiums.

Barcode Tickler HW03- S08 DELINQUENT PMT REC'D generates to the user of record for reinstatement of the AU, when OFR notifies ACES that an S08 client has made a delinquent premium payment on or before the last day of the 4th month of delinquent payment months.

See the Apple Health eligibility manual - WAC 182-511-1250 Healthcare for workers with disabilities (HWD) -- Premium Payments - Clarifying Information - Initial Premium Amount for information on entering the initial premium amount.

What happens if a client is eligible for Healthcare for Workers with Disabilities - HWD (S08) and other Categorically Needy (CN) or Medically Needy (MN) medical coverage?

Barcode Tickler HW01-S99 SPENDDOWN GREATER THAN HWD PREMIUM generates to the user of record when a client is approved for a MN SSI Related w/Spenddown (S99) medical Assistance Unit (AU) and the system finds they meet S08 employment requirements.

See the Apple Health eligibility manual - WAC 182-511-1100 Health care for workers with disabilities (HWD) -- Retroactive coverage - Worker Responsibilities for more information on S08 and S99 eligibility.

Barcode Tickler HW05-S08 CLIENT TURNING AGE 65, REVIEW FOR L22 ELIGIBILITY generates to the user of record 60 days prior to the client turning age 65 for clients who are eligible on an S08 AU . This tickler advises the user of record that the Clint is nearing age 65 and should consider other medical coverage.

See the Apple Health eligibility manual - WAC 182-511-1050 Healthcare for workers with disabilities (HWD) -- Program requirements for more information on the program's age requirements.

Mainframe Processing

How do I screen Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

This function is not available in ACES Mainframe. See Online Processing - How do I screen Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)? for steps on screening S08 medical.

How do I process a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

This function is not currently available in ACES Mainframe. See Online Processing - How do I process a Healthcare for Workers with Disabilities - HWD (S08) Assistance Unit (AU)? for steps on processing an S08 AU.

How do I finalize a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

This function is not currently available in ACES Mainframe. See Online Processing - How do I finalize a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)? for steps on finalizing an S08 AU.

How do I process retro medical for a Healthcare for Workers with Disabilities - HWD (S08) medical Assistance Unit (AU)?

To process retro medical for an S08 AU, see:

After finalizing the retro period for an S08 AU, the AU remains in pending status. ACES sends the Office of Financial Recovery (OFR) the AU information for the retro base period and sends the premium notices to the client.  If the client pays the premiums for all or some of the retro months, OFR sends notification to the system and the pending retro months for months paid are AUTO opened.

NOTE: If retro month premiums are not paid within 120 days from the billing date, the pending retro months are AUTO denied.

What happens if the Healthcare for Workers with Disabilities - HWD (S08) premium is not paid for an active S08 Assistance Unit (AU)?

Barcode Tickler HW02-90 DAYS NON-PAYMENT OF PREMIUM FEES generates when a client has not paid their premiums for 90 days. This tickler advises the user of record that the client is nearing HWD termination and sanction for non-payment of premiums.

Barcode Tickler HW03- S08 DELINQUENT PMT REC'D generates to the user of record for reinstatement of the AU, when OFR notifies ACES that an S08 client has made a delinquent premium payment on or before the last day of the 4th month of delinquent payment months.

See the Apple Health eligibility manual - WAC 182-511-1250 Healthcare for workers with disabilities (HWD) -- Premium Payments - Clarifying Information - Initial Premium Amount for information on entering the initial premium amount.

What happens if a client is eligible for Healthcare for Workers with Disabilities - HWD (S08) and other Categorically Needy (CN) or Medically Needy (MN) medical coverage?

Barcode Tickler HW01-S99 SPENDDOWN GREATER THAN HWD PREMIUM generates to the user of record when a client is approved for a MN SSI Related w/Spenddown (S99) medical Assistance Unit (AU) and the system finds they meet S08 employment requirements.

See the Apple Health eligibility manual - WAC 182-511-1100 Health care for workers with disabilities (HWD) -- Retroactive coverage - Worker Responsibilities for more information on S08 and S99 eligibility.

Barcode Tickler HW05-S08 CLIENT TURNING AGE 65, REVIEW FOR L22 ELIGIBILITY generates to the user of record 60 days prior to the client turning age 65 for clients who are eligible on an S08 AU . This tickler advises the user of record that the Clint is nearing age 65 and should consider other medical coverage.

See the Apple Health eligibility manual - WAC 182-511-1050 Healthcare for workers with disabilities (HWD) -- Program requirements for more information on the program's age requirements.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.