Healthcare for Workers with Disabilities (HWD) (S08)

Created on: 
Nov 22 2019

Online Processing

Mainframe Processing

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 can process Healthcare for Workers with Disabilities (HWD) (S08) Assistance Units (AUs)?

Users with Secured Task HWD Update in their ACES.online profile can complete the following functions for S08 AUs:

  • Screen a new S08 AU,
  • Re-open an S08 AU,
  • Add-a-person to an S08 AU,
  • Reinstate an S08 AU,
  • Initiate an ER for an S08 AU,
  • Enter a date in the Client Chosen HWD Begin Date field, and
  • Update the HWD Employment Good Cause indicator.

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

If an HWD premium isn’t paid for 90 days on an active S08 AU, Barcode tickler HW02-90 DAYS NON-PAYMENT OF PREMIUM FEES generates.  This tickler advises the user of record that the client is nearing HWD termination and sanction for non-payment of premiums.

When the premium is paid, Barcode Tickler HW03- S08 DELINQUENT PMT REC'D generates to the user of record when the Office of Financial Recovery (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?

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

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.

How are S08 (Healthcare for Workers with Disabilities) premiums calculated?

For information on how S08 premiums are calculated, see Apple Health eligibility manual - WAC 182-511-1250 Healthcare for workers with disabilities (HWD) - Premium payments.

How do clients pay their S08 (Healthcare for Workers with Disabilities) premiums?

S08 premiums are paid directly to the Office of Financial Recovery (OFR). For more information, see Apple Health eligibility manual - WAC 182-511-1250 Healthcare for workers with disabilities (HWD) - Premium payments - Worker Responsibilities.

What happens if the S08 (Healthcare for Workers with Disabilities) 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 closes the S08 Assistance Unit and determines 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.

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. On the Client Details page, update the HWD Employment Good Cause indicator:

  • Yes (Y) - Client meets HWD employment requirements
  • No (N) – Client does not meet HWD employment requirement.
NOTE: If the HWD Employment Good Cause indicator is No (N) or blank and there is no earned income coded, the S08 AU will deny for Reason: Employment Requirement Not Met (196).
  1. To complete the interview, follow 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.

What is the Healthcare for Workers with Disabilities (HWD) Employment Good Cause indicator?

The HWD Employment Good Cause indicator is used if a client meets HWD employment requirements at Application or during an Eligibility Review and they have no earned income.

The HWD Employment Good Cause indicator changes to [blank] when a new Healthcare for Workers with Disabilities (HWD) (S08) Assistance Unit (AU) is screened, re-opened, or an Eligibility Review is initiated.

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.

Mainframe Processing

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.

 

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