medicaid buy in for workers with disabilities mbi medicaid buy in for workers with disabilities (...

Download MEDICAID BUY IN FOR WORKERS WITH DISABILITIES MBI MEDICAID BUY IN FOR WORKERS WITH DISABILITIES ( MBIWD)

Post on 25-Dec-2015

215 views

Category:

Documents

2 download

Embed Size (px)

TRANSCRIPT

  • Slide 1
  • MEDICAID BUY IN FOR WORKERS WITH DISABILITIES MBI MEDICAID BUY IN FOR WORKERS WITH DISABILITIES ( MBIWD)
  • Slide 2
  • 2 What is MBIWD? MBIWD is an Ohio Medicaid program that was created to enable Ohioans with disabilities to work and still keep their health care coverage
  • Slide 3
  • 3 Who is Eligible? Answer the following 5 questions to determine who should consider applying for MBIWD
  • Slide 4
  • 4 1.Are you between the ages of 16 and 64? If yes, continue If yes, continue If no, you are not eligible If no, you are not eligible You can age out of MBIWD
  • Slide 5
  • 5 2. Do you have a job that pays you regularly? If yes, you may be eligible If yes, you may be eligible The amount you work doesnt matter The amount you work doesnt matter Having FICA and either state or federal taxes withheld does matter Having FICA and either state or federal taxes withheld does matter Self employed? You must be reporting to the IRS or have last years tax return Self employed? You must be reporting to the IRS or have last years tax return
  • Slide 6
  • 6 3. Do you have a disability that meets the Social Security standard? Yes, if: Yes, if: You are eligible for Medicaid due to disability You are eligible for Medicaid due to disability You receive an SSDI or SSI check You receive an SSDI or SSI check You can earn wages at or above Substantial Gainful Activity (SGA)
  • Slide 7
  • 7 4. Is Your Income < $2,256 a Month ($27,072/Year)? Medicaid counts total income: Medicaid counts total income: benefit checks benefit checks earned income earned income * MBIWD also has a $20,000 * * MBIWD also has a $20,000 annual earnings disregard if needed * http://codes.ohio.gov/oac/5101:1-41-30
  • Slide 8
  • 8 5. Do You Have more than $10,580 in Resources? If no, you may be eligible Resources that dont count: Resources that dont count: the house you live in the house you live in 1 car 1 car term life insurance term life insurance PASS plan PASS plan Resources that do count: Resources that do count: Cash, savings accounts, certificates of deposit, anything you own that could be converted to cash Cash, savings accounts, certificates of deposit, anything you own that could be converted to cash
  • Slide 9
  • 9 Premiums Replace spenddown and patient liability Replace spenddown and patient liability Based on family income over 150% of Federal Poverty Level (10% of the difference) Based on family income over 150% of Federal Poverty Level (10% of the difference) Other health insurance premiums can be deducted from MBIWD premium Other health insurance premiums can be deducted from MBIWD premium
  • Slide 10
  • The 2009 Federal Poverty Levels Persons in Family Poverty Level150% of FPL250% of FPL 1$10,830 $16,245$27,075 2$14,570 $21,855$36,425 3$18,310 $27,465$45,775 4$22,790 $34,185$56,975 5$22,050 $33,075$55,125 6$25,790 $38,685$64,475 7$33,270 $49,905$83,175 8$37,010 $55,515$92,525
  • Slide 11
  • 11 Premium Calculations For a Single Adult Monthly gross income$2,500 Less 150% FPL for single person - $1,354 = $1146 Multiplied by 10% x.10 = $114.6 Other medical premiums- $96.4 Total monthly premium= $18.2
  • Slide 12
  • MBIWD Eligibility and Premium Scenarios 12 For an adult, (unmarried) disabled person with less than $10,580 in resources and monthly health insurance payments of $96.40.
  • Slide 13
  • MBIWD Eligibility and Premium Scenarios Income (earned & unearned) Eligible?Premium Amount $10,000Yes$0 $20,000Yes$0 $30,000Yes$18 $40,000Yes$102 $50,000Yes$185 $60,000Yes$268 $70,000Yes$352 $80,000Yes$435 $90,000 +Non/a 13
  • Slide 14
  • MBIWD Eligibility and Premium Scenarios 14 For an adult, (unmarried) disabled person with less than $10,580 in resources and no monthly health insurance payments.
  • Slide 15
  • MBIWD Eligibility and Premium Scenarios Income (earned & unearned) Eligible?Premium Amount $10,000Yes$0 $20,000Yes$31 $30,000Yes$115 $40,000Yes$198 $50,000Yes$281 $60,000Yes$365 $70,000Yes$448 $80,000Yes$531 $90,000 +Non/a 15
  • Slide 16
  • 16 Once you are eligible what then? If you lose your job you have 6 months to find a new one If you lose your job you have 6 months to find a new one If you get behind (2 months) in paying premiums, you will lose eligibility If you get behind (2 months) in paying premiums, you will lose eligibility If you are determined medically improved you can remain in the program with slightly higher work requirements (40 hours a month earning state or federal minimum wages whichever is lower) If you are determined medically improved you can remain in the program with slightly higher work requirements (40 hours a month earning state or federal minimum wages whichever is lower)
  • Slide 17
  • 17 A Recap of MBIWD Benefits MBIWD removes a major disincentive to work and encourages clients to attain competitive employment as a realistic goal in recovery MBIWD removes a major disincentive to work and encourages clients to attain competitive employment as a realistic goal in recovery
  • Slide 18
  • 18 A Recap of MBIWD Benefits MBIWD does not require a specific number of hours worked only requires regular paid employment - except for the medically improved category MBIWD does not require a specific number of hours worked only requires regular paid employment - except for the medically improved category
  • Slide 19
  • 19 A Recap of MBIWD Benefits There is no spenddown There is no spenddown There may be a small monthly premium There may be a small monthly premium
  • Slide 20
  • 20 W hat is the role of Benefits Planning? Work Incentives planning Work Incentives planning Impact of earnings on benefits Impact of earnings on benefits Assistance completing proper forms Assistance completing proper forms
  • Slide 21
  • 21 W hat is the role of Benefits Planning? Contact local WIPA project for services Contact local WIPA project for services Legal Aid Society of Greater Cincinnati (800) 582-2682 Legal Aid Society of Greater Cincinnati (800) 582-2682 COVA (877) 521-2682 COVA (877) 521-2682 Ohio Legal Rights Service (800) 282-9181 Ohio Legal Rights Service (800) 282-9181
  • Slide 22
  • 22 CMH System Spends $6 Million/month on Spenddown! ~ 27,000 individuals on spenddown ~ 27,000 individuals on spenddown average monthly spenddown = $240 average monthly spenddown = $240 Clients spenddown is met through: Clients spenddown is met through: incurred costs of receiving mental health services incurred costs of receiving mental health services paid by a Board or provider pursuant to Ohio administrative code paid by a Board or provider pursuant to Ohio administrative code
  • Slide 23
  • Individuals with a spenddown, who enroll in MBIWD, go off spenddown.
  • Slide 24
  • 24 Relationship of MBIWD to Medicaid Financing and Spenddown Providers can effectively encourage seeking competitive employment opportunities and/or develop part time work or paid job exploration opportunities within the mental health system (NOTE: Providers will need to address ethical issues of hiring persons treated by their agency) Providers can effectively encourage seeking competitive employment opportunities and/or develop part time work or paid job exploration opportunities within the mental health system (NOTE: Providers will need to address ethical issues of hiring persons treated by their agency)
  • Slide 25
  • 25 Relationship of MBIWD to Medicaid Financing and Spenddown Administrative burden (see next slide) of spenddown is reduced and state and local funds previously used for spenddown are available to be reinvested into service delivery Administrative burden (see next slide) of spenddown is reduced and state and local funds previously used for spenddown are available to be reinvested into service delivery
  • Slide 26
  • 26 Spenddown=Administrative Burden In Cuyahoga County, administrative costs associated with spenddown ranged from approximately $12,000 a year for a provider with a relatively small caseload to $60,000 a year for a provider with a large caseload.
  • Slide 27
  • Spenddown Examples Not Enrolled in MBIWD Hours/MO 70 Hourly Rate $7.00 HI Premium $96.40 SSDI/MO $1,200 Spenddown = $707.10 Enrolled in MBIWD Hours/MO 70 Hourly Rate $7.00 HI Premium $96.40 SSDI/MO $1,200 Spenddown = None Premium = $0 27
  • Slide 28
  • 28 Local area experiences MHACs Assessment of Current and Potential Demand Analysis of number of consumers on spenddown, average amount, and time spent on spenddown Analysis of number of consumers on spenddown, average amount, and time spent on spenddown Review of current programs providing employment services Review of current programs providing employment services Consumer survey Consumer survey
  • Slide 29
  • 29 Consumer Survey Results Consumers from a number of mental health provider agencies in Cuyahoga County were asked to complete a survey about their opinions about employment as it relates to the possibility of enrolling in a Medicaid Buy- In program. Consumers were asked to complete six questions; this report includes the results of those responses*. Consumers from a number of mental health provider agencies in Cuyahoga County were asked to complete a survey about their opinions about employm

Recommended

View more >