Idaho Admin. Code r. 16.03.05.799

Current through September 2, 2024

Section 16.03.05.799 - MEDICAID FOR WORKERS WITH DISABILITIES

An individual is eligible to participate in the Medicaid for Workers with Disabilities coverage group if the individual meets the requirements below.

01.Non-Financial Requirements. An individual must:

a. Be at least sixteen (16) but less than sixty-five (65) years of age;

b. Meet the Medicaid residency requirement under Section 100 of these rules;

c. Meet the citizenship requirements under 42 CFR 435.406, Citizenship and Non-citizen Eligibility;

d. Meet the SSN requirements under Section 103 of these rules; and

e. Meet the child support cooperation requirements under Sections 703 through 706 of these rules.

02.Disability. An individual must meet the medical definition for having a disability or blindness used by the SSA for Social Security Disability Insurance (SSDI) and SSI benefits.

03.Employment. An individual must be employed which may include self-employment. Proof of employment must be provided to the Department. Hourly wage or hours worked will not be used to determine employment.

04.Countable Resources. Cannot exceed ten thousand dollars ($10,000) for an individual or fifteen thousand dollars ($15,000) for a couple. When calculating resources, the following items will be excluded:

a. Any resources excluded under Section 210 and Sections 222 through 299 of these rules;

b. A second vehicle as described in Section 222 of these rules;

c. Life insurance policies;

d. Retirement accounts; and

e. Exempt trusts as described in Section 872 of these rules.

05.Countable Income. Is calculated using exclusions and disregards as described in Sections 300 through 547 of these rules. The countable income for:

a. An individual cannot exceed five hundred percent (500%) of the current federal poverty guideline for a household of one (1).

b. A couple cannot exceed five hundred percent (500%) of the current federal poverty guideline for a household of two (2).

06.Earned Income Test. Gross income is the total of earned and unearned income before exclusions or disregards. Each individual's gross earned income must be at least fifteen percent (15%) of their total gross income to qualify.

07.Cost-Sharing. A participant in the Medicaid for Workers with Disabilities coverage group may be required to cost-share; the costs are determined under the provisions in IDAPA 16.03.18, "Medicaid Cost-Sharing."

Idaho Admin. Code r. 16.03.05.799

Effective July 1, 2024