Section 477-27-005 - MEDICAID INSURANCE FOR WORKERS WITH DISABILITIES (MIWD) Individuals who meet the necessary disability criteria, have income within income guidelines, and are working may be eligible for Medicaid Insurance for Workers with Disabilities (MIWD). An individual may be eligible for Medicaid Insurance for Workers with Disabilities (MIWD) in either the Basic Coverage Group or the Medical Improvement Group, as defined by The Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999. After application of income disregards, individuals with income less than 200% of the Federal Poverty Level (FPL) are eligible for Medicaid with no premium; individuals with incomes of 200, but less than 250 % of the Federal Poverty Level (FPL) are eligible for Medicaid with a monthly premium payment.
005.01TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT (TWWIIA) BASIC COVERAGE GROUP ELIGIBILITY REQUIREMENTS. In order to receive Medicaid in the Basic Coverage Group, the individual must meet the requirements below: 005.01(A)AGE. An individual must be at least 16, but less than 65 years old.005.01(B)DISABILITY. An individual must be determined disabled by the Social Security Administration (SSA) or state review team (SRT). This determination is made without regard to earnings.005.01(C)EARNED INCOME. Participants must have earned income, which includes self-employment.005.01(D)INCOME LIMIT. Combined countable earned and unearned income of the household is more than 100%, but less than 250% of the Federal Poverty Level (FPL).0050.1(E)RESOURCE LIMIT. Countable resources are no more than $4,000 for an individual or $6,000 for a couple.005.02TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT (TWWIIA) MEDICAL IMPROVEMENT GROUP ELIGIBILITY REQUIREMENTS. In order to receive Medicaid in the Medical Improvement Group, the individual must meet the requirements below: 005.02(A)AGE. An individual must be at least 16, but less than 65 years old.005.02(B)EARNED INCOME. Participants must have earned income, which includes self-employment. 005.02(B)(i)MINIMUM AMOUNT. Medical Improvement Group participants must earn at least the Federal minimum wage and be employed at least 40 hours per month.005.02(C)INCOME LIMIT. Combined countable earned and unearned income of the household is more than 100%, but less than 250% of the Federal Poverty Limit (FPL).005.02(D)RESOURCE LIMIT. Countable resources are no more than $4,000 for an individual and $6,000 for a couple.005.02(E)BASIC COVERAGE GROUP. Medical Improvement Group participants must have been enrolled in the Basic Coverage Group, but lost eligibility due to a medically improved disability.005.02(F)MEDICALLY IMPROVED DISABILITY. Medical Improvement Group participants no longer meet the medical criteria for disability as defined by the Social Security Administration (SSA) or state review team (SRT) under section 002.02(C)(ii)(1). Medical Improvement Group participants must continue to have a medically improved disability. 005.02(F)(i)DEFINITION. A medically improved disability is determined by the Department, and is defined as: (1) A medically determinable severe impairment which continues to substantially limit the ability to work or conduct daily life activities;(2) The mental or physical health condition has been stabilized by assistive technology, medication, treatment, monitoring by medical professionals, or a combination of these factors, and the loss of medical services may result in a deterioration of the condition; and(3) The loss of medical assistance could result in the individual's inability to continue in the workforce or health problems would regress to the point where the individual would meet the Social Security Administration (SSA) or state review team (SRT) definition of disabled.005.02(F)(ii)DOCUMENTATION. The determination that an individual has a medically improved disability is reviewed by the Department every 12 months. During this review, the Department will analyze findings reported by a physician following a diagnostic examination of the individual. The report may be made from information in existing medical records from a physician, clinic, or hospital where the individual has been treated if the treatment was directly related to the impairment. The medical documentation must reflect examination or treatment received within the prior 12 months. There must be medical information from an examination which has occurred within three months of the time period for review.005.03DISABILITY DETERMINATION. Individuals who are not receiving a Social Security Disability payment must be determined disabled by the state review team (SRT). Receipt of a Social Security Disability Insurance (SSDI) payment meets the disability requirement.005.04PREMIUM PAYMENT. Participants in either the Basic Coverage Group or the Medical Improvement Group who have income of 200% or more of the Federal Poverty Level (FPL) but less than 250% must pay a monthly premium in order to receive coverage. The amount of the monthly premium is calculated according to the chart at 477-000-012. 005.04(A)PREMIUM DUE. If the individual is determined eligible for Medicaid with a premium, the individual must pay the full premium no later than the 21st day of the month following the month for which the payment is designated. Failure to pay the required premium by the 21st of the following month will result in ineligibility for the month for which the premium was owed.477 Neb. Admin. Code, ch. 27, § 005
Amended effective 9/28/2021