Medicaid Works

Medicaid Works is a program for people with disabilities who work. Under this program, workers with disabilities who earn less than 250 percent of the Federal Poverty Level, can pay a monthly premium and buy into the Medicaid program.

Eligibility Information

Any person who is between the ages of 16 and 64 who has a disability and is working can apply for the program.  The person must also meet the Social Security definition of disabled and earn less than 250 person of the federal poverty level as noted in the chart listed below. A person cannot have more than $5,000 in personal assets.

NOTE:  these income limits change in April of each year.

Except for earnings, all applicants must continue to meet the Social Security definition of disability and meet the all other requirements of the program. Earnings due to work are not a consideration in determining whether a disability exists.

Can I qualify for the program if I am an immigrant?

Disabled immigrants who might be eligible for the program include qualified immigrants such as:

• Lawful Permanent Residents. 
• Immigrants Granted Asylum under section 208 of the Immigration and Nationalization Act (INA). 
• Refugees admitted to the United States under section 207 of the INA. 
• Immigrants paroled into the United States under INA section 212(d)(5) for at least one year. 
• An immigrant whose deportation is being withheld under section 243(h) of the INA. 
• An immigrant granted conditional entry under section 203(a)(7) of the INA. 
• An immigrant who is Cuban and Haitian Entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980. 
• Battered immigrants who meet the requirements for qualified alien status.

Whose income is counted?

In the Medicaid Works Program, the income of the working disabled individual is counted.  There is a limit of $657 on the amount of unearned income a person can have.  Some examples of unearned income include money received through Social Security benefits, workers’ or veteran’s compensation or interest.  This limit changes each year.  If the applicant is married, spouse income is only counted if it is over $45,000 per year.

Can I have a retirement fund?

Yes. Any employer or individual retirement plan approved by the Internal Revenue Code is permissible under the program (for example, an Individual Retirement Account).

How do I prove I am working?

A person applying for the Medicaid Works program must provide proof of employment (for example, pay stubs or written verification from the employer that verifies employment.)

If you are self-employed, you will have to provide records (for example, W-2 forms) to demonstrate employment. Also, for the independent contractor, verification may be provided with a 1099 IRS form as proof of income and employment.

If I am in the program, do I have to let you know when my income or address changes?

Yes.  You are required to report all changes in income, name or address to your case worker within 10 days of the change.

Do I have to pay a premium?

Yes. To buy into the program you must pay a monthly premium. The monthly premium amount is:

• $35 if your income is between $867 - $1,300 per month
• $45 if your income is between $1,301 and $1,734 per month
• $55 if your income is between $1,735 and $2,167 per month

You will receive a monthly premium payment notice that will be due by the 5th of each month.  You will pay your premiums one month in advance.  Your first premium will be for two months.   The remainder of your premiums will be for one month.  You can receive a 10% discount if you pay on a quarterly or annual basis.

Can my premium be increased or decreased?

Yes. If your income increases or a decreases your premium payment may change.

What if I fail to pay my premium payments?

You will receive notices of premiums that are due each month.  If the payments have not been received for two months in a row, you will be sent a notice telling you that you are no longer in the program.
If you are no longer in the program because you did not pay your premium for two months in a row and you want to come back into the program, you will have to pay any missed premiums before you can reapply for benefits.

Are there other costs for the program in addition to premiums?

Yes, the usual Medicaid co-payments for services apply to the Medicaid Works Program.  Please refer to the Global Choices benefit package in KYHealth Choices for co-pay and benefit information.

Can I apply for the program if I already receive SSDI and Medicare?

Yes.  As long as you are working, and meet all other eligibility criteria, you can buy into Medicaid with an affordable premium payment under the Medicaid Works program.

Can I apply if I have other health insurance?

If you have other health insurance, you would continue to use that insurance as the primary payer for your medical care.  Your other insurance may not cover all the services you need.  You can have private or employer health insurance and receive services through Medicaid Works.

What if I stop working after I get into the program?

If you quit your job or lose it for some reason but plan on returning to work, you can continue to receive benefits under the program for 6 months.  If you have not returned to work within 6 months, you will no longer be in the program.  When you get another job you can apply for the program again

Where do I go to apply for the program or if I have more questions?

To apply for the program, you should go to your local Department for Community Based Services office.  If you do not know where your local office is, you can call (800) 635-2570.