The MLO Minute: “Workers with Disabilities Can Now Earn More and Still Keep Medicaid!” —
Effective April 1, 2023, Pennsylvania has a new category of Medical Assistance: Workers with Job Success (WJS), which is an expansion of the Medical Assistance for Workers with Disabilities (MAWD) program. MAWD is an important program that allows certain workers with disabilities to still qualify for Medical Assistance, even if they have earned income from their wages that would typically put them over the income limit for regular Medical Assistance. The WJS program expands this income limit even more, meaning that a person can have an even higher income than allowable for MAWD and still qualify for WJS. Importantly, a person may be able to maintain eligibility for their Waiver benefits as well as being in the WJS program as long as they meet the functional eligibility requirements for the Waiver.
In order to qualify for WJS, the individual must be between the ages of 16 and 65, be working and earning income, and have been on MAWD for at least a continuous 12 months. They must have countable monthly income between 250% and 600% of the then-current Federal Poverty Limit for an individual. The MAWD program is for persons with income less than the 250% of the FPL, which means that the WJS program allows a person to have significantly more income and still qualify. In fact, in 2023, a person can have a monthly gross income of up to $7,290.00 (or up to $9,860.00/month for a married couple) and still qualify for WJS if they meet the other requirements. Additionally, to qualify for WJS, the person must have countable resources less than $10,000.00 at the time of the initial eligibility. Once the person is in the WJS program, the resource limit is no longer applicable.
Like MAWD, WJS also has a cost sharing element. Participants in WJS must pay a monthly premium in order to keep their coverage. The premium amount will be determined by the Department of Human Services and will depend on the participant’s gross income. Either a premium of 7.5% of their countable income will be determined (if income is between 250% and 450% of the FPL), or, if the income is over 450% of the FPL, then the person may need to pay a “full cost premium” of (currently) $948.00/month.
Both the MAWD and WJS programs are designed to allow working disabled individuals the opportunity to be employed without the fear of losing their Medical Assistance coverage, and the WJS program expands this. These important programs can allow a working disabled individual to earn more income and maintain greater independence while still maintaining their essential health care coverage through Medical Assistance and the Home and Community Based Services.
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