Oregon Medicaid Work Incentives Jeff Stell, Oregon Department of Human Services

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Medicaid In Oregon - 1 Modified Adjusted Gross Income (MAGI) Medicaid authorized by the Affordable Care Act; Administered by the Oregon Health Authority directly at the 5503 Processing Center; Income limit is 138% of the Federal Poverty Level ($1366 in 2016); No resource limit; No disability, age, or blindness criteria; If receive services, there is no offset. Not eligible for MAGI if receiving Medicare or over the age of 65. Conclusion: working clients with MH disorders who can be on MAGI should be on MAGI.

Oregon Supplemental Income Program – Medical (OSIPM) OSIPM is for individuals who are aged (age 65 or above), blind, or disabled. Income standards are tied to SSI standards ($733 and $2199). Blindness and disability requirements are defined by Social Security Administration. If a person is receiving SSI or Social Security under Title II (or both), they meet the blindness and disability requirements for OSIPM.

Work Incentive Programs for People with Disabilities SSI recipients: Earned income is deducted at basically a $1 of SSI to $2 of earned ratio. Individuals on SSI can work and retain their SSI benefits. As long as a person is receiving SSI, they are “assumed eligible” to receive OSIPM. When a person’s earned income (either by itself or when combined with other income) becomes high enough that it closes SSI, the individual is potentially eligible for 1619(b) benefits. A person determined eligible for 1619(b) retains Medicaid eligibility as long as they are in 1619(b) status. A person in 1619(b) status does not have to pay an offset for services.

Work Incentive Programs for People with Disabilities - 2 For people not receiving SSI or in 1619(b) status, Oregon has the Employed Persons with Disabilities (EPD) program. EPD allows individuals to work without risking Medicaid or services. Working individuals in MH treatment can be eligible for EPD. The individual must meet all of the regular OSIPM eligibility requirements, except where EPD’s requirements are different.

EPD Requirements Must meet Social Security definition of “disabled” or “blind”. This is determined by the Social Security Administration or the Presumptive Medicaid Disability Determination Team (PMDDT). A person already receiving Title II SSB is assumed to meet the disability or blindness requirements for EPD. Must meet the EPD Adjusted Income Standard. All unearned income is excluded when determining eligibility for EPD; Earned income must be less than $5,035 in 2016. Must meet the EPD Resource Limit of $5,000. May also have “Approved Accounts” in addition to other EPD resources. Cannot be “assumed eligible” for OSIPM (SSI or 1619[b]).

EPD Requirements - 2 EPD Participant Fee The EPD Participant Fee is determined by combining the individual’s countable earned and unearned income and comparing it to the EPD Participant Fee Standard. Example: Jeff is in a residential MH treatment facility. He has $900 per month in SSB, and $900 per month in earned income. Per the above chart, his PF is $100. Most individuals on EPD pay $100 per month for the PF. Monthly Countable Income Monthly Participant Fee Under $743 $0 $743 - $989.99 $50 $990 - $2,474.99 $100 $2,475 and above $150

How To Apply Contact your local APD office. If your client already has a worker at APD, contact that person. For a list of local APD offices: http://www.oregon.gov/DHS/Offices/Pages/Seniors-Disabilities.aspx

Questions? My contact information: Jeff Stell Medicaid Policy Analyst Oregon Department of Human Services Aging and People with Disabilities Program (503) 373-1425 Jeff.stell@dhsoha.state.or.us