1. Cheri Herman Long Term Care Coordinator Division of Public Assistance

2. Role of Division of Public Assistance DPA caseworkers determine: Eligibility for Adult Public Assistance Eligibility for Regular and Specialized Medicaid programs When the Division of Health Care Services needs to be alerted to a Medicaid recipient’s need for Medicare Buy-in 2

3. Who Must Apply for SSI? If you are age 65 or older and your monthly income is less than the SSI need standard, you must apply for SSI in order to establish eligibility for Adult Public Assistance (APA) cash assistance. SSI is Supplemental Security Income, it is needs based federal program for seniors and persons with disabilities. A person applies for SSI through the Social Security Administration. 3

4. APA Resource Requirements Resource eligibility: $2,000 in liquid resources for an individual $3,000 in liquid resources for a couple When resources are counted: If at the first moment of the month an individual/couple is over the resource limit there is no eligibility for that month 4

5. APA Need Standards Individual living independently or in an assisted living home: $1,339 in 2014 Couple with one eligible living independently or in an assisted living home: $1,608 in 2014 Couple with both eligible living independently or in an assisted living home: $1,983 in 2014 5

7. Why Working Disabled Medicaid Buy-In? Working Disabled Medicaid Buy-In allows a disabled individual or the spouse of a disabled individual to enter the work force without the risk of losing needed medical coverage The Working Disabled Medicaid Buy-In has higher income and resource limits than Regular Medicaid The Working Disabled Medicaid Buy-In category may require the payment of a small monthly premium 7

8. Who May be Eligible for Working Disabled Medicaid Buy-In? The Division of Public Assistance will consider the Working Disabled Medicaid Buy-In category when: An individual, currently receiving APA/SSI benefits returns to work and it is the earned income wages of the disabled individual or the disabled individual’s spouse that cause ineligibility for continued APA/SSI benefits An individual applies for APA and APA-Related Medicaid benefits and in reviewing the application it appears it is the earned income of either the applicant or the applicant’s spouse that causes ineligibility for APA and APA-Related Medicaid 8

9. Working Disabled Medicaid Buy-In Disability Requirements The disabled individual must be determined disabled using Social Security Regulation. This can happen by: Having received Supplemental Security Income (SSI) and losing eligibility due to earned income Receiving Social Security Disability (SSDI) payments Having a State Only Disability Decision completed* * Note: The Division of Public Assistance is the only agency that can initiate a State Only Disability decision 9

10. Working Disabled Medicaid Buy-In Income and Resources Working Disabled Medicaid Buy-In income limit is 250% of the Federal Poverty Level (FPL) the monthly income limit is: $2,990 for a single individual $4,038 for a couple $5,086 for a family of three ($1048 for each extra person) The resource limit is: $10,000 for an individual $15,000 for an individual living with his or her spouse 10

11. Working Disabled Medicaid Buy-In Income Tests There are two income tests when determining eligibility: Test #1: Family Income Test: The family’s monthly income cannot exceed 250% of the poverty level. Test #2: The disabled individual’s unearned income (i.e. Social Security Disability) must be within the APA Income Standards. Only the unearned income of the individual and his or spouse will count in this test. 11

12. Working Disabled Medicaid Buy-In Household Members The applicant, applicant’s spouse, and any dependent children are counted in the household size Dependent means: The natural or adopted child of either the eligible or ineligible spouse, who lives in the same household. The dependent must be under the age of 18 or under the age of 22 if a student regularly attending school or post- secondary education. 12

13. Working Disabled Medicaid Buy-In Premiums May Be Required Households with an annual family income that is less than 100% of the Federal Poverty Level (FPL) will not have a monthly premium No one will be charged a premium in excess of 10% of their annual net family income The Division of Health Care Services (DHCS) determines the monthly premium amount, sends notice of the premium due, and collects the premiums 13

14. What if Medicaid is Needed and Income Exceeds 250% of FPL? The State of Alaska allows the use of Qualifying Income Trusts (QITs) A QIT is a legal instrument that an individual can use to bring the individual’s income within the Medicaid Need Standard so they can qualify for Medicaid coverage However, a QIT is a legal tool that must be carefully considered and legal advice should be sought before starting the process 14

15. Qualifying Income Trusts Qualifying Income Trusts (aka Miller Trusts) Irrevocable Composed of income only Trustee named Must stipulate that upon death all remaining trust funds (up to the amount paid by Medicaid) must be paid to the State of Alaska 15

17. Dual Medicare / Medicaid Recipients When a Medicaid recipient is also a recipient of Medicare the following happens: The State will begin to pay for the Medicare premiums – this is called “Buy-in” Medicare is the first payer and Medicaid is secondary Most prescription drug coverage is provided through the Medicare Part D plan, except for uncovered prescriptions 17

18. How Medicare Buy-In Works The Division of Public Assistance caseworker enters specific codes when authorizing the Medicaid benefits These codes tell the Division of Health Care Services (DHCS) that the Medicaid recipient also is a Medicare beneficiary DHCS then sends information to Medicare and begins to pay the premiums Sometimes there is a delay in Buy-in starting, if this happens the Medicaid recipient is reimbursed 18

19. Questions? Division of Public Assistance Contact Information Cheri Herman 3601 C St, Ste 460 Anchorage, AK 99524 Phone (907) 269-7854 Fax (907) 269-3099 Medicaid Policy Specialist dpapolicy@alaska.gov 19