MB HWD 1.1.20 Changes



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services DivisionPO Box 45600, Olympia, WA 98504-5600H19-071 Policy & Procedure December 30 2019TO:Home and Community Services (HCS) Division Regional AdministrationsDevelopmental Disabilities Administrations (DDA) Regional AdministratorsArea Agency on Aging (AAA) DirectorsFROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Deputy Assistant Secretary, Developmental Disabilities Administration (DDA)SUBJECT:Apple Health for Workers with Disabilities (HWD). Changes effective 1/1/2020PURPOSE:To explain the changes in the Apple Health for Workers with Disabilities (HWD)BACKGROUND:HWD recognizes the employment potential of people with disabilities. The enactment of the federal Ticket to Work and Work Incentives Improvement Act of 1999 enables many people with disabilities to work and keep their health care. HWD is a categorically needy Medicaid program for workers with disabilities. The program has no asset test but does have premium payment requirements. Until 1/1/2020, the countable income limit is 220% of the federal poverty level, (currently it is $2,290 for 1 person, $3,100 for 2 people), and the age limit is 16-64. Starting 1/1/2020 there is no income limit and no age limit. Those eligible for HWD can receive HCBS Waiver, CFC or MPC if functionally eligible and approved. HWD clients do not pay participation toward the cost of personal care, but must pay room and board when residing in an alternate living facility. HWD covers nursing facility (NF) admissions that are under 30 days as a short stay. A redetermination is done from HWD/S08 to NF/L02 for NF admissions of 30 days or more. WHAT’S NEW, CHANGED, OR CLARIFIED:Beginning in January 2020, Washington State is?making changes to its Apple Health for Workers with Disabilities (HWD) program. Changes include the removal of income caps and maximum age limits that currently force some workers with blindness or disabilities to choose between keeping their health care, including essential services and supports, and keeping their jobs.?The effect of these changes will be to increase the amount of money people can earn, and the length of time people can work and still receive services under the HWD program. These work incentives align with the supported employment initiative. They encourage more people to work without risking their health care.Clients will be able to save earnings accumulated while on HWD in a separate account that will be excluded from future SSI-related Apple Health program eligibility. This can occur if a client needs a redetermination to another program because they are no longer employed at renewal or are admitted into a nursing facility for 30 days or more. This account is coded as “Earnings Accumulated while Enrolled in HWD-Exempt MA (EH)” in ACES. Clients who are age 65 or older and employed do need a disability determination, if a current one is not already established based on BENDEX data or information in the electronic case record (ECR). A non-grant medical assistance (NGMA) referral to the Division of Disability Determination Services will be needed for those 65 and older applying for HWD when there is no current disability documented in the record. HCS has assigned HWD public benefit specialist (PBS) staff by region who determine eligibility for the program. DDA has assigned HWD PBS staff who determine eligibility for those on DDA services and those who are not receiving any services from DDA or HCS. This list of HWD PBS staff is attached below. HWD PBS staff are also listed in the Apple Health manual under HWD. ACTION:DDA and HCS HWD PBS will be sending general correspondence letters prior to 1/1/2020 based on a barcode ad-hoc list of clients who are 65 and older with earnings, giving them information on the HWD changes. In most cases the HWD premium is much less than HCBS Waiver participation, when participation toward service cost is required.HWD PBS specialty staff will receive training on the 1/1/2020 changes in 11/2019.HCS will be adding an article about the HWD changes in the wellness newsletter that is sent out to HCS HCBS Waiver clients. What should staff do if a client reports employment or wants to be employed?For HCS and AAA social worker/case management staff:Notify the HWD PBS in your region if the client is not on SSI and may benefit from HWD. Clients on SSI report their wages to the Social Security Administration for the determination of Medicaid. If the client is on food benefits, wages must be reported to PBS staff. The list of PBS HWD specialists by region is attached below. Notify the HCS Employment team at SupportedEmployment@dshs. or 1-844-427-8256 or contact a Regional Employment Specialist when a HCS client starts employment or wants to be employedR1 Jim Bischoff Support Employment Specialist 509-585-8073 HYPERLINK "mailto:James.Bischoff@dshs." James.Bischoff@dshs. R2 Krystal Baumann Support Employment Specialist 360-522.2363 HYPERLINK "mailto:Krystal.Baumann@dshs." Krystal.Baumann@dshs. R3 Vicki Gilleg, Support Employment Specialist 360-870-4918Vicki.Gilleg@dshs. Send or give the client information on the HWD program: HCA 22-333 Apple Health For Workers with Disabilities HCS Public Benefit Specialists (PBS)Applicants:When a request is received, via an application for HWD, the Financial Applications Customer Service Specialist or the Public Benefit Specialist based on regional processes will make the initial contact and document the following in narrative:Is the client physically working or not? This does not include collecting sick leave and other employment based benefits. If speaking with the client, verbally request verification of earnings.Forward the application to the appropriate regional HWD PBS. The HWD PBS will review the application within 5-days of receipt. If discovered that it will be more beneficial for the applicant to receive HCBS Waiver services, the HWD PBS will communicate to the HCS PBS based on regional processes for assigning new applications and the PBS will process the HCBS Waiver application. The PBS will also communicate vice versa to the HWD Specialist. Recipients:The current PBS will request verification of earnings by sending the Employment Verification (Form No. 14-252). You can attach this form to an ACES letter. Send an e-mail correspondence to your Regional HWD Specialist. Do not forward in DMS. The HWD Specialist will be responsible for closing and opening HWD cases, the HWD specialist will redetermine eligibility for the appropriate medical program. If there is any overpayment for HCBS Waiver or Basic Food (SNAP), the PBS for the assigned alphabet will process it. DDA:Questions regarding HWD for DDA clients and those not on HCS services should be referred to the HWD toll free number at (800) 871-9275.For DDA Case Resource Managers: For clients who are working:If a client is on a HCBS waiver that includes employment supports and wants to increase paid work hours or wages, but has concerns about their benefits, please connect with your Regional Employment Specialist to explore resources:Region 1 – Carrie Bayha, 509.374.2128Region 2 – Rod Duncan, 425.740.6453Region 3 – David Money, 253.404.5553If a client receives employment supports funded through a State Only ETR, prior to the next assessment contact the client about expanded HWD and possible Medicaid eligibility. If client is found Medicaid eligible the Case Resource Manager (CRM) will submit a waiver request.3. Case resource managers should watch the How Public Benefits Support Employment: Apple Health for Workers with Disabilities Talking Points for DDA CRMs to learn more about how to discuss HWD with clients. DDA Public Benefit Specialists (PBS): Process for a client currently receiving DDA services who is working and their income and/or resources are over the current program limit(s); when a change is reported by the client, a CRM via 15-345, or the LTC PBS discovers the change:The current medical program remains active to allow the client to provide verification or take corrective action to remain income and resource eligible.The LTC PBS will contact the client or authorized representative (AREP) and request additional information by phone and/or mailing a Request for Information letter (023-02) to include specified mandatory text based on the Long-Term Care & Specialty Programs Unit’s process and procedures.Income:The LTC PBS will review and verify the current and anticipated on-going income, and budgeting method; to include if the client’s income has reduced, is temporary, or if the client plans to reduce their work hours.Resources:The LTC PBS will review, and address excess resources; to include if the client plans to spenddown or convert to an excludable resource.After the LTC PBS reviews and verifies all changes they will determine if an HWD referral is required.If the client’s income and/or resources are and will continue to exceed the program limit, and if the client/AREP prefers to maintain their current income and/or resources with the understanding that they will have to pay a monthly premium for medical benefits:The LTC PBS will document in the narrative, set a communication (COMM) tickle to @HWD notifying the HWD Specialists of the request for HWD consideration, and notify the client via mail of the HWD referral;Current medical program will remain active during the HWD referral process;Once HWD eligibility has been determined, the HWD specialist will terminate the current medical program.Process for a working client who has just been determined functionally eligible for DDA services and their income is over the CN limit or SIL:The LTC PBS will start application process to include completing an interview, and requesting required verification that is needed to determine financial eligibility. One verification is received, and the LTC PBS determines an HWD referral is needed; the LTC PBS will document in the narrative, and notify the HWD specialists for HWD consideration.Process for working clients who are not receiving and have not requested HCBS:When a request is received via an application for HWD, the application will be assigned to @HWD for financial eligibility to be determined by an HWD Specialist.For HWD referrals from CSD:The PBS will process all applications and other general case action for Basic Food, S02, and other related programs;If the client is not active on HWD, determine if the client is potentially eligible, including being employed before referring to the HWD program. If potentially eligible, follow HWD referral process located in the CSD Procedure Handbook. Only an HWD specialist will determine financial eligibility if a client is changing from HWD to another medical program.RELATED REFERENCES: Health Care Authority Announcement on HWD changes: 22-333 Apple Health For Workers with Disabilities Handout for clientsApple Health Manual Working clients and long term services and supports: ACES instructions Healthcare for Workers with Disabilities: new rule on Apple Health for Workers with Disabilities in Chapter 182-511 WAC will be final on 1/1/2020. The text of the new rule is located at: Public Benefits Support Employment: Apple Health for Workers with Disabilities - Talking Points (S):\s\s\s\sCONTACT(S):Michael Corcoran HCS Employment Program Manager 360-725-2614 Michael.Corcoran@dshs. Lori Rolley HCS Financial Eligibility and Policy 360-725-2271 Lori.Rolley@dshs.Ann M. Vasilev, HCBS Waiver Services Unit Manager 360-407-1551 Ann.Vasilev@dshs.Branda Matson DDA Employment & Day Unit Manager 360-704-1522 Branda.Matson@dshs. Marcie Birdsall, DDA LTC & Specialty Programs Unit Manager 360-407-1576 Marcell.Birdsall@dshs. ................
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