Medicaid Insurance for Workers with Disabilities

Medicaid Insurance for Workers with Disabilities (MIWD)

Medicaid Insurance for Workers with Disabilities (MIWD), referred to by some as Nebraska's Medicaid Buy-In, is intended to allow people who are competitively employed and who, because of wages would lose their benefits, to purchase Medicaid like private insurance. The program is administered by the Nebraska Department of Health & Human Services and was implemented in July of 1999.

View the MIWD brochure.

Many people with disabilities want to work but worry that doing so could jeopardize their vital health and long term care coverage. MIWD offers people with disabilities who are working or interested in working the opportunity to keep their Medicaid coverage while on the job. Benefits include the same as those available through Nebraska Medicaid; the opportunity to earn more without the risk of losing health care benefits and support services; higher income eligibility; increased personal and financial independence; and Personal Assistance Services (PAS) at the workplace.

Your local DHHS Medicaid Eligibility Worker can provide you with eligibility and enrollment information *or you can contact a Work Incentives Specialist with Easter Seals Nebraska to help you with your benefits and answer questions. Contact Easter Seals Nebraska at 1-800-471-6425.

*The Nebraska Department of Health and Human Services has offices serving each of Nebraska's 93 counties. Contact information for each office, as well as other offices that provide DHHS-related services, can be found at the Nebraska Department of Health and Human Services website.

What are the Social Security disability thresholds for 2008?
For Substantial Gainful Activity (SGA), they are:

For Substantial Gainful Activity (SGA), they are: Non-blind: $940 per month Blind: $1,570 per month.
The monthly earnings amount Social Security uses to determine if a month counts for the Trial Work Period (TWP) is $670 per month.
The Supplemental Security Income (SSI) Federal Benefit Rates (FBR) is $637 for an eligible individual and $956 for an eligible couple.
The monthly income amounts that will have no effect on eligibility or benefits for SSI beneficiaries who are students is $1,550 and the yearly maximum is $6,240.

FAQ about Medicaid, Medicare, SSI and SSDI

Medicaid Insurance for Workers with Disabilities (MIWD) Eligibility

Many people with disabilities want to work, but they don’t because they fear they will lose their needed Medicaid benefits. Nebraska’s Medicaid Insurance for Workers with Disabilities (MIWD) offers a workable solution to this problem. It allows people with disabilities who are working or want to work the opportunity to buy their health care coverage.

Through Nebraska’s Medicaid Insurance for Workers with Disabilities, people can:

Earn more save more and keep their health care coverage.
Medicaid provides qualifying individuals a broad range of medical/health services that employer health insurance may not cover (e.g., pre-existing conditions or personal assistance services.
The MIWD allows qualifying people with disabilities whose income levels are too high for them to receive SSI, to purchase Medicaid coverage much like one would purchase any health insurance policy.
The MIWD program may be appropriate for disabled (AABD) clients who are working and would otherwise qualify for Medicaid but have a Share of Cost due to earnings. The MIWD program has a small client base state wide, but an awareness about the program is important. Some also refer to this program as Working Disabled.

Main MIWD program points to be aware of:

The individual must qualify for Medicaid except for income (Share of Cost);
Be determined disabled by Social Security or State Review Team;
Have income within guidelines using a 2 part test.
Only Medicaid workers determine eligibility for MIWD.
Easter Seals does a benefit analysis with individuals to help them make employment decisions.
Social Security determines if an individual qualifies for any trial work period time if gross earnings are $620 or more per month.

Useful Resources:

Independent Living Centers and Their Contact Information
Please contact an Independent Living Center in your area for more information.

Chapter 8 Regulations for Medicaid Insurance for Workers with Disabilities

Flow Chart for Medicaid Insurance for Workers with Disabilities

One-Stop Career Centers Employment Systems
One-Stop Career Centers were created by the Workforce Investment Act of 1998 and are designed to serve as a streamlined delivery system for both businesses needing to hire workers and people seeking jobs, including people with disabilities.

Procedures for Working Disabled Medicaid Premium Payment:

Test A - Income Steps

Disregard all the disabled individual's earned income.
Disregard all the disabled individual's unearned income that is based on a trial work period.
1. Social Security Disability payment is disregarded if he/she is in a trial work period. The worker must contact Social Security to verify the trial work period.
2. VA Disability payment, Worker's Compensation payment , Civil Service disability, and private disability insurance must be verified with the source to determine if the receipt of the payment is based on that source's trial work period.
Count all other unearned income for the disabled individual and spouse.
Count the spouse's net earned income ($65 + 1/2 disregarded).
Total the countable income for the individual or couple; if
1. Greater than the single or couple FBR ($637 or $956) = Fail Eligibility
2. Less than or equal to the single or couple FBR ($637 or $956) = Pass and go to Test B.

Test B - Income Steps

Calculate the countable earned income. Give the $65 + 1/2 disregard to the individual or couple. [The disabled individual's earned income IS counted, unlike Test A.]
Calculate all gross unearned income for the individual or couple. Only give the $20 general income disregard and the $10 interest/dividend disregard on ALL unearned income. [The disabled individual's unearned income that was disregarded in Test A is now counted.]
Total all countable income for the individual or couple.
1. If countable income is EQUAL to or GREATER than 250% of Federal Poverty Level for the household = FAIL eligibility for Working Disabled Medicaid Premium Payment (MIWD). Reject the case with a manual IM-8 unless the individual chooses a share of cost.
2. If countable income is LESS than 200% of Federal Poverty Level for the household [101% through 199%] = PASS eligibility for Working Disabled Medicaid Premium PAYMENT. [200% FPL 1 = $1,734, 2=$2,334] The disabled individual would also be eligible for Medicare Part B buy-in.
3. If countable income is 200% to 250% of Federal Poverty Level [200% through 249%] = PASS eligibility for Working Disabled Medicaid Premium Payment (MIWD) WITH A MONTHLY PREMIUM PAYMENT. [See chart] The disabled individual in NOT eligible for Medicare Part B buy-in.

Disability Determination
Individuals currently receiving a Social Security Disability payment (SSDI) will not need an additional disability determination. All other individuals considered for this program must have a disability determination from the State Review Team (SRT).