Employed Persons with Disabilities Program Presented by Janell

Employed Persons with Disabilities Program Presented by: Janell White, APD Medicaid Policy Analyst

What’s the Benefit? Plus Medical Benefit Package Attendant Care Services Developmental Disability Services Home & Community Based Care Mental Health Services Medicare & Private Ins. Combo

Eligibility Differences Disability only, not age Higher adjusted income limit of 250% of Federal Poverty Level (earned income only) Oregon Supplemental Income Program Medical (OSIPM) = $783 OSIPM-EPD = $2, 603 (changes every March) Deducts additional expenses Higher countable resource limit ($5, 000) Gross earnings up to $5, 291 Employment

Disability Must meet the Social Security Administration (SSA) definition of disability Receiving Social Security Disability Insurance (SSDI) Determination by DHS’s Presumptive Medicaid Disability Determination Team (PMDDT) If SSI, assumed eligible for OSIPM (no EPD) If no SSDI and working, not required to apply, but is encouraged

EPD & Loss of SSDI Going over Substantial Gainful Activity (SGA) SSA disability determination stands for 12 months Presumptive determination must then be completed by the DHS PMDDT looks at earnings and SGA differently for EPD participants OAR 461 -125 -0370

EPD & Loss of SSDI (cont’d) If due to transition to Social Security Benefits (SSB) when at age 65 DHS will check SSA records to see if disability determination was permanent or not If not, PMDDT will determine disability once the SSA determination expires

Employment Ongoing work activity for which the individual provides DHS with proof of one of the following: Tax payments under FICA Tax payments under SECA Clear and convincing evidence of self-employment Individuals who work for organizations that are not required to pay FICA under federal tax laws are considered to meet the definition of employed even if the employer does not file FICA

Employment Examples Self-Employed Pet Sitter Not valid: Donna watches her neighbor’s dog once a month for $5 Valid: Sara pet sits for a variety of people. She typically has 2 -3 jobs per month at an average of $50 per job. She advertises on Craigslist, Rover, and through flyers at local pet stores and veterinary clinics.

Employment Examples Church driver Not valid: Jerry drives parishioners to church events using the church’s van. He is paid a monthly stipend, but is not on the church payroll as an employee, nor is he paid as an independent contractor. Valid: Shawn drives parishioners to church events using the church’s van. He is paid monthly as an independent contractor and is given a form 1099 at the end of the year for tax purposes

Employment Examples Teacher Not valid: Sam is a substitute teacher with the school district. In the Summer she is laid off and first on the list for rehire in the Fall. Valid: Riley is a teacher with the school district. She is contracted, so does not work in the Summer, but is still considered an employee and does not have to reapply each Fall.

Loss of Employment Once eligible, remains “engaged in employment” while not working if the employer treats as an employee, such as when on Family Medical Leave (FMLA) Once employment ends, must report to DHS within 10 days May remain on EPD up to 12 months if ineligible for OSIPM due to resources only Have to remain eligible for EPD, except for employment

Income Deductions Exclude all unearned income (Pensions, SSDI, veterans’ disability) Standard deductions ($85 off earned income) Employment and Independence Expenses (EIEs) Any expense that can reasonably be expected to enhance the individual’s independence and facilitate employment Payments made to an Approved Account

Income Deductions Blind Work Expenses (BWEs) Expenses incurred by blind individuals that facilitate employment and independence Includes costs that workers without disabilities must pay, such as taxes, union dues, and payroll mandatory contributions Impairment Related Work Expenses (IRWEs) Payment for a service or an item that the individual must purchase or rent in order to work. Expense must be directly related to work and must be necessary, due to the disability. Allows earnings over $5, 291

Income Example Luke Income: $6000 Gross Earnings, $1580 SSDI, $800 VA Expenses: $300 to Approved Account (EIE), $150 for interpreter services (IRWE) Exclude SSDI & VA income Standard deduction: $6000 - $85 = $5915 Divide in half: $5915 / 2 = $2957. 50 Deduct expenses: $2957. 50 - $300 (EIE) - $150 (IRWE) = $2507. 50 is under the EPD adjusted income limit of $2603 so Luke is eligible

Approved Accounts Purpose: Disability-Related Expenses Retirement Accounts (401 k, IRA, Keogh, etc. ) Requirements Segregated from other accounts Only individual’s name on account Deposited funds must be from the individual’s earnings or from an employer Monthly contributions are deducted from countable income as an EIE Account balance is not counted as a resource

Participant Fee EPD participants pay a monthly fee as a condition of eligibility Based on total countable earned and unearned income Failure to pay results in closure and overpayment Monthly Countable Income Under $794 - $1, 057. 99 $1, 058 - $2, 644. 99 $2, 645 and above Monthly Participant Fee $0 $50 $100 $150

Participant Fee Example Luke Countable Income: $6000 Earned + $1580 SSDI + $800 VA = $8380 Participant Fee = $150 Monthly Countable Income Under $794 - $1, 057. 99 $1, 058 - $2, 644. 99 $2, 645 and above Monthly Participant Fee $0 $50 $100 $150

Questions?

Who to Contact Janell White APD Medicaid Policy Analyst apd. medicaidpolicy@state. or. us