Recently, PHLP has heard from many people with disabilities who received notice that they are no longer eligible for Waiver services due to their income. Prior to taking action to end Medicaid benefits, County Assistance Office (CAO) caseworkers are supposed to review people for all possible Medicaid eligibility categories. Although the Medicaid system has information needed to review these people for coverage under the Medical Assistance for Workers with Disabilities (MAWD) category, that is not happening consistently. As a result, people are losing their waiver coverage.We wanted to provide readers with information about how MAWD can help someone stay eligible for Medicaid while keeping their waiver services.
Eligibility for any of Pennsylvania’s home and community-based waiver programs includes both financial and clinical criteria. The clinical criteria vary depending on the waiver program. For example, the Community HealthChoices, OBRA, Consolidated and Adult Autism waivers each have different clinical eligibility criteria. However, the financial eligibility criteria for all PA Medicaid waivers is the same.
Financial criteria include income and resource limits. The 2024 income limit for all waiver programs is $2,829 a month. Only the income of the person getting or applying for the waiver counts toward the income limit. The resource limit for all waivers is $8,000 for single people. Married individuals have a higher resource limit that looks at the couple’s combined assets. People who live with their child(ren) under 21 have no resource limit.
Using MAWD to Qualify for Waiver
People with disabilities who use waiver services (e.g. personal care or skilled nursing to help them live independently) may want to work or already work and want to earn more, but are afraid of going over the waiver income limit and losing their waiver benefit and services. However, if they are ages 16 to 64 and meet the financial eligibility criteria for MAWD (which has higher income and resource limits than the waiver programs) they can get or keep waiver coverage!
People ages 16 to 64 can get MAWD if they are working and have a disability or significant documented health conditions. They must also meet income and resource limits to qualify for MAWD. The MAWD 2024 monthly countable income limit is $3,138 for a single person and $4,259 for a married person (both spouses’ income counts). The MAWD resource limit for single and married individuals is $10,000. To get MAWD, someone must pay a monthly premium equal to 5% of their countable income after all deductions and disregards are taken.
MAWD has different, more generous, income counting rules than the waiver programs. For instance, the waiver allows very few disregards and the entire amount of most gross (before deductions) income someone receives counts against the waiver income limit. In contrast, MAWD disregards $20 from the applicant’s unearned income (e.g. Social Security Disability), and disregards more than half of earned income. If the amount left over after these and other possible disregards is less than the MAWD income limit, they can qualify for MAWD which will allow them to get or keep waiver coverage. For a more full overview of the MAWD income-counting rules, see PHLP’s MAWD fact sheet.
Even though these rules about how MAWD and waiver can work together are not new, CAO caseworkers often do not apply them when reviewing someone’s eligibility and end up terminating or denying waiver even for people who meet the MAWD criteria. And even when workers are aware that MAWD and waiver can work together, there are limitations in the eligibility system that make it challenging to place people in both MAWD and waiver. As a result, even people who have been on MAWD and a waiver for years have been erroneously terminated from the waiver.
PHLP is advocating with the Department of Human Services to address the systemic barriers to MAWD enrollment for people getting or seeking waiver benefits. In the meantime, individuals age 16 to 64 who are working and denied or terminated from a waiver program based on income should call PHLP’s Helpline at 800-274-3258 for free legal help.