The Medical Assistance for Workers with Disabilities (MAWD) program provides comprehensive health coverage to employed people with disabilities for a nominal monthly fee. As with all Medical Assistance (Medicaid or MA) programs in Pennsylvania, there are income and resource guidelines that must be met to qualify. Typically, income and other qualifications must be certified every six months. However, during the COVID-19 emergency, the state issued three new policy clarifications about income instability and the ongoing need for care that treat income and resources leniently.
- PMW-19831-316: MAWD premium assistance during the COVID-19 pandemic.
- As noted above, there are income guidelines to qualify for the MAWD program. However, in addition to meeting the income limits, MAWD recipients are responsible for paying a monthly premium (usually 5% of their countable monthly income) for their health coverage.
- During the COVID-19 emergency, many people have been laid off, furloughed, or had their income severely reduced. In a prior clarification, the state has allowed MAWD recipients to self-report a decrease income to lower their monthly MAWD premium.
- If a MAWD recipient reports unemployment due to the COVID-19 emergency, the County Assistance Office (CAO) will review the recipient for other categories of MA coverage. If not eligible for other MA coverage, the CAO will maintain MAWD coverage. The CAO will give “good cause” for each month of the COVID-19 emergency. Previously, the CAO would only extend the good cause exception for two months.
- In short, this policy allows MAWD recipients who do not qualify for any other type of Medical Assistance to remain in the MAWD program, even if they are unable to pay their premium. It remains in effect for the duration of the COVID-19 emergency.
- PMW-19917-316: Extending the MAWD age limit during the COVID-19 emergency.
- Prior to the COVID-19 emergency, MAWD coverage only lasted until the recipient reached the age of 65.
- However, to maintain health coverage for as many people as possible during this emergency, the State has ordered that when a recipient turns 65, their CAO automatically reviews for all other types of Medical Assistance.
- If the individual has income or resources that exceed the income or resource limits for other MA categories, the CAO should complete an override to maintain full MA coverage.
- If the individual has Medicare and is eligible for Buy-In only, the CAO will complete an override to enroll the individual in Buy-In and maintain full MA coverage.
- In short, this policy ensures there will be no lapse in coverage or denial of Medical Assistance for individuals switching to Medicare at age 65 for the duration of the COVID-19 emergency.
- PMW-19919-316: MAWD reinstatement for individuals that were terminated from the MAWD program based on non-payment of their January and February premiums
- Prior to the COVID-19 emergency, MAWD recipients could be terminated for non-payment of their MAWD monthly premium.
- The state has allowed MAWD recipients to self-report that they mailed their premium payment, for January and February 2020, to the MAWD mailbox. If they were terminated for nonpayment of their premiums during those months, the CAO should reinstate the individual’s MAWD coverage.
- The reinstatement period has been extended from 30 to 60 days.
These policy clarifications are the state’s attempt to maximized MAWD enrollment during the COVID-19 emergency. If you or someone you know has lost MAWD or MA coverage during the pandemic, please call our Helpline at 1-800-274-3258. We will be happy to assist and provide guidance during these uncertain times.