Workers with Job Success is a new Pennsylvania Medicaid eligibility category that will start April 1, 2023. People who have been covered by Medical Assistance for Workers with Disabilities (MAWD) for twelve months can move from MAWD into Workers with Job Success (WJS) and keep their Medicaid coverage when their income goes over the MAWD income limit.
Workers with Job Success was created through Act 69 of 2021. Even though the law took effect December 28, 2021, it has not yet been fully implemented because of the Medicaid continuous eligibility protections that have been in place since March 2020. These protections prevent people from losing Medicaid even if their income or resources go above the applicable limits. The continuous eligibility protections will end April 1, 2023.
Eligibility for the WJS program
To qualify for Workers with Job Success, someone must meet the following criteria:
- Be age 16 through 64;
- Covered by MAWD for the last twelve months, without a break*;
- Be working and earning income;
- Have countable monthly income over the MAWD limits** but under $7,290 (single); $9,860 (married); and
- Have countable resources under $10,000. Once someone moves to WJS, resources can go above $10,000 without jeopardizing their continued eligibility for WJS or future eligibility for MAWD.
* While the continuous eligibility protections have been in place, someone may have been eligible for MAWD but not moved to the MAWD category. Individuals who would have been in MAWD if not for these protections may need some additional help getting flagged and moved to WJS.
** Please see here for 2023 income and resource limits for Medicaid and Other Health Programs, including MAWD.
Individuals who have been on MAWD for at least the last twelve months, without a break, do not need to wait until April 1st before they can start earning more income. These individuals who start earning more money now, or those who started to earn higher income during the pandemic, can move to the new WJS category if their income is over the MAWD limit when their benefits are renewed after April 1st. As is possible with MAWD, individuals who qualify financially for WJS and functionally for Home & Community Based Services (HCBS) can be enrolled in both programs at the same time.
Both MAWD and WJS require people to pay a monthly premium for their coverage. For most people moving from MAWD to WJS, their premium will increase from 5 percent to 7.5 percent of their countable income. For people with the highest incomes, their premium may be based on their Adjusted Gross Income. In these cases, people will be charged the full cost monthly premium as determined by the Pennsylvania Department of Human Services. The 2023 full cost premium amount has not yet been released. The 2022 full premium amount was $948 per month.
For More Information
The Pennsylvania Department of Human Services created a Frequently Asked Questions document and issued an Operations Memo about Workers with Job Success. Read past PHLP newsletter articles about WJS here. Stay tuned to future newsletters and PHLP’s Resource Library for more information about Workers with Job Success! Our 2023 MAWD Guide is currently posted there. People who have questions about WJS eligibility or who need help getting into WJS after it starts can contact PHLP’s Helpline at 1-800-274-3258 or firstname.lastname@example.org.