presented by scott lay and janet stevely

Seniors and People with Disabilities Division of the Oregon Department of Human Services

This presentation is sponsored by the Oregon Competitive Employment Project, which is part of the Oregon State Department of Human Services, Office of Vocational Rehabilitation Services. The project is funded

through a Medicaid Infrastructure Grant from the U.S. Centers for Medicare and Medicaid Services (CFDA # 93.768).

Presented byScott Lay and Janet Stevely

Employed Persons with Disabilities

Program


A Little About You…

Many of you work with people who get SSDIMany of you know people paying residential off setMany of you work with Brokerage customers who are not Medicaid Waiver eligible (State General Funds only)


Today’s Agenda

What is EPD?

What are the eligibility requirements for EPD?

How Much Does It Cost?

How can EPD help people with Developmental Disabilities?

How does someone apply?


Disincentives to Work

Keeping people interested in work if most of their earnings go to pay “off set”;

Keeping resources under Medicaid limits;

Keeping income under Medicaid Waiver limits.

EPD HELPS OVERCOME BARRIERS!


What is EPD?

EEmployed

PPersons with

DDisabilities


What Does It Do?

Allows Individuals to Work without Risking Medicaid and/or Long-Term Care Services.

It can also help establish eligibility for Medicaid for those not already eligible.


How Do People with DD Benefit from EPD?

Provides access to Medicaid Services (if eligible);Allows working individuals to keep earned income (eliminates “off set”);Allows for a higher resource limit ($5,000 vs $2,000);Allows for higher earnings; andAllows a customer to save in special accounts.


Developmental Disability Medicaid Waivers

Comprehensive Waiver (Comp)

- Group Homes- Supported

Living- Foster Care- Comp In-Home

Support

Support Services Waiver (Brokerage)

Individuals live in own home or with family


Examples – EPD allows…

George to eliminate off set payments to his group home!Ryan to become Medicaid Waiver eligible, even with an employer paid retirement account!Susan (on waitlist) to access Medicaid (OHP Plus)!


Basic Medicaid Waiver Eligibility

Must have a disabilityMust have income under 300% of SSI ($637 x 3 = $1,911)Must have resources under $2,000 (single individual)Must need and have entered Waiver services (meet the level of care criteria)


Specific EPD Eligibility

Must be employed (Traditional or

self-employment) Adjusted Earned Income Less than 250% of FPL ($2,167/Month)

Countable Resources Less Than $5,000

Not Be Assumed Eligible for OSIP (SSI eligible)


Disability Criteria

Disability Must Meet SSA Criteria

Use Current SSA Determination

PMDDT Determination

Do Not Have to Pursue SSA (but a good idea)


Employed

Employed or self-employed - Paying or filing for FICA or SECA tax;

Remain “Engaged in Employment” if Not Working and Still Being Treated as an Employee.


Adjusted Income Limit

$ 4,419- 20- 65$ 4,334/2 = $2,167

250% of FPL (Earnings Only)

$2,167 per Month Adjusted Earned Income

$4,419 per Month Gross Earned Income

Employment and Independence Expenses are Allowed as Deductions


Income Deductions

Employment and Independence Expenses (EIEs);

Broader than IRWEs and BWEs;

Allows Earnings Over $4,419;

“Reasonably be expected to enhance the individual’s independence and employment opportunities.”


Resources Allowed

$5,000 Resource Limit

Standard Exclusions

Approved Accounts are Excluded from Resource Limit


Approved Accounts

Allows consumer to save for:

• Retirement Accounts

• Disability Related Expenses Retirement Accounts

Held in Segregated Account at a Financial Institution

Must be From Own Earnings or From Employer, Based Upon Earnings


QUESTIONS?


How Much Does It Cost?

No More Off-Set

Monthly Participant Fee

Condition for On-Going Eligibility

Consumer still pays Room and Board


EPD “buy-in” based on Countable Income

All unearned income (SSDI);Plus earned income.

The consumer’s gross income (before taxes) from traditional employment, and/or;The consumer’s gross income (before taxes) from self-employment (standard business expenses deducted*).


EPD Sliding Fee

If the Consumer’s countable income (unearned + earned, less deductions) is:$0 - $650.99(75% FPL) = Fee $0; $651 - $866.99(FPL) = $50/mo.;$867 - $2,167.99 (250% FPL) =

$100/mo.;$ 2,168 and above= $150/mo.


QUESTIONS?


Advantages of EPD under Comprehensive Services

Allows people to keep more income by eliminating residential off set;Allows for higher income and resources while maintaining Medicaid Waiver eligibility;Allows for special accounts.


Who Pays Off Set?

No Off Set –

Pays Off Set –

EPD participant fee-

SSI eligible, including 1619(b);Childhood Disability Benefit (CDB)Pickle Amendment

300% Rule (earned and unearned income)

EPD participant fee based on sliding scale ($0 - $150)


Comprehensive Waiver – Off Set Calculation

Off Set Calculation without EPD:

Unearned Income – in excess of $638.70 (2008)

Earned income – in excess of $65.00


George – Comp Services

Without EPD:

$ 1200.00 Unearned- 638.70$ 561.30 – off set

$ 400 Earned- 65$ 335.00 – off set

$1600.00 Total Income- 896.30 Total Off Set$703.70 - 494.70 Room & Board

$ 144.00

With EPD:

$ 1200.00 Unearned+ 400.00 Earned$ 1600.00 Total Income- 100.00 EPD$ 1500.00- 494.70 R&B

$ 1005.30

($861.30 more than without EPD)

.


Sally – Comp Services

Without EPD:

$ 700.00 Unearned- 638.70 $ 61.30 Off set

$ 250.00 Earned- 65.00$ 185.00 Off Set

$ 950 .00 Total inc- 246.30 Total off set$ 703.70- 494.70 Room & Board

$ 144.00

With EPD:

$ 700.00 Unearned+ 250.00 Earned$ 950.00 Total Income

- 100.00 EPD$ 850.00

- 494.70 R & B

$ 355.30

($211.30 more)


Advantages for Brokerage Customers

Obtain or maintain Medicaid Waiver eligibility;

higher income limit

higher resource limit

Ability to save in special accounts;

Consider for people who need to transfer to a Comprehensive Services Model (pay off set).


Ryan – Brokerage customer

Ryan is not Medicaid eligible because of a $6,000 401K paid by his employer, EPD will consider the 401K as an approved account, and exclude it as a resource;Once Medicaid Waiver eligible, Ryan is eligible for up to $10,140/yr individual budget through the Brokerage and OHP Plus.


Ryan - Brokerage

Without EPD:Brokerage

customer with Personal Agent;

Eligible for up to $4,056/year individual budget;

Medicare.

With EPD:Brokerage

customer with Personal Agent;

Eligible for up to $10,140/year individual budget;

OHP Plus.


Sara - Brokerage

$ 1000 SSDI$ 500 Trust income$ 800 Wages$ 2,300 Total Income

Her income is too high for 300% Rule, but not under EPD!


Susan – on Wait List

Susan is on the wait list for Brokerage services;She currently receives SSDI and Medicare. She is not currently eligible for Medicaid;She is employed.EPD would help her access Medicaid (OHP Plus).


How You Can Help!

Identify customers who may benefit from EPD (now or in the future);

Get them to SPD to apply;

Share this information with others;

Help those who are not currently employed understand the benefits of working, EPD removes barriers!


Likely Candidates:

Those on the wait list who are working and not currently Medicaid eligible;Those in Comprehensive service paying off set;Brokerage customers receiving General Funds only;Anyone needing to maintain Medicaid eligibility with earned income;People who want to work and are afraid of losing benefits.


How to Apply

Contact Local SPD Office

For a List of Local SPD Offices:

http://www.oregon.gov/DHS/spwpd/offices.shtml


Where Can I Get Help?

Local SPD Office

Work Incentive Network (WIN) – see brochures.

Jeff StellMedicaid Program [email protected]


QUESTIONS?

presented by scott lay and janet stevely

Documents

disabilities division

workkeeping people

epd help people

waiver services

medicaid services cfda

medicaid ohp

disabilities programseniors

developmental disabilities