Frequently Asked Questions

Medicaid Infrastructure Grant (MIG)
Support the Competitive Employment of People with Disabilities

General Medicaid Infrastructure Grant (MIG) Questions

Question: What is the program all about? What is going on?

Answer: The Ticket to Work and Work Incentive Improvement Act (TWWIIA) provides grant funding to States to improve their Medicaid systems. These funds must be used to expand the availability of Personal Assistance Services (PAS) to the work environment and to develop a Medicaid Buy-In program. Both of these services require that a person be involved in competitive employment to be eligible.

Personal Assistance services are services provided to an individual with a disability(s) to perform personal tasks that they would normally do for themselves if they did not have a disability.

Medicaid Buy-In allows individuals who return to competitive work to have substantial earnings and savings and still have Medicaid coverage.

In South Dakota the Medicaid Infrastructure Grant is called the Freedom to Work Project. Since South Dakota does not have personal assistance services available outside the home, the first year activities have been focused on making that service available through Medicaid. In order to continue with the Project and develop a Medicaid Buy-in program South Dakota must, by December 31, 2002, commit to have personal assistance services available at the workplace with service delivery available by December 31, 2003.

Question: What definition of "competitive employment" will be used? How does minimum wage fit into the picture?

Answer: "Competitive employment" means work--

• in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting; and
• for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled.

An integrated work setting means a setting typically found in the community in which employed disabled individuals interact with non-disabled individuals, other than the non-disabled individuals who are providing the employment service. A person with a disability who is self-employed is considered to be engaged in competitive employment provided that such self-employment meets the definition of competitive employment.

The Freedom to Work Project Steering Committee recommended a minimum of 40 hours of work per month to be eligible for personal assistance services. No recommendation has been established for the Medicaid Buy-In definition of "competitive employment" at the present time.

Question: Will these programs serve everybody? Who will it serve?

Answer: The program will serve individuals with disabilities who work in a competitive job and meet earnings and resource requirements. A person has to be a Medicaid recipient to be eligible for personal assistance services. To be eligible for a Medicaid Buy-In, a person must be working competitively and have a disability as determined by Disability Determination Services.

Question: How is it going to impact me?

Answer: The Freedom to Work Project is going to provide training to individuals with disabilities to help them understand and utilize the many work incentives that are currently available within the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. If you have a severe disability requiring personal assistance services and receive Medicaid, Personal Assistance Services will be made available at your work site as well as at home. Finally, the Project is going to work toward the development of a Medicaid Buy-In Program which will allow you to earn more money and retain more assets while retaining Medicaid coverage. At this stage in the development of the Medicaid Buy-In, specific amounts of earnings and assets have not yet been recommended.

Question: Are you going to get me a job? Are there going to be jobs for people with disabilities?

Answer: Assistance in finding a job will continue to be provided by the South Dakota Division of Rehabilitation Services, South Dakota Division of Services to the Blind and Visually Impaired, or other employment networks. Currently approximately 900 persons with disabilities obtain employment annually through the above listed programs.

Question: Am I going to be forced to go to work?

Answer: No, under the Ticket to Work legislation, currently all participation is voluntary. If, however, the Social Security Administration discovers through a continuing disability review (CDR) that your disability no longer exists or that it no longer is of a severity to prevent you from working, then your Supplemental Security Income (SSI) or Social Security Disability Income (SSDI) could be discontinued.

Question: Will I lose my Social Security, my benefits?

Answer: The reason these programs are being made available to the states is to encourage individuals with disabilities to return to work and decrease the cash payments from Supplemental Security Income (SSI) or Social Security Disability Income (SSDI), but still retain medical insurance through Medicaid. There is nothing in the current legislation which forces you to give up your cash payments, but it is hoped that with the incentive of retaining Medicaid you will find it to your benefit to replace cash benefit payments with work income that exceeds your SSI or SSDI benefits.

Question: What can we do to encourage people to use currently available work incentives? How can/will consumers learn to manage their own benefits and gain confidence in doing so?

Answer: There are two Benefits Specialists available in the state -one in Pierre who serves any SSI or SSDI beneficiary who is interested in obtaining information and assistance on returning to work; and one in Sioux Falls who works only with consumers of vocational rehabilitation services through the Divisions of Rehabilitation Services (DRS) or Service to the Blind and Visually Impaired (SBVI). Since the capacity of these services are currently limited in the state, the Freedom to Work Project will be providing training on benefits planning to individuals with disabilities across the state this next year. This training will assist individuals in managing their benefits and earnings effectively.

Question: What is the relationship between the Freedom to Work Project and "The Ticket?"

Answer: They are complementary programs. Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) beneficiaries are receiving a Ticket to Work to encourage them to work with a vocational rehabilitation agency or another employment network to receive assistance in returning to work. The Freedom to Work Project is:

• making personal assistance services available at the workplace to assist individuals in being able to work; and,
• working towards a Medicaid Buy-in so individuals who return to work and give up their SSI or SSDI can still retain health insurance in addition to their earnings.

Question: What does the Steering Committee do?

Answer: The Steering Committee directs the Freedom to Work Project. In designing Personal Assistance Services (PAS) and a Medicaid Buy-in (MBI) a multitude of decisions must be made. The Steering Committee, through several workgroups, evaluates each of these decision points and then brings recommendations to the entire Steering Committee for discussion and action. They also develop approaches for keeping the larger disability community informed on the project's status and involved with the project development and implementation. When called for by the project, the Steering Committee makes formal recommendations to policymakers in the relevant state agencies.

Question: If we want success with the project, do we target certain populations?

Answer: Because these are Medicaid programs and services, the only "targeting" that can be done is defined by the Act. To be eligible an individual with a disability must:

• be determined to be disabled by the Disability Determination Services;
• must be working in or seeking competitive employment;
• must meet income and asset requirements to be determined by the Project and,
• in the case of personal assistance services, must be determined through an assessment process to require personal assistance services.

No additional "targeting" of individuals to be served is allowed.

Question: Why aren't people taking advantage of currently available work incentives i.e., 1619(a) and 1619(b)?

Answer: We believe the primary reason people are not taking advantage of current work incentives is misinformation or lack of information. Many individuals with disabilities and service providers believe that to do any work is to jeopardize the receipt of benefits. Furthermore, managing benefits while working can be difficult if a person does not have assistance or has not been trained in managing benefits, so for many, the "path of least resistance" leads to not working.

Medicaid Buy-In Questions

Question: What is a MAWD?

Answer: A MAWD is a work incentive that allows working people with disabilities to pay a cost-share (such as a premium) to participate in the state's Medicaid program, just like they would if they were buying private health insurance.

Question: Who is eligible?

Answer: Eligibility criteria for a South Dakota Medicaid Buy-In has not yet been determined. However, to be eligible for a Medicaid Buy-In, a person must be working competitively and have a disability as determined by Disability Determination Services.

Question: Does "disability" enter into the eligibility equation? If so, what specific definition of "disability" will be used?

Answer: When applying for Supplemental Security Income (SSI), which is the only current means of obtaining Medicaid, income is a factor in whether a person is determined to be disabled. When the Medicaid Buy-In is in place, a person's level of disability will be determined independent of their income. Disability will continue to be determined by Disability Determination Services.

Question: Are there people on SSI who do not have a disability, and if so, will they be eligible for a Medicaid Buy-In?

Answer: Yes, there are people on SSI who do not have a disability. However, a person must have a disability as determined by Disability Determination Services to be eligible for the Medicaid Buy-In. A person who does not meet this criteria would not be eligible for a Medicaid Buy-In.

Question: How many people does South Dakota expect will benefit from/be involved with a Medicaid Buy-In? What's going to be the cost of the Medicaid Buy-In?

Answer: Because the details of the program are yet to be finalized, it is not possible at the present time to determine how many people will benefit from the Medicaid Buy-In or how much it will cost. However, some cost-models do exist, as well as data from the experiences from other states who have already implemented Medicaid Buy-Ins. Therefore, once the program details are finalized, an estimate can be made as to how many people might enroll in a Medicaid Buy-In as well as how much it will cost.

Question: Will volunteer work be included in the definition of employment?

Answer: No, unless the individual receives monetary compensation for his/her time spent volunteering and meets the definition of competitive employment.

Question: How much money will I be able to keep?

Answer: This element of the South Dakota Medicaid Buy-In has yet to be determined. However, one advantage of a Medicaid Buy-In is the opportunity for a person to earn and keep more resources than if that person was enrolled in Medicaid through a Medicaid program other than the Medicaid Buy-In.

Question: How does a Medicaid Buy-In relate to current Medicaid waiver services?

Answer: The relationship between the Medicaid Buy-In and Medicaid waivers is very complicated. Freedom to Work staff is continuing to research the details of these relationships as the Medicaid Buy-In development continues.

Personal Assistance Services Questions

Question: Who is eligible?

Answer: Individuals who are Medicaid recipients and show a need for the service through the assessment process.

Question: Does "disability" enter into the eligibility equation? If so, what specific definition of disability will be used?

Answer: Yes, those with severe disabilities will be more likely to meet the needs assessment criteria for the service. The definition is that a person must be a Medicaid recipient and determined to be disabled based on a determination by Disabilities Determination Services.

Question: Are there people on SSI who do not have a disability, and if so, will they be eligible for expanded personal assistance services?

Answer: Yes, there are people on SSI who do not have a disability. However, individuals without a disability would not present a need that would qualify them for these services.

Question: Why are personal assistance services limited to 40 hours/month? Who will monitor these hours?

Answer: This limit is the current number of hours provided in the Medicaid State Plan. It was the Freedom to Work Steering Committee's recommendation to maintain this level of service in an attempt to gauge a starting point from which to further develop the service. Regarding monitoring of hours, the expanded personal assistance services program is still in the developmental stages, and therefore, specific components of the program, such as who will monitor the hours and how, have yet to be determined.

Question: Who's going to provide personal assistance services?

Answer: It is expected that provider agencies that are approved by the Department of Social Services will fill this role.

Question: Will volunteer work be included in the definition of employment?

Answer: No, unless the individual receives monetary compensation for his time spent volunteering and meets the definition of competitive work.

Question: How much money will I be able to keep?

Answer: A person who receives expanded personal assistance services would be under the same assets/resources limitations as all Medicaid recipients. If the person is still receiving SSI the $1 reduction in the SSI payment for every $2 earned would continue, as would the $85 disregard.

Question: How do personal assistance services relate to current Medicaid waiver services?

Answer: The relationship between personal assistance services and Medicaid waivers is very complicated. Freedom to Work staff is continuing to research the details of these relationships as personal assistance services development continues.

Question: Are currently available personal assistance services under utilized?

Answer: Project staff does not have any data that would indicate that current personal assistance services are under-utilized.

Question: How many people does South Dakota expect will benefit from/be involved with personal assistance services? What will be the fiscal impact of expanded personal assistance services?

Answer: Because the program's service definitions are yet to be finalized, it is not possible to determine how many people will benefit from the expanded personal assistance services or how much it will cost.

Other Questions

Question: How do we engage SSA personnel in the FTW project?

Answer: N/A

Question: How do we encourage and support consumers participating in training events?

Answer: N/A

Question: How do we deliver needed training?

Answer: N/A

Question: How can you assure consumers that if they go to work with higher earnings these new programs will really work for them (grace period; medically improved; Social Security Administration (SSA) demo awards)?

Answer: N/A

Question: What can we do to lessen the fear factor?

Answer: N/A