IM-77 August 28, 2007

When an employed person with a disability makes an application for Medical Assistance, register the application as a non-spend down Medical Assistance application. Explore the individual's eligibility under the various Medical Assistance programs for persons with disabilities (such as Medical Assistance Non-spend down/spend down, Section 1619 Status, and HCB). If eligible for multiple categories, approve the individual for the category that provides the lowest cost sharing. In some cases the individual may be eligible for both a MA non-spend down category and TWHA non-premium. MA non-spend down categories including Section 1619, HCB, and MOCDD should always be approved before TWHA. Approve in the following order:

If eligible for TWHA, approve the individual by entering the first day of eligibility in IMU5 Field 13 E, the Medicaid Begin Date, entering a “T” level of care in Field 13G, and a level of care/reason code (Field 13G2) as follows:

“1” - Basic Coverage Group, premium
“2” - Basic Coverage Group, non-premium
“3” - Medically Improved Group, premium
“4” - Medically Improved Group, non-premium

Enter one of the following codes in Field 23, MA/NC Eligibility Criteria:

“T” - Basic Coverage Group
“I” - Medically Improved Group

Edits have been added to ensure that the correct entries are made in the following fields for the above Medical Assistance groups:

Field 23 - MA-NC Eligibility Criteria
Field 33 - Expense
Field 34 - Net Income
Field 35 - Deficit/Surplus
Field 41 - Gross Income


IM-77 August 28, 2007

The approval notice for the TWHA program is the Notice of Case Action (IM-32TWHA). A pamphlet, entitled “What You Should Know About Ticket to Work Health Assurance (TWHA) Program” (IM-4 TWHA), has been developed to explain the basic program requirements. Use the pamphlet to explain the program to interested persons, and include it with the approval letter for this program.