Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: DISABILITY AND SUBSTANTIAL GAINFUL ACTIVITY CALCULATIONS FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM
MANUAL REVISION #55
DISCUSSION:
The purpose of this memorandum is to introduce changes made to the 0855.005.25 Disability section of the Medical Assistance for the Aged, Blind, and Disabled (MHABD) manual.
Earnings are not considered in the disability determination for Ticket to Work Health Assurance (TWHA). However, if a participant is ineligible for TWHA based on excess income, a disability determination for MHABD non-spend down/spend down coverage should be explored if the participant’s income, excluding sick and/or vacation pay, is below the Substantial Gainful Activity (SGA) limit for MHABD.
EXAMPLE: Mr. Lee worked 1 week during the month of February for which he received $1,000 in wages. Mr. Lee then received $1,000 for 1 week of vacation pay and $2,000 for 2 weeks of sick pay at $1,000 each week. His total monthly gross income was $4,000.
Mr. Lee’s income exceeds the $3,035.00 limit for TWHA. However, only the $1,000 received for work activities is applied toward the SGA limit of $1,220.00 for MHABD. Therefore, Mr. Lee should have a Medical Review Team (MRT) decision completed to determine eligibility for MHABD spend down.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
PL/cj