MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

0855.000.00 Ticket to Work Health Assurance (TWHA) Program

IM-22 April 11, 2024; IM-106 December 28, 2023; IM-72 May 27, 2020; IM-67 July 16, 2013; IM-77 August 28, 2007; IM-75 July 11, 2005; IM-78 June 28, 2002

Senate Bill 236 (2001) enacted the Medicaid provision from Section 201 of the federal Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170). The program was called Medical Assistance for Workers with Disabilities (MA-WD) and was funded effective July 1, 2002. The program had a gross income limit of 250% of the federal poverty level (FPL), but had a liberal disregard of the spouse’s income. Participants with income above 150% FPL paid a premium. The available resource limit was $999.99. The MA-WD program was eliminated effective August 28, 2005, after passage of Senate Bill 539 (2005).

A new version of the Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170), RSMo 208.146, was authorized by Senate Bill 577 (2007) and effective August 28, 2007 for a period of six years. The program was named Ticket to Work Health Assurance (TWHA) program. Senate Bill 127 (2013) extended the TWHA program for another six years. Senate Bill 514 (2019) extended the Ticket to Work Health Assurance program through August 28, 2025. 

Senate Bill 106 (2023) made changes to asset limit calculations, modified the income calculations and updated disregards to earned income of a spouse.

The purpose of the TWHA program is to provide medical care for persons with disabilities, age 16 through 64, who are employed. The income limit for this program is defined as income up to 250% of the FPL, excluding earned income between 250% and 300% of the FPL of the worker with a disability. Participants with income above 100% FPL will pay a premium to receive coverage. The income of  a spouse is included, but the first $50,000 of earned income is disregarded, when determining eligibility for the TWHA program.

TWHA has two components, a Basic Coverage Group and a Medically Improved Group. The Basic Coverage Group is for participants who have earnings but are determined to be permanently and totally disabled. The Medically Improved Group is for participants who have lost their eligibility for the Basic Coverage Group solely due to medical improvement. Both groups provide full Medicaid benefits.

Continuous Eligibility for Children (CEC)

Continuous eligibility for participants under the age of 19 must be applied for children who are eligible for MO HealthNet TWHA Coverage.

  • The TWHA premium must be paid monthly for the child to receive payment of medical claims.
  • Coverage begins once the TWHA premium has been paid. MO HealthNet Division (MHD) determines coverage if TWHA premium is paid each month.
  • Increasing the TWHA premium amount is not allowed during the CEC period.
  • Decreasing the TWHA premium amount is allowed during the CEC period.

Note: Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) in the MAGI Manual.