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, but had a liberal disregard of the spouse’s income. Persons 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. The TWHA program will end August 28, 2025, unless reauthorized by the General Assembly.
The purpose of the Ticket to Work Health Assurance (TWHA) program is to provide medical care for persons with disabilities, age 16 through 64, who are employed. The gross income limit for this program is 250% of the federal poverty level (FPL), excluding any earned income between 250% and 300% of the federal poverty level of the worker with a disability. This results in an actual gross income limit of 300% FPL. The net income limit is 85% FPL. Participants with income above 100% FPL will pay a premium to receive coverage. The income of the spouse is included 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 persons who have earnings but are determined to be permanently and totally disabled. The Medically Improved Group is for persons who have lost their eligibility for the Basic Coverage Group solely due to medical improvement. Both groups provide full Medicaid benefits.