A TWHA participant’s need is determined as a single individual or a married couple as it is for Medical Assistance PTD non-spend down and spend down programs. In determining eligibility for a married individual, consider the income and resources of both individuals.
To prevent TWHA couples from both paying a full TWHA premium , the IMU5 system requires married couples to be combined in one TWHA case. Couples will be responsible to pay one premium amount whether one or both members of the couple are eligible for TWHA. Both spouses can receive TWHA coverage if both meet all eligibility factors for TWHA. If both spouses are eligible for TWHA enter both as a level of care “T” in field 13G in IMU5. If one spouse is eligible for TWHA and the other is not, the system requires the non-eligible spouse to be entered as an included person (level of care “Z” in field 13G) in IMU5. The spouse not meeting TWHA criteria could be determined eligible for another Medicaid category following the rules of that category.
If the spouse is disabled but is not employed or does not meet other TWHA eligibility criteria, then the non-employed spouse’s eligibility is determined as it is now. The regular MA disability, need and resource determination is made using the couple need and resource standards. Count the income, allowing the regular MA earnings disregards for the TWHA spouse’s earnings. Count the resources of the TWHA participant allowing the additional TWHA resource exclusions.