Positive Approaches Journal, Volume 11, Issue 3

Volume 11 ► Issue 3 ► November 2022

The Importance of Medical Assistance for Workers with Disabilities

Ashley Davis-Moulfair

Introduction

Working and maintaining essential medical benefits and supportive services can be a delicate balancing act for individuals with disabilities. Medical Assistance is often not only an essential layer of medical coverage, but the gateway criteria for individuals to receive third party services that foster the skills, confidence, and independence necessary to garner success in the workforce. Unfortunately, that same success has the potential to threaten their eligibility for Medical Assistance and the crucial supportive services they need due to strict income requirements.

Background

The Medical Assistance for Workers with Disabilities (MAWD) program in Pennsylvania is a unique program that works to keep individuals with disabilities covered while allowing them to further themselves in their employment journey and build financial stability. Supporting people with disabilities while they gain a strong foothold in the working world not only fosters independence and self-sufficiency for recipients of MAWD, but also contributes to an inclusive workforce and a decreased need for long-term public assistance.

The MAWD program was established in Pennsylvania through the options provided in the federal Ticket to Work and Work Incentives Improvement Act (TWWIIA) of 1999 (Public Law 106-170). Pennsylvania subsequently passed Act 77 of 2001, which provided the state share of funds necessary to implement MAWD.

What is MAWD?

The MAWD program boasts higher income thresholds than many other Medical Assistance categories in Pennsylvania and pairs this flexibility with a modest monthly premium based on the recipient’s net income. To qualify for MAWD, an individual must be between the ages of 16 and 65, have a disability that adheres to Social Security Administration’s (SSA) requirements or the department’s disability review criteria, be employed and receiving compensation with countable monthly income (after allowable deductions) equal to or less than 250% of the Federal Poverty Income Guidelines (FPIG), and have countable household resources totaling no more than $10,000. MAWD recipients pay a monthly premium calculated at 5% of their countable income.

Figure 1: MAWD Income and Resources Limits by Household Size

Note: The figures below are actual income limits based on either a household size of one (only the MAWD recipient) or a household size of two (a MAWD recipient and their spouse). 

Household Size	2022 250% FPIG Monthly Income Limit	2022 250% FPIG Annual Income Limit	Resource Limit
1	$2,832.00	$33,975.00	$10,000.00 (None, if they received Workers with Job Success)
2	$3,815.00	$45,775.00	$10,000.00 (None, if they received Workers with Job Success)

The MAWD umbrella also encompasses two sub-category groups with the intent to extend coverage for workers as they progress. The first is the Workers with a Medically Improved Disability category, which serves MAWD recipients whose disability has improved to the point where they no longer qualify under SSA or the department disability review criteria. Most of the eligibility criteria for this category mirrors that of MAWD, but with the key distinction of requiring that the individual work at least 40 hours per month earning at least minimum wage.

Pennsylvania further expanded MAWD in December 2021 by creating the new Workers with Job Success (WJS) category with the passage of Act 2021-69 of July 1, 2021 (P.L. 374). WJS is unique in its flexibility with income eligibility, allowing MAWD recipients to advance professionally while maintaining access to Medical Assistance coverage and the crucial services facilitated by their eligibility. In order to qualify, an individual must have at least 12 previous consecutive months of enrollment in a MAWD category and countable income that is over 250% of the FPIG and less than or equal to 600% of the FPIG. Although individuals must also adhere to the $10,000 resource limit required of the other MAWD categories, they are able to accumulate resources beyond that threshold in the MAWD program once enrolled in WJS.

Figure 2: MAWD WJS Income and Resource Limits by Household Size

Note: The figures below are actual income limits based on either a household size of one (only the MAWD WJS recipient) or a household size of two (a MAWD WJS recipient and their spouse). 

Household Size	2022 600% FPIG Monthly Income Limit	2022 600% FPIG Annual Income Limit	Resource Limit
1	$6,795.00	$81,540.00	$10,000.00 at initial eligibility, then disregarded
2	$9,155.00	$109,860.00	$10,000.00 at initial eligibility, then disregarded

 

The premium structure for recipients of WJS is also unique in contrast to its counterpart categories. Individuals enrolled in this category pay a monthly premium that is 7.5% of their countable monthly income if that income is between 250% and 450% FPIG.  However, if the individual’s countable income is above 450% FPIG and their annual adjusted gross income reported on their federal 1040 tax form is at or more than $75,000 compounded with Social Security cost-of-living adjustments since 2000 ($125,944.84 in 2022), the individual is responsible to pay a full cost monthly premium as determined by the department (currently $948).

The Impact of MAWD

The MAWD program has a domino effect on its recipients and the overarching support they receive, and Medical Assistance eligibility has distinctly personal implications for individuals with disabilities. We spoke with two working adults with disabilities and their families to explore how MAWD influences their access to services and the ripple effects that drive their personal success.

Amelia 

Amelia is 45 years old and resides with her mother, Lillian. Amelia was diagnosed with pervasive developmental disorder and autism spectrum disorder (ASD), and she has low support needs that allow her to be fairly independent in her day-to-day responsibilities. In addition to her Medical Assistance benefits, Amelia also receives supportive services from Pennsylvania’s Adult Community Autism Program (ACAP), a managed care program available across four counties, which has provided her with key life skills as well as transportation to and from work. Of utmost importance is the face-to-face time furnished by a Community Supports Provider (CSP) who offers individualized hands-on interaction that helps Amelia practice skills such as cooking, shopping, and scheduling doctor’s appointments. Working with her CSP has also built Amelia’s confidence and independence to the point where she was able to live independently in her own apartment for five years. The services afforded by ACAP and the CSP have been key in improving Amelia’s communication skills and in keeping her active outside the home, which is something Lillian proclaims is especially challenging.

Amelia has been working since she graduated from high school and spent 25 years of her employment tenure at a local grocery store performing various duties including bagging groceries, stocking shelves, and collecting shopping carts. When Amelia’s father passed away in 2017, she was awarded a Social Security survivor’s benefit on top of her Social Security disability (SSD) payment. Combined with her wages from her grocery store employment, Amelia was suddenly over the income limit for her current Medical Assistance program. At that point, she made the seamless transition into the MAWD program and saw no changes to her coverage or eligibility for supportive services beyond the addition of a monthly premium.

Amelia’s mother, Lillian, said that if not for MAWD, Amelia may have lost her Medical Assistance once she received her survivor’s benefit in 2017. Lillian asserts that if that had happened, “She would not have her support with the ACAP program, which to me means that I would have had to figure out what to do for her for support. Up until we found the ACAP program, we really didn’t have support for her. My husband and I figured out how to help her on our own.”

During the pandemic, Amelia had to step back from her work at the store in order to safeguard her health. After a while, she officially ended her employment with the grocery store and became self-employed from home. Amelia now performs household duties such as cleaning, helping her mother and neighbors with the trash, and other miscellaneous tasks for several hours a month. This change, although unplanned, has proven a positive change for Amelia as she has noticed a reduction in physical and emotional stress, more flexibility, and an improvement to her diabetes management. She still meets the requirements for MAWD and has experienced no alterations in the medical care or supportive services that assist her.

Steven

Steven is a 49-year-old man with ASD who lives independently with low support needs. Although he exerts significant autonomy in traveling to events by bus, carrying his own cell phone, and managing his schedule, Steven still requires the assistance provided by ACAP. His CSP helps him continue to build social and basic life skills, offers general advice, and provides companionship. ACAP also provides Steven with a behavioral health specialist and his CSP provides reliable transportation to and from Steven’s counseling sessions as well as his job. Steven’s mother, Carol, who says she is well into her 70s, states that the services afforded by ACAP help relieve her mental burdens about what will happen to her son when she is no longer around. Carol also asserts that ACAP also advocates for the individuals they serve by working to educate doctors and other public servants on how to treat and interact with people with disabilities.

Steven joined the workforce in his late 20s and is currently employed part-time at a hotel doing general housekeeping duties within the common areas. He has been working at the hotel two to three days per week for over seven years, and he has never been late or taken a sick day. Steven enjoys the routine and social interaction of his employment, although previous stints working full-time proved to be overwhelming and caused him anxiety.

In reflecting on the benefits of MAWD and the necessity of Medical Assistance/Medicaid for her son Steven, Carol said, “It’s good to have MAWD, because if he started working more hours then he could be in MAWD and get Medicaid. And that is a very good thing.”

Steven became eligible for the MAWD program by virtue of his combined wages and Social Security income. Since becoming a MAWD recipient, his Medical Assistance coverage has remained consistent and has allowed him to access the full extent of ACAP services he needs to remain successful in his personal and professional life.

More Than Just Medical Assistance

Supporting individuals with disabilities is a holistic endeavor, and the true impact of the MAWD program goes far beyond that of medical coverage. In fact, Medical Assistance acts as a doorway to a host of varied third-party agencies and services that provide wraparound supports to build up individuals. Additionally, a Medical Assistance program that is directly geared toward keeping recipients gainfully employed and even promotes professional advancement while maintaining the same level of medical coverage, fosters growth and independence without fear of losing the very supports that help individuals succeed.

The Pennsylvania Department of Human Services (DHS) holds the MAWD program in high regard as a crucial safety net for individuals with disabilities. Although the program currently covers approximately 29,430 individuals, it is believed that there is a significant population who are not aware of the program and its flexibilities. The MAWD program should be shared amongst the community of entities who serve individuals with disabilities to help ensure that people are not stunted in their desire to work for fear of losing their benefits. Individuals, their families, our communities, and our workforce will be better served if the goals and ambitions of those with disabilities are fully supported.

Information about the MAWD program can be found on the DHS website (www.dhs.pa.gov/MAWD). Individuals can apply for Medical Assistance and other public assistance programs via Pennsylvania’s online application portal, COMPASS, (www.compass.state.pa.us) or at any County Assistance Office (www.dhs.pa.gov/Services/Assistance/Pages/CAO-Contact.aspx).

References 

1.       Medical Assistance Eligibility Handbook. services.dpw.state.pa.us. Accessed October 4, 2022. http://services.dpw.state.pa.us/oimpolicymanuals/ma/index.htm#t=Title_Page.htm

2.     Department of Human Services, Office of Income Maintenance. Introduction of a New Medical Assistance for Workers with Disabilities (MAWD) Eligibility Group - Workers with Job Success (WJS). PA Department of Human Services. Published July 1, 2022. Accessed October 4, 2022. http://services.dpw.state.pa.us/oimpolicymanuals/ma/Introduction_of_a_New_MAWD_Eligibility_Group_-_Workers_with_Job_Success_(WJS).pdf

Biography

Ashley Davis-Moulfair has worked for the Office of Income Maintenance (OIM) as Communications Coordinator for over four years. Prior to this position, she spent two years as an Income Maintenance Caseworker with OIM processing public assistance benefits. She received a Bachelor of Science in (English) Education from Millersville University.

Contact Information

Ashley Davis-Moulfair

Communications Coordinator

PA Department of Human Services, Office of Income Maintenance

adavismoul@pa.gov