A man in a wheelchair does work at a table in his house

The Vermont Statewide Independent Living Council (S I L C), along with the Vermont Center for Independent Living (V C I L) and the Vermont Coalition of Disability Rights (V C D R), have been instrumental in bringing about changes to the M W P D program which will enhance work incentives. This effort has been ongoing for many years.

Such changes will allow more people with disabilities to retain Medicaid while productively maintaining employment. It will also allow M W P D beneficiaries to work more hours without fear of losing vital healthcare.

In 2015, the State legislature incorporated 4, M W P D work enhancement changes into an omnibus economic development bill which became Act 51. The 4 changes would potentially:

  1. Increase the entry level asset threshold to a more realistic, $10,000 for single and, $15,000 for couple (in conformity with many other states);
  2. Disregard retirement Social Security income after conversion from S S D I, at retirement age;
  3. Disregard income of both, the M W P D beneficiary for purposes of determining eligibility of the nonworking spouse for traditional Medicaid and, the spouse of the M W P D beneficiary.

A key aspect of legislative success was the strong support of Chairman Bill Botzow of House Commerce and Economic Development Committee and his insight that such changes constitute “workforce enhancement.”

After passage of Act 51, an A H S inter-departmental task force was established to proceed with the legislative mandate. It was realized that further legislation by way of a technical correction was necessary to properly implement the changes. The original M W P D authorizing statute was thus amended, within another omnibus economic development bill, to allow for the new entry level asset thresholds. This bill was signed into law as Act 157 of 2016.

After a public comment period, the 4 mandated changes were entered into the Global Commitment Register (G C R) as official and final State policy on Aug 1st, 2016. On September 6th, 2016, the Medicaid State Plan Amendment (S P A), incorporating all 4 changes, was submitted to C M S (Centers for Medicaid and Medicare Services), as per legislative directive and proper procedure. C M S has, by rule, 90 days to respond. They did so late in October with comments and questions for the State.

In summary, C M S has concerns, not unexpected, about the spousal disregard of the M W P D beneficiary for purposes of determining eligibility of the nonworking spouse for traditional Medicaid. Although other states have instituted such a disregard, there exists a technical issue roughly related to the nonworking spouse not being within a discrete eligibility category. At this time, A H S is strongly leaning toward removing this potential change from the S P A package to allow speedy approval of the other three changes. The State has, in addition, queried C M S about issues related to protecting M W P D beneficiaries in certain circumstances.

After expected C M S approval of the remaining three changes to M W P D, a 6-month rule-making process would begin, one which incorporates another public comment period. It is thus expected that implementation would commence in mid-2017. The 4th change will be considered and refined for future submission to C M S.

An outstanding issue needs to be determined: those former M W P D beneficiaries who lost eligibility by the old rules, but who would have remained eligible if the new rules were in effect, could be reinstated. This could be accomplished by the rule-making process by allowing for retroactive eligibility or a “look-back” period. Thus, it is important for such former beneficiaries to comment upon the importance of restoring their eligibility.

As of November 7th, 2016, the State and CMS continue to discuss the M W P D changes to make certain that details are in order and to conform to Federal rules. C M S approval is pending.

TAGS: Employment