After several formal steps along the route to implementation, three of the four proposed and subsequently legislated changes to the Medicaid for Working Persons with Disabilities (MWPD) program – changes meant to enhance employment incentives – are scheduled to take effect on January 1st, 2018.
The MWPD clauses within Act 51 of 2015 are finally on the verge of being implemented!
The necessary Medicaid State Plan Amendment (SPA) was written and the MWPD policy changes were been placed in the Global Commitment Register (GCR), after an initial public comment period, as final State policy in August, 2016.
Since that time many definitive exchanges have occurred between the Agency of Human Services (AHS) team responsible for the MWPD changes and the Centers for Medicare and Medicaid (CMS) which must approve all Medicaid State Plan Amendments (SPA’s). After a significant delay, CMS technically approved (i.e. allowed) three of the four proposed changes late June 2017.
Although AHS is currently awaiting (expected) formal written approval from CMS, the agency did decide to initiate the necessary 6-month rule-making process as of July 1st, 2017. Such a process entails another 30 day plus public comment period, including a formal public hearing. The public comment period began August 2nd, 2017, as per announcement, and ends Sept. 12th, 2017. The formal public hearing is scheduled for Tuesday, Sept. 5th, 2017 at 2 PM at the Waterbury State Office Complex.
AHS has pre-filed with the Secretary of State’s office and has assumed responsibility for presenting before ICAR (Interagency Committee on Administrative Rules). Subsequent to the conclusion of the public comment period, AHS will present the changes before LCAR (Legislative Committee on Administrative Rules) as the process proceeds.
Sarah Launderville, ED of VCIL (Vermont Center for Independent Living), Ed Paquin, since retired President of VCDR (Vermont Coalition of Disability Rights), and I met informally with the AHS team, at their behest, on July 7th, 2017. It was stated that the MWPD rules, as amended, appear to be very clear and straightforward and in accordance with Act 51 and the GCR final policy. The AHS team asked if they could relay our approval when presenting before ICAR and LCAR and there were no objections from the advocates.
An explanation as to why one of the proposed changes – the “reverse” spousal income disregard (i.e. disregarding the income of the MWPD spouse for purposes of determining eligibility of the non-MWPD spouse for non-MWPD Medicaid), was not allowed by CMS: 1. primarily, there are no disregards allowed, under Federal law, for “traditional” or MAGI (Modified Adjusted Gross Income) Medicaid. Thus, a spouse of an MWPD beneficiary applying for MAGI Medicaid, could NOT make use of any kind of income disregard. 2. under the “comparability” rule, if such a disregard (i.e. of the income of the MWPD beneficiary) is allowed, many other income disregards would also need to be allowed. Extending the scope of such disregards would have been much beyond the intent of Act 51.
Although nothing can be done about the fact that no disregards are allowed for MAGI Medicaid, it is possible, in the future, that the “reverse” spousal disregard request can be modified to allow for a disregard of the income of the MWPD beneficiary when the non-MWPD spouse applies for non-MAGI Medicaid (e.g. Medicaid for Aged, Blind and Disabled). There are no immediate plans for AHS to craft such a request but the possibility exists for the long run.
AHS/DAIL/VR, as per Act 51, is committed to an outreach effort to those who might benefit from the rule changes. In addition, the relevant AHS departments will make an effort, as I understand, to locate those MWPD beneficiaries who were not eligible (or lost eligibility) under the old rules but would be eligible (or would not have lost eligibility) under the new ones.
There still exists some question as to whether those potential beneficiaries over the age of 65 can apply or re-apply for MWPD. At present, the AHS team is researching that issue and is expected to definitively answer shortly. If the answer is in the negative, further legislation might needed for this small group for equity’s sake. House Commerce and Economic Development Committee Chairman, Bill Botzow, has offered to introduce such legislation if necessary.
Bottom line: the advocates long striving for changes to the Vermont MWPD program to enhance work incentives will see the fruits of their labor harvested in January 2018 (barring unforeseen and unanticipated developments).
Sam Liss, VT SILC Member