GIS 10 MA/021: Changes to MBL for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD)

The purpose of this General Information System (GIS) message is to inform local departments of social services (LDSS) of changes for the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) data entry and SSI-related (SSI-R) MBL output screens.

Effective with the October 18th migration, for any SSI-related community budget with an effective date of November 1, 2010 or later, MBI-WPD Expanded Eligibility Codes "V" (MBI-WPD SSI-Related Budgeting Prior to MBI-WPD Budgeting) and "W" (MBI-WPD Only) will be disabled. MBI-WPD eligibility will no longer be displayed on the Expanded Eligibility screen. For SSI-related Budget Types 04, 05, 06 and 08, MBI-WPD eligibility will be displayed on the SSI-Related MBL budget output screen just below the Earned Income section. This new section will consist of three lines: the individual's MBI-WPD Net Income Amount; the individual's eligibility (at 150% or 250% FPL) or ineligibility due to excess income and/or resources; and the amount of MBI-WPD premium, if applicable. See below for a sample MBL budget screen for an individual eligible at 150%.

Note: There continues to be a moratorium on premium collection.

When calculating an SSI-related community budget, eligibility for the MBI-WPD program will automatically be displayed even if there is no earned income in the Earned Income section. As work is a requirement of the MBI-WPD program, the LDSS must verify that there is work activity and earned income before eligibility under the MBI-WPD program is authorized.

LDSS Reminders

At renewal or when performing an undercare change, if an individual has an Individual Categorical Code (ICC) of "70" (Medicaid Buy-In Disabled Basic Group) or "71" (Medicaid Buy-In Medically Improved) and there is no earned income in the budget, the worker must check to see if the individual is in a grace period. If there is no grace period, the worker must determine if one is needed and take the appropriate steps. For further information on grace periods, see 04 OMM/ADM-5, pages 6-8 and 10 OHIP/ADM-2, page 5. If a grace period has been exhausted or the individual is ineligible for a grace period, Medicaid eligibility cannot be continued under the MBI-WPD program. If an individual had been participating in the MBI-WPD Basic Group (ICC of 70), eligibility must be re-determined under an SSI-related budget (Medicaid Income Level) or under an ADC-related budget, if eligible. The individual is given a choice between the two budget types. If an individual was in the MBI-WPD Medical Improvement Group (ICC 71), eligibility cannot be re-determined using an SSI-related budget as the individual does not meet the disability criteria. In either situation, the ICC of "70" or "71" must be changed to reflect the appropriate category.

It should be noted that a Continuing Disability Review (CDR) must be completed for a Medical Improvement Group individual (ICC 71) if the following conditions apply: the individual is on an expiring Change of Medical Condition Grace Period; the individual continues to work, though less than the required 40 hours a month or minimum wage; and the individual's medical condition has not improved. The CDR will determine if the individual is disabled so that eligibility may be considered in the MBI-WPD Basic Coverage Group. If not, the budget must be changed to a Budget Type 01 or 02 as appropriate.

Note: See PDF for CSMSWMS UPSTATE PRODUCTION for GLOBAL USERS Display