Medicaid Works

Medicaid Works is a program for people with disabilities who work. Under this program, workers with disabilities who earn less than 250 percent of the federal poverty level can pay a monthly premium to buy into the Medicaid program.

Anyone between the ages of 16 and 64 with a disability who is working can apply for the program. Applicants also must meet the Social Security definition of disabled and earn less than 250 percent of the federal poverty level. See the chart listed below. A person cannot have more than $5,000 in personal assets.

Note: These income limits change in April of each year.

Except for earnings, all applicants must continue to meet the Social Security definition of disability and meet all other requirements of the program. Earnings from work are not considered in determining whether a disability exists.

Disabled aliens may be eligible for this program if they meet the qualification to be considered a qualified alien. These qualifications can be found in 907 KAR 1:011.

In the Medicaid Works Program, the income of the working disabled individual is counted. Participants may have up to $694 in unearned income to quality. Unearned income includes Social Security benefits, workers or veterans compensation or interest. This limit changes each year. Married applicants must claim their spouses’ income if more than $45,000 per year.

Yes. Any employer or individual retirement plan approved by the Internal Revenue Code is permissible under the program (for example, an Individual Retirement Account).

A person applying for the Medicaid Works Program must provide proof of employment (for example, pay stubs or written verification from the employer that verifies employment.)

If you are self-employed, you will have to provide records (for example, Schedule C forms) to demonstrate employment. Also, for the independent contractor, verification may be provided with a 1099 IRS form as proof of income and employment.

Yes. You are required to report all changes in income, name or address to your case worker within 10 days of the change.

Yes. To buy into the program you must pay a monthly premium. The monthly premium amount is:

$35 if your income is between $908 – $1,361 per month

• $45 if your income is between $1,362 and $1,814 per month
• $55 if your income is between $1,815 and $2,269 per month

You will receive a monthly premium payment notice that will be due by the 5th of each month. You will pay your premiums one month in advance. Your first premium will be for two months. The remainder of your premiums will be for one month. You can receive a 10% discount if you pay on a quarterly or annual basis.

Yes. If your income increases or a decreases your premium payment may change.

You will receive notices of premiums that are due each month. If the payments have not been received for two months in a row, you will be sent a notice telling you that you are no longer in the program.

If you are no longer in the program because you did not pay your premium for two months in a row and you want to come back into the program, you will have to pay any missed premiums before you can reapply for benefits.

Yes, the usual Medicaid co-payments for services apply to the Medicaid Works Program. Please refer to the Global Choices benefit package in KYHealth Choices for co-pay and benefit information.

Yes. As long as you are working, and meet all other eligibility criteria, you can buy into Medicaid with an affordable premium payment under the Medicaid Works program.

If you have other health insurance, you would continue to use that insurance as the primary payer for your medical care. Your other insurance may not cover all the services you need. You can have private or employer health insurance and receive services through Medicaid Works.

If you quit your job or lose it for some reason but plan on returning to work, you can continue to receive benefits under the program for 6 months.If you have not returned to work within 6 months, you will no longer be in the program. When you get another job you can apply for the program again

To apply for the program, you should go to your local Department for Community Based Services office. If you do not know where your local office is, you can call (800) 635-2570.