February 27, 2008
HEALTH INSURANCE FOR DISABLED RESIDENTS UNDER AGE 65
By: Meghan Reilly, Legislative Fellow
You asked about state health insurance programs for individuals with disabilities under age 65 who are waiting for their Medicare benefits to begin.
Individuals under age 65 receiving Social Security Disability Income (SSDI) must wait two years before Medicare covers their health care needs. Medicaid may be an option during this period. It is available to someone whose net income, if single and living in most parts of the state, is $491.92 per month and assets are no more than $1,600. For employed individuals exceeding asset or income limits, the Medicaid for Employed Disabled (MED) program offers the same benefits with more liberal financial eligibility criteria. A person can have countable income up to $75,000 per year and $10,000 in counted assets such as a checking or savings account. The Department of Social Services (DSS) administers Medicaid.
DSS also administers State Administered General Assistance (SAGA) medical assistance, which provides health-center based medical assistance to low-income persons who do not qualify for, or who are awaiting an eligibility determination from, other state or federal programs. The income limit is the same as for regular Medicaid and assets cannot exceed $1,000.
Connecticut's Pharmaceutical Assistance Contract to the Elderly and Disabled, ConnPACE, is a federal- and state-funded prescription drug assistance program. With ConnPACE, out-of-pocket expenses include a $30 annual application fee and $16.25 co-pay per prescription. For single people, the income limit for 2008 is $23,700. The income that counts toward ConnPACE eligibility includes adjusted gross income, plus Social Security.
To qualify, applicants must meet Medicaid income and asset limits. The Medicaid income limit for a disabled single person is $491.92 per month. Applicants with higher income may qualify if they have high medical bills.
For employed applicants, part of their earnings will not be counted to make up for work-related expenses. Some unearned income is also disregarded. Unearned income includes federal Supplemental Security Income (SSI), Social Security benefits, veterans benefits, and pensions. After the appropriate deduction is subtracted from gross income, countable income must be less than the Medicaid income limits.
The asset limit for one person is $1,600. Assets include, but are not limited to, bank accounts, certificates of deposit, stocks and bonds, cash surrender value of life insurance policies, and non-home property. A home is not counted as an asset while it is the applicant's primary residence.
Medicaid for Employed Disabled (MED)
The MED program allows a person with a disability to be employed, earn income, and be eligible for Medicaid. The covered services are the same as those under regular Medicaid. A person can have countable income up to $6,250 per month ($75,000 per year) and still be eligible for the program. Applicants must earn taxable wages to qualify. Single individuals pay no premiums until their income reaches $1,634.00 per month. The monthly premium is 10% of any income above the limit.
If a person stops working because of a health problem or loses a job through no personal fault, the individual can stay on MED for up to one year. For coverage to continue, the person must plan to return to work when health improves or be looking for another job.
A car used for getting to work or medical appointments is not counted as an asset, nor is a home. A single person can have $10,000 in counted assets such as a checking or savings account, as well as any amounts
saved in approved retirement accounts such as an IRA or 401K. A person may also have a special DSS-approved account with money set aside to save for a special employment expense.
The Connect to Work Center at the Bureau of Rehabilitation Services offers benefits counseling services to people with disabilities who are either working or are thinking about going to work
STATE-ADMINISTERED GENERAL ASSISTANCE (SAGA)
SAGA provides medical assistance to low-income persons who do not qualify for, or who are awaiting an eligibility determination from, other state or federal medical assistance programs.
The system is based primarily at the state's network of federally qualified health centers. Community Health Network, which is the administrative services organization running the program for DSS, has also enrolled hospital outpatient clinics, primary care physicians, specialists, dentists, and pharmacies in the SAGA medical network (www.chnct.org).
ConnPACE is a prescription drug assistance program for the elderly and certain people with disabilities. Out-of-pocket expenses include a $30 annual application fee and $16.25 co-pay per prescription. There is no yearly dollar limit on the amount of prescriptions covered. Generic drugs are substituted for brand-name drugs unless otherwise indicated by the prescribing physician. A renewal notice is sent to ConnPACE members annually, and members must re-apply to continue membership. If the initial application or renewal is not approved, the application fee is refunded (http://www.connpace.com/howitworks.html).
ConnPACE income eligibility levels increased as of January 1, 2008. For single people, the income limit is $23,700. For couples, the income limit is $31,900. The income that counts toward ConnPACE eligibility includes adjusted gross income, plus Social Security. Applicants for the 2008 calendar year may use 2007 income or provide an estimate of 2008 income. These income levels must be shown with either a tax return or copies of sources of income (http://www.connpace.com/income.htm).