Presented by Scott Lay and Janet Stevely

1. Employed Persons with Disabilities Program Presented by Scott Lay and Janet Stevely This presentation is sponsored by the Oregon Competitive Employment Project, which is part of the Oregon State Department of Human Services, Office of Vocational Rehabilitation Services. The project is funded through a Medicaid Infrastructure Grant from the U.S. Centers for Medicare and Medicaid Services (CFDA # 93.768). Seniors and People with Disabilities Division of the Oregon Department of Human Services

2. A Little About You… • Many of you work with people who get SSDI • Many of you know people paying residential off set • Many of you work with Brokerage customers who are not Medicaid Waiver eligible (State General Funds only) Seniors and People with Disabilities Division of the Oregon Department of Human Services

3. Today’s Agenda • What is EPD? • What are the eligibility requirements for EPD? • How Much Does It Cost? • How can EPD help people with Developmental Disabilities? • How does someone apply? Seniors and People with Disabilities Division of the Oregon Department of Human Services

4. Disincentives to Work Keeping people interested in work if most of their earnings go to pay “off set”; Keeping resources under Medicaid limits; Keeping income under Medicaid Waiver limits. EPD HELPS OVERCOME BARRIERS! Seniors and People with Disabilities Division of the Oregon Department of Human Services

5. What is EPD? • Employed • Persons with • Disabilities Seniors and People with Disabilities Division of the Oregon Department of Human Services

6. What Does It Do? Allows Individuals to Work without Risking Medicaid and/or Long-Term Care Services. It can also help establish eligibility for Medicaid for those not already eligible. Seniors and People with Disabilities Division of the Oregon Department of Human Services

7. How Do People with DD Benefit from EPD? • Provides access to Medicaid Services (if eligible); • Allows working individuals to keep earned income (eliminates “off set”); • Allows for a higher resource limit ($5,000 vs $2,000); • Allows for higher earnings; and • Allows a customer to save in special accounts. Seniors and People with Disabilities Division of the Oregon Department of Human Services

8. Comprehensive Waiver (Comp) Group Homes Supported Living Foster Care Comp In-Home Support Support Services Waiver (Brokerage) Individuals live in own home or with family Developmental Disability Medicaid Waivers Seniors and People with Disabilities Division of the Oregon Department of Human Services

9. Examples – EPD allows… • George to eliminate off set payments to his group home! • Ryan to become Medicaid Waiver eligible, even with an employer paid retirement account! • Susan (on waitlist) to access Medicaid (OHP Plus)! Seniors and People with Disabilities Division of the Oregon Department of Human Services

10. Basic Medicaid Waiver Eligibility • Must have a disability • Must have income under 300% of SSI ($637 x 3 = $1,911) • Must have resources under $2,000 (single individual) • Must need and have entered Waiver services (meet the level of care criteria) Seniors and People with Disabilities Division of the Oregon Department of Human Services

11. Specific EPD Eligibility • Must be employed (Traditional or self-employment) • Adjusted Earned Income Less than 250% of FPL ($2,167/Month) • Countable Resources Less Than $5,000 • Not Be Assumed Eligible for OSIP (SSI eligible) Seniors and People with Disabilities Division of the Oregon Department of Human Services

12. Disability Criteria • Disability Must Meet SSA Criteria • Use Current SSA Determination • PMDDT Determination • Do Not Have to Pursue SSA (but a good idea) Seniors and People with Disabilities Division of the Oregon Department of Human Services

13. Employed • Employed or self-employed - Paying or filing for FICA or SECA tax; • Remain “Engaged in Employment” if Not Working and Still Being Treated as an Employee. Seniors and People with Disabilities Division of the Oregon Department of Human Services

14. $ 4,419 20 65 $ 4,334 /2 = $2,167 Adjusted Income Limit • 250% of FPL (Earnings Only) • $2,167 per Month Adjusted Earned Income • $4,419 per Month Gross Earned Income • Employment and Independence Expenses are Allowed as Deductions Seniors and People with Disabilities Division of the Oregon Department of Human Services

15. Income Deductions • Employment and Independence Expenses (EIEs); • Broader than IRWEs and BWEs; • Allows Earnings Over $4,419; • “Reasonably be expected to enhance the individual’s independence and employment opportunities.” Seniors and People with Disabilities Division of the Oregon Department of Human Services

16. Resources Allowed • $5,000 Resource Limit • Standard Exclusions • Approved Accounts are Excluded from Resource Limit Seniors and People with Disabilities Division of the Oregon Department of Human Services

17. Approved Accounts • Allows consumer to save for: • Retirement Accounts • Disability Related Expenses • Retirement Accounts • Held in Segregated Account at a Financial Institution • Must be From Own Earnings or From Employer, Based Upon Earnings Seniors and People with Disabilities Division of the Oregon Department of Human Services

18. QUESTIONS? Seniors and People with Disabilities Division of the Oregon Department of Human Services

19. How Much Does It Cost? • No More Off-Set • Monthly Participant Fee • Condition for On-Going Eligibility • Consumer still pays Room and Board Seniors and People with Disabilities Division of the Oregon Department of Human Services

20. EPD “buy-in” based on Countable Income • All unearned income (SSDI); • Plus earned income. • The consumer’s gross income (before taxes) from traditional employment, and/or; • The consumer’s gross income (before taxes) from self-employment (standard business expenses deducted*). Seniors and People with Disabilities Division of the Oregon Department of Human Services

21. EPD Sliding Fee If the Consumer’s countable income (unearned + earned, less deductions) is: • $0 - $650.99(75% FPL) = Fee $0; • $651 - $866.99(FPL) = $50/mo.; • $867 - $2,167.99 (250% FPL) = $100/mo.; • $ 2,168 and above= $150/mo. Seniors and People with Disabilities Division of the Oregon Department of Human Services

22. QUESTIONS? Seniors and People with Disabilities Division of the Oregon Department of Human Services

23. Advantages of EPD under Comprehensive Services • Allows people to keep more income by eliminating residential off set; • Allows for higher income and resources while maintaining Medicaid Waiver eligibility; • Allows for special accounts. Seniors and People with Disabilities Division of the Oregon Department of Human Services

24. No Off Set – Pays Off Set – EPD participant fee- SSI eligible, including 1619(b); Childhood Disability Benefit (CDB) Pickle Amendment 300% Rule (earned and unearned income) EPD participant fee based on sliding scale ($0 - $150) Who Pays Off Set? Seniors and People with Disabilities Division of the Oregon Department of Human Services

25. Comprehensive Waiver – Off Set Calculation Off Set Calculation without EPD: • Unearned Income – in excess of $638.70 (2008) • Earned income – in excess of $65.00 Seniors and People with Disabilities Division of the Oregon Department of Human Services

26. Without EPD: $ 1200.00 Unearned 638.70 $ 561.30 – off set $ 400 Earned 65 $ 335.00 – off set $1600.00 Total Income - 896.30 Total Off Set $703.70 - 494.70 Room & Board $ 144.00 With EPD: $ 1200.00 Unearned + 400.00 Earned $ 1600.00 Total Income 100.00 EPD $ 1500.00 494.70 R&B $ 1005.30 ($861.30 more than without EPD) George – Comp Services . Seniors and People with Disabilities Division of the Oregon Department of Human Services

27. Without EPD: $ 700.00 Unearned - 638.70 $ 61.30 Off set $ 250.00 Earned 65.00 $ 185.00 Off Set $ 950 .00 Total inc - 246.30 Total off set $ 703.70 - 494.70 Room & Board $ 144.00 With EPD: $ 700.00 Unearned + 250.00 Earned $ 950.00 Total Income - 100.00 EPD $ 850.00 494.70 R & B $ 355.30 ($211.30 more) Sally – Comp Services Seniors and People with Disabilities Division of the Oregon Department of Human Services

28. Advantages for Brokerage Customers • Obtain or maintain Medicaid Waiver eligibility; • higher income limit • higher resource limit • Ability to save in special accounts; • Consider for people who need to transfer to a Comprehensive Services Model (pay off set). Seniors and People with Disabilities Division of the Oregon Department of Human Services

29. Ryan – Brokerage customer • Ryan is not Medicaid eligible because of a $6,000 401K paid by his employer, • EPD will consider the 401K as an approved account, and exclude it as a resource; • Once Medicaid Waiver eligible, Ryan is eligible for up to $10,140/yr individual budget through the Brokerage and OHP Plus. Seniors and People with Disabilities Division of the Oregon Department of Human Services

30. Without EPD: Brokerage customer with Personal Agent; Eligible for up to $4,056/year individual budget; Medicare. With EPD: Brokerage customer with Personal Agent; Eligible for up to $10,140/year individual budget; OHP Plus. Ryan - Brokerage Seniors and People with Disabilities Division of the Oregon Department of Human Services

31. Sara - Brokerage $ 1000 SSDI $ 500 Trust income $ 800 Wages $ 2,300 Total Income Her income is too high for 300% Rule, but not under EPD! Seniors and People with Disabilities Division of the Oregon Department of Human Services

32. Susan – on Wait List • Susan is on the wait list for Brokerage services; • She currently receives SSDI and Medicare. She is not currently eligible for Medicaid; • She is employed. • EPD would help her access Medicaid (OHP Plus). Seniors and People with Disabilities Division of the Oregon Department of Human Services

33. How You Can Help! • Identify customers who may benefit from EPD (now or in the future); • Get them to SPD to apply; • Share this information with others; • Help those who are not currently employed understand the benefits of working, EPD removes barriers! Seniors and People with Disabilities Division of the Oregon Department of Human Services

34. Likely Candidates: • Those on the wait list who are working and not currently Medicaid eligible; • Those in Comprehensive service paying off set; • Brokerage customers receiving General Funds only; • Anyone needing to maintain Medicaid eligibility with earned income; • People who want to work and are afraid of losing benefits. Seniors and People with Disabilities Division of the Oregon Department of Human Services

35. How to Apply • Contact Local SPD Office • For a List of Local SPD Offices: • http://www.oregon.gov/DHS/spwpd/offices.shtml Seniors and People with Disabilities Division of the Oregon Department of Human Services

36. Where Can I Get Help? • Local SPD Office • Work Incentive Network (WIN) – see brochures. • Jeff Stell Medicaid Program Analyst 503-945-6834 jeff.stell@state.or.us Seniors and People with Disabilities Division of the Oregon Department of Human Services

37. QUESTIONS? Seniors and People with Disabilities Division of the Oregon Department of Human Services