1. Medicaid for Transition Age Youth and Workers with Disabilities Annette Shea, Center for Disability and Aging Policy December 12, 2013

2. Overview Affordable Care Act and Medicaid for transition age youth Medicaid and non-Medicaid provisions – Eligibility and Enrollment – Medicaid Buy-In

3. Affordable Care Act: New Opportunities for States Transition-aged youth with disabilities will have the opportunity to enter the workforce and choose employment instead of committing to not working and relying on social security benefits. Younger adults making occupational decisions can enter adulthood with less risk of losing access to health coverage. States expanding Medicaid will offer individuals with income up to 133% of the federal poverty level access to Medicaid without an asset limit. ACA provisions currently in effect: Lifting of pre-existing condition in offering private or commercial health insurance No more life time caps Coverage of Dependents to age 26

4. Medicaid Eligibility and Enrollment for Youth in Transition Income from children, through age 18, is not counted toward financial eligibility for the family when SSI methodologies are applied. MAGI rules apply regarding how income is counted. An adult individual applying for Medicaid may: – Use streamlined eligibility without consideration due to disability. – Identify a disability as consideration for eligibility; financial and non-financial criteria would be used to determine eligibility. Criteria is state-specific Annual redeterminations would be for the eligibility group a beneficiary is enrolled in. Applicants have right to appeal decision.

5. Medicaid Buy-In Medicaid Buy-In Programs are authorized by CMS and operated by State Medicaid agencies. Enrollment nationally is approximately 200,000. There are 46 Medicaid Buy-In programs nationally. Most recently approved state is Colorado with a current enrollment of more than 1000. Financial eligibility criteria is states specific. States have great flexibility in regards to the treatment of income and assets for Medicaid Buy-In programs. States also have some benefit flexibility, state plan and community-based long- term care programs. Over the past 10 years more than 400,000 individuals with disabilities have been enrolled in the program. Total earnings among all participants in 2011 was about $1.15 billion.

6. Summary Transition age youth with disabilities have opportunities for successful employment experiences and access to critical community-based benefits. Youth with disabilities transitioning to adulthood have benefit options within Medicaid and the private health insurance market.

7. Contact information Annette Shea Center on Disability and Aging Policy (CDAP) Administration for Community Living (ACL) US Department of Health and Human Services One Massachusetts Avenue NW Washington, DC 20001 (202) 357-3427 Email: Annette.Shea@acl.hhs.govAnnette.Shea@acl.hhs.gov ACL website: http://www.hhs.gov/aclhttp://www.hhs.gov/acl