1. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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). Presented by Scott Lay and Janet Stevely Employed Persons with Disabilities Program

2. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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)

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

4. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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!

5. Seniors and People with Disabilities Division of the Oregon Department of Human Services What is EPD? E E mployed P P ersons with D D isabilities

6. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

7. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

8. Seniors and People with Disabilities Division of the Oregon Department of Human Services Developmental Disability Medicaid Waivers 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

9. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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)!

10. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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)

11. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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)

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

13. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

14. Seniors and People with Disabilities Division of the Oregon Department of Human Services Adjusted Income Limit $ 4,419 - 20 - 65 $ 4,334 /2 = $2,167 250% 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

15. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.”

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

17. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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

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

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

20. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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*).

21. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

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

23. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

24. Seniors and People with Disabilities Division of the Oregon Department of Human Services Who Pays Off Set? 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)

25. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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

26. Seniors and People with Disabilities Division of the Oregon Department of Human Services George – Comp Services 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).

27. Seniors and People with Disabilities Division of the Oregon Department of Human Services Sally – Comp Services 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)

28. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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).

29. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

30. Seniors and People with Disabilities Division of the Oregon Department of Human Services Ryan - Brokerage 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.

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

32. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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).

33. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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!

34. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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.

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

36. Seniors and People with Disabilities Division of the Oregon Department of Human Services 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

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