Section 405 IAC 2-9-5 - Employment requirements; continuing eligibility when employment endsAuthority: IC 12-15-1-10; IC 12-15-41-15
Affected: IC 12-15-2-6.5; IC 12-15-41
Sec. 5.
(a) In order for an individual to be eligible for Medicaid for employees with disabilities, the individual must be engaged in a substantial and reasonable work effort. This means that the person must be either employed or self-employed, with the intent of such work activity being ongoing. The individual's monthly earned income must exceed the sixty-five dollar ($65) earned income disregard described in section 2 of this rule. Employment must be verifiable by pay stubs or other verification from an employer documenting that the income is subject to income tax and FICA withholding. Self-employment must be verified by the individual's income tax return or, in the case of a new business for which a tax return has not yet been filed, the personal business records of the individual.(b) In order for a member of Medicaid for employees with disabilities to remain eligible when the definition of medically improved disability in section 7 of this rule is met, the member must be employed as defined in subsection (a) and must have monthly earnings as calculated under 405 IAC 2-5-1 that are equal to or greater than the federal minimum wage times forty (40), unless the provisions in subsection (c) are met.(c) A member who is involuntarily not working can remain eligible for the Medicaid for employees with disabilities program for up to twelve (12) months if he or she meets all other program requirements and either:(1) is on temporary medical leave from his or her employment as defined in subsection (d); or(2) maintains a connection to the workforce by participating in at least one (1) of the following activities:(A) Enrollment in a vocational rehabilitation program.(B) Enrollment or registration with the department of workforce development.(C) Participation in a transition from school to work program.(D) Participation with an approved provider of employment services.(d) As used in this section, "temporary medical leave" means a leave from the place of employment due to health reasons when the employer is keeping a position open for the individual to return. If the employer is no longer holding a position open, the member must maintain a connection to the workforce as defined in subsection (c)(2) in order for coverage to continue under Medicaid for employees with disabilities.(e) In order to remain eligible upon becoming unemployed, the member or his or her authorized representative must submit a written request for continued coverage to the local office of family and children no later than sixty (60) days after termination of employment. Attached to this written request must be verification that the member meets the requirements in subsection (c). On a quarterly basis thereafter, as long as the member continues to be unemployed and wishes coverage to continue, verification of his or her medical leave or workforce connection status must be provided to the local office of family and children. The quarterly verification must consist of a statement from the agency or service provider that documents the member's continued participation in an activity that constitutes connection to the workforce, or from the member's employer stating he or she remains on a temporary involuntary medical leave.(f) A member who voluntarily terminates his or her employment for any reason is not eligible for Medicaid for employees with disabilities. Eligibility for the other Medicaid categories will be pursued.(g) A member who fails to submit the initial request for coverage continuation within the required sixty (60) day period or who fails to submit the quarterly verification report is no longer eligible for Medicaid for employees with disabilities. Eligibility for other Medicaid categories will be pursued. Office of the Secretary of Family and Social Services; 405 IAC 2-9-5; filed Jun 10, 2002, 2:21 p.m.: 25 IR 3119; errata filed Jun 28, 2002, 10:17 a.m.: 25 IR 3769; errata filed Aug 22, 2002, 3:14 p.m.: 26 IR 35; filed Jun 21, 2005, 3:00 p.m.: 29 IR 10; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAReadopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFAFiled 6/11/2021, 2:35 p.m.: 20210707-IR-405190602FRA