We thought National Disability Employment Awareness month would be a good time to re-post information about one of the most significant work incentives initiatives to be developed in Florida in quite some time. The Working People with Disabilities Program allows Medicaid waiver recipients the opportunity to earn and save substantially more without losing essential Home and Community-Based services. The following (updated) article appeared in the FSACentral blog earlier this year.
The Working People with Disabilities Program was approved by the Florida legislature in 2019 and after federal approval began enrolling clients in 2020, offering them the ability to move out of poverty by removing one of the most significant barriers to competitive employment that people with disabilities experience – Medicaid income limits.
The program involved a rule change that effectively increases the income threshold people with disabilities on the Medicaid waiver must stay under to keep Medicaid insurance. For those not enrolled in the program, Florida Medicaid only allows its waiver recipients to earn $27,000 a year and have $2,000 of savings. By enrolling in the program, individuals can earn around $52,000 and have assets totaling $13,000 without losing benefits. It should be noted that recipients of the iBudget, CDC +, Long-Term Care and Familial Dysautonomia waivers are eligible for this program.
The passage of this change is a great example of self-advocacy in action. After completing her master’s degree, Florida self-advocate and former legislative aide Sarah Goldman, found herself facing the choice between under-employment and keeping the personal care services she requires to work and live independently. Unwilling to accept this choice, Goldman began to research options. She discovered that 46 states allow people with disabilities to “buy in” to Medicaid insurance for a monthly premium, allowing them to receive the care they need without adhering to oppressive income limits. Florida does not have Medicaid buy-in.
With help from the Florida Developmental Disabilities Council (FDDC), Goldman and Florida Self-Advocates Network'D Vice-President, Amanda Baker, became familiar faces advocating for the program over the years. Baker has cerebral palsy and requires a personal care assistant to dress and help her prepare for each day. For Baker, the ability to accrue assets is as important as the higher earning capacity.
“This policy change will allow people on the Medicaid waiver to earn and save enough money to have a level of independence we’ve never been able to have before in Florida. We are now allowed to save for things like a vehicle or a vacation without losing the services we need to be able to work,” Baker said.
Conventional wisdom behind income limits for all Medicaid recipients – not just people with disabilities-- is that once they are educated, trained, and able to acquire stable, full-time employment, they will start purchasing reduced-cost health insurance from their employers as they continue to advance professionally. But because most private health insurance plans do not include personal care assistance benefits, people who need those services in order to work and live independently were stuck. Although there are trust programs that have allowed waiver recipients to surpass earning limits, they are complicated to set-up, can have difficult requirements, and some require deposited funds to be paid to the state upon death.
Working Peoples is a game changer when it comes to systems change in competitive employment for people with disabilities. It will allow people to advance professionally while enjoying the financial freedom that comes with higher pay and job satisfaction. Working People's will allow one to ask for that long-deserved raise or more hours, post for a promotion or apply for a higher paying job, and/or begin to save more, not just for disability-related expenses, but vacations and other items.
It’s a true example of community inclusion because now many more workers with disabilities will be able to grow professionally like others in the workforce.
Although the program took a while to get rolling, its benefits apply retroactively to January 1, 2020, so the sooner people start the enrollment process, the sooner they'll reap the benefits. Here are a few tips . . .
• Don't take "I don't know" for an answer. Although APD has posted instructions and written about the program in its newsletter, word is getting out slowly and your Waiver Support Coordinator (WSC) or employment coach may not have heard about it yet. Be patient but persistent -- this program is law, not a rumor! Ask your providers to check with APD about the program, or direct her/him to this page: Supported Employment | Providers (myflorida.com)
• If you receive SSI/SSDI, start reporting your extra income to Social Security, letting them know you are enrolling in the Working People with Disabilities Program. Keep records of your reporting as it may take Social Security a few weeks or months to review your case. At some point as your SSI/SSDI benefits cease your Medicaid eligibility review will be transferred to Florida Department of Children and Families (DCF). It's important to stay patient during this process and keep the end goal in mind. To make sure you have covered all the bases, we also recommend you contact DCF, letting them know you want to take advantage of this program and that you HAVE already let Social Security know.
• If you don't receive SSI/SSDI, work with your WSC to report the new income to DCF, letting them know you will be taking advantage of the Working People with Disabilities program. Be advised that in some, but not all instances, proof of disability is being required by DCF.
• As every good advocate knows, it’s important to stay on top of the agencies involved, regardless of what you have been told. Stay in touch with them to confirm enrollment and that they have all the information they need from you. While its fine to call these agencies, especially if you need to report income, experts advise to also email the agencies via their general information address to establish a paper trail. Write a detailed message saying you want to enroll in the program. Keep a copy of the email and follow-up if you haven't heard anything in 10 days.
• Make a record of all phone calls to Social Security and copies of all correspondence sent by mail or fax as well as proof that your documents were sent (the top sheet verifying that a fax was sent or return mail receipts work well).
• Keep FSACentral/FL SAND posted on your progress. We are keeping track of feedback and may even be able to help you advocate. You can reach us at firstname.lastname@example.org