Policy Directive                                                                          Issuance Number: MS 09-08

Medical Services Policy Manual                                             Issuance Date:       03/09/09

From: Joni Jones, Director                                             Expiration Date: Until Superseded

Subj:  Working Disabled Eligible to Receive AAPD Services

The AAPD Waiver has been amended to include the Working Disabled category as a group that is eligible for services within the waiver.  In order to be eligible for the AAPD Waiver services and the Working Disabled category, applicants must meet both the medical criteria of the AAPD Waiver program (MS 26115 II) and the financial criteria of the Working Disabled category (MS 28030).

Referral for Assessment

When an applicant or recipient of the Working Disabled category applies for the services available within the AAPD category, the county worker will complete a DHS-3330 within 2 days of the office interview for referral to the DHS RN or AAPD counselor for coordination of the medical assessment.  For a recipient of the Working Disabled category, completion of a new application is not necessary unless it is time for the annual reevaluation of the Working Disabled category.  The assessment process in MS 26125 will be followed.  The application, reevaluation, or the request for AAPD services on an active Working Disabled case will be pended until receipt of the DHS-704 from the Home and Community Waiver Unit.

County Office Eligibility Determination

The county worker will determine if the applicant meets the eligibility requirements of the Working Disabled category (MS 28015).

For Working Disabled/AAPD cases, disability will be determined using the Working Disabled criterion which allows an individual to earn over SGA at the time of application.  MS 28025 provides guidance on when to refer to MRT for a disability decision.  A referral to MRT is not necessary for an applicant who received SSI or SSA disability within the last year and lost entitlement solely due to employment or when an applicant is still considered as an active SSI or SSA disability recipient whose cash benefits were suspended due to earnings.  However, to be eligible for AAPD waiver, the disability must be determined as physical.  The county worker must contact the local SSA office requesting verification of physical disability.  If unable to verify if a physical disability exists through SSA, then a MRT determination is required.

The applicant or recipient may be eligible for retroactive eligibility, if needed, for the Working Disabled category (MS 28060).  However, the individual will not be eligible for the AAPD Waiver until the day of the month in which the Waiver eligibility is finalized by the caseworker (MS 26156) and approval submitted to ANSWER.

AAPD Transition to the Working Disabled Category

AAPD recipients may also request to transition to the Working Disabled category.  Once the caseworker determines eligibility for the Working Disabled category, the AAPD category will be closed and the Working Disabled category will be approved effective with the day after closure. 

AAPD recipients who have earnings that cause ineligibility for AAPD should be reviewed before closing to see if they would meet the financial criteria of the Working Disabled category.  Once the caseworker determines eligibility for the Working Disabled category, the AAPD category will be closed and the Working Disabled category will be approved effective with the day after closure.  The AAPD case will then be reopened manually by ANSWER System Support.

NOTE:  An AAPD applicant or recipient may still be eligible for AAPD when employed as long as his/her total income (earned + unearned) does not exceed the waiver income limit.  Also, an individual can remain categorically eligible for the AAPD waiver when SSI eligible but no longer in payment status.  Social Security Disability rules allow beneficiaries to earn over SGA during their Trial Work Periods and Extended Periods of Eligibility.  The county worker is not required to verify or request verification of income and resources.  The DHS-704 is required to meet the medical necessity as well as verification that a physical disability exists.

Adding the Working Disabled to AAPD

A system change is required in ANSWER to systematically add the AAPD waiver.  Until the change is completed, a manual process has been developed.  The ANSWER System Unit will manually add the WAIV record to the Working Disabled category (10).

Once the county worker has established that the Working Disabled applicant/recipient or the AAPD recipient has met both the Working Disabled and AAPD criteria, the county worker will approve the Working Disabled category, if not currently open.  The county worker will then email the Central Office, OPPD, Medicaid Eligibility Unit requesting the AAPD criteria to be added.  (This email should include all of the names listed below.)  

On the date the county worker takes the action to approve the Working Disabled category and close the AAPD Waiver case, if there is an active AAPD Waiver case, a DHS -3330 must be sent to the appropriate DAAS RN or Counselor.  The DHS-3330 must include the effective date the AAPD waiver eligibility is established or the date of closure ending the AAPD wavier eligibility, whichever is appropriate.  

County workers must follow the above instructions for the proper processing of these cases to avoid inaccurate reporting.

Central Office Process

The Central Office, OPPD, Medicaid Eligibility Unit will view the narrative in ANSWER to verify that requirements for AAPD waiver eligibility have been determined.  Then the Medicaid Eligibility Unit will contact ANSWER Support to request that the AAPD waiver be attached to the approved Working Disabled category.  If eligibility has not been determined, the county office will be contacted by OPPD Medicaid eligibility Unit for necessary action.

ANSWER System Support will transmit a WAIV record (waiver number 2930 and 2935) with the category of Working Disabled (10) to EDS to pay claims to the AAPD waiver providers.  For reporting purposes, it is imperative that recipients qualifying for both programs be reflected as such in the system.  

Inquiries:         Judy Dauterman, 501-682-8259

                         Carmen Banks, 501-682-8258

                         Carla Droughn, 501-682-8254

                         Dona Young, 501-682-1562