NOW YOU CAN GET MEDICAID!

In January 2001, New Mexico implemented the Working Disabled Individuals Program (WDI)!

To qualify for this Medicaid category, you must:

1. Meet the SSA criteria for disability - a severe impairment that has lasted or is expected to last for at least 12 months.
2. Have a recent attachment to the work force. You are considered to have a recent attachment to the work force, if:
3. Your quarterly earnings meet the SSA definition of a qualifying quarter ($900/quarter), or
4. You have enough qualifying quarters to receive SSDI, and as a result of qualifying for SSDI, you lose your SSI.
5. Must be 18 years of age or older.
6. Have countable resources of less than $10,000. A married couple must have countable resources of less than $15,000.
7. A person could gross approximately $44,000 a year and still qualify for this program. Net earned income is calculated by disregarding $20.00 (only if not applied to unearned income) then subtracting $65.00, then one half of the remainder, then allowable Impairment Related Work Expenses. The resulting net income must not exceed 250% of the poverty level or $1,871 a month.
8. Have unearned income (such as SSDI, etc.) of less than

$1,148/gross a month.

A qualifying quarter is defined as you have worked and earned at least $900 per federal quarter.

If you are presently on Social Security Disability Insurance (SSDI) or Supplemental Security Income for disabled (SSI) you meet the SSA criteria for Disability.

There are co-payments for this category of Medicaid. Maximum amount of annual co-payments are based on your annual earned income. You will be required to pay for certain services and items at time of service. The co-payments are:

$5 per outpatient visit, other practitioner visit,

clinic visit, urgent care visit, outpatient therapy

session, or behavioral health sessions

$5 per dental visit

$15 per emergency visit

$25 per inpatient hospital admission

$2 per prescription, applies to prescription and non-

prescription drug items

* * Native Americans are exempt from co-payments.

NMICIE is funded by a grant awarded to the Human Services Department by the Centers for Medicare and Medicaid Services (CMS) in the amount of $500,000 a year. This publication does not necessarily reflect their views and no official endorsement should be inferred. The Division of Vocational Rehabilitation is a partner in the program

How do you apply for this Medicaid program?

You must apply at your local Income Support Division office. Tell the interviewer you are applying for Medicaid Category 043-Working Disabled Individuals. Fill out form MAD 327, available at http://www.state.nm.us/hsd/mad/GenInfo.htm. Please note that you will need to return the completed form to your local ISD office. ISD office locations are available by calling the Human Services Department at 1-888-997-2583 and at the website http://www.state.nm.us/hsd/offices.html.

Bring proof of wages to show that you have earned or expect to earn at least $900 in the current calendar quarter.

If you are currently on SSA benefits, bring current award letter.

If you are not currently on SSA benefits, you will need to bring the following information and current medical information to support your claim of a disability. Please bring the following:

1. Social Security card;
2. Birth certificate or comparable proof of age;
3. Names, addresses, and phone numbers of all doctors, hospitals, clinics, and institutions that have treated you (and approximate dates of treatment);
4. All medical records available to you;
5. A copy of W-2 forms, latest tax bills, copy of lease, or rental agreement, insurance policies, bankbooks and/or statements, vehicle registration, and any other documents showing resources and assets.
6. Claim number of any other benefits you receive or expect to receive; and
7. If applicable, spouse’s income (use the latest filed income tax report and current itemized list of household living expenses).

All activities of the Division of Vocational Rehabilitation are conducted without regard to race, color, creed, religion, sex, age, national origin or type of disability. Program materials are available in alternative formats. * Brochure Revised 3/18/02 *

How Long Does Benefit Determination Take?

"Completed applications must be acted upon and notice of approval, denial, or delay sent out within 60 days of the date of application. Individuals will have time limits explained and be informed of the date by which the applications should be processed." If found ineligible, there is an appeals process.

Eligibility begins the month of approval. A redetermination of eligibility is made every twelve (12) months. You must have qualifying earned income in each quarter to maintain eligibility.

You may be eligible for up to three (3) months retroactive Medicaid coverage beginning after January 1, 2001.

Special provisions for Retirement Funds -

Contributions to Internal Revenue Service recognized retirement fund accounts are not considered a resource in the eligibility determination so long as funds are not withdrawn from the account. Examples of such retirement funds include PERA, ERA and employer’s qualifying pensions plan, 401(K) plan, civil service annuity, IRA, Roth IRA, KEOUGH PLAN.