Example

Melanie's Story

Melanie is 35 years old and has cerebral palsy. She hasn’t been able to work for the past 6 months due to her disability. She’s been living on $850/month in Social Security Disability Insurance (SSDI) benefits and has had Medical Assistance (MA) to help pay for her health care expenses.

She’s been feeling better recently and wants to go back to work part-time for a computer design company. Unfortunately, the job does not come with health insurance and she’d be earning too much money to keep her MA without a spenddown. She really wants to take this job, but she’s worried that a spenddown would be too expensive. She has to have health coverage, because her prescription drugs, physical therapy, and Personal Care Assistance (PCA) services would cost her several thousand dollars per month if she didn’t have coverage.

Health Coverage Options

First, Melanie looks at MA with a spenddown. With earnings of $1,500/month plus her $850 SSDI benefit, her maximum monthly spenddown would be $263. This means she’d have to pay the first $263 of her medical expenses each month before MA would start paying. This is not a good option. It would be great to be back at work, but to spend almost two-thirds of her salary on her health care coverage would be disappointing, to say the least.

Then Melanie looks at getting an individual plan on MNsure. She knows that starting in 2014, nobody can be turned down for a plan, but she doesn’t know how good the plans that are available really are. After filling out her information, it turns out that she could sign up for a plan that would cost her about $150 a month for the premium. The problem is that the plan has a deductible and also has copayments that are way higher than her old copayments were. Furthermore, it wouldn’t pay for the personal assistance services she needs like MA does. She hopes to find another option.

MA-EPD

Finally, Melanie remembers a program she had heard about called Medical Assistance for Employed Persons with Disabilities (MA-EPD). The program is designed for people in situations like hers. MA-EPD would allow her to go back to work, earn any level of income, and save up any amount of money while still qualifying for the program. Instead of paying up to $263 each month on a spenddown, she would only have to pay a $150 monthly premium for MA-EPD. And MA-EPD would pay for the same services that standard MA covers. Each time she needs medical services, it would be a lot cheaper than the private insurance plan she saw on MNsure.

Melanie is ecstatic. She’ll be able to go back to work, doing something she really enjoys. And she’ll be able to keep her health coverage for a reasonable monthly premium. She grabs her bank statements and some other personal information and heads straight to the county or tribal human services office to apply.