Example

Armando's Story

Armando has bipolar disorder and has been in and out of work for a number of years. Two years ago his condition worsened and he had to quit working altogether. This was a difficult time for Armando. He moved back in with his parents and they gave him a little money to live on each month.

Between the cash gifts from his parents and the $2,000 he had saved in the bank, Armando was able to get by for awhile. Armando had another problem though. After he lost his job, he lost his health insurance and he really needed health coverage so he could continue to see his psychiatrist and pay for the prescription medications he needed to manage his disability.

Applying for Benefits

A friend suggested he apply for Medical Assistance (MA). One afternoon, the two of them went down to Armando’s county or tribal human services office so he could apply for MA. After going through the State Medical Review Team (SMRT) process, he was determined disabled by the state of Minnesota. Because Armando had less than $3,000 in assets and an income below 100% of the Federal Poverty Guidelines ($1,305 per month), he qualified for standard Medical Assistance. This was extremely important. Now, he could get the medical care he needed and all he had to pay was the monthly deductible of $0 and prescription drug copayments of $0 – $0. Armando was relieved to say the least.

Around the same time he applied for MA, Armando also went to his local Social Security office and applied for Social Security Disability Insurance (SSDI). Five months after submitting his application, he was approved for SSDI and began getting a monthly SSDI benefit of $900.

Spenddown

While it was great to get the extra money from SSDI, this new source of unearned income caused his total countable monthly income to rise above the MA income limit of $1,305 per month (through Medical Assistance (MA)). Between the SSDI check and the $200 he was getting from his parents each month, his total countable monthly income was $1,100. Armando was able to stay on MA at this income level, but now he had to start paying a monthly spenddown. And his monthly spenddown was not cheap: $450.

A spenddown is like an insurance deductible. You have to pay for a certain amount of your medical costs each month before MA will start paying for your medical bills. If you don’t have any medical bills in a particular month, you don’t have to pay, but for Armando, that was rarely the case. His prescription medications cost about $500 per month and he usually had at least one visit to the psychiatrist each month. That was another $120. So most months, Armando was paying the full $450 spenddown and MA was paying for the rest of the cost of his medical care.

Return to Work

After a couple months of this, Armando decided he’d try to go back to work. He got a job at a local coffee shop and started working regularly again. The job was good for him: he got out of the house, made friends with his co-workers, and the regular work schedule gave his life some needed structure. He was working 20 hours per week, making money, and feeling good about things.

When he returned to work, Armando called his county or tribal human services office to report his change in income. He talked with his financial worker to report his new earnings. He also asked her about a program he had heard about from one of his friends. It was something about people with disabilities who work.

"Medical Assistance for Employed Persons with Disabilities (MA-EPD)," his worker responded. "That could be an excellent program for you."

MA-EPD was perfect for Armando. The program is designed for working Minnesotans with a disability (aged 16 and up). You can earn any level of income (you must earn more than $65 per month), keep more assets, and stay on MA. There’s a monthly premium for MA-EPD coverage, based on your income and household size. In Armando’s case, his monthly premium would be $81, far less than the spenddown he’d been paying. And the coverage was the same as he had with standard MA. Armando went to the county, paid his premiums, and enrolled in MA-EPD.

MA-EPD turned out to be a great fit for Armando. He was able to continue working, see his psychiatrist regularly, and most importantly, his mental health and general outlook on life improved. He's planning to move out of his parents' house any day now.