House passes smaller Medicaid program for working disabled

JEFFERSON CITY, Mo. -- A year after eliminating a Medicaid program for the working disabled, the state House passed legislation Thursday to restart a smaller, more restrictive version of the health-care program.

The Medical Assistance for Workers with Disabilities program would begin anew July 1, if senators and Gov. Matt Blunt also sign off on the legislation. The House passed it 152-2.

The MAWD program, also known as the Ticket to Work program, provided Medicaid coverage last year to 16,987 disabled people who earned too much to qualify for traditional Medicaid but who worked at least a minimal amount each month. It cost about $250 million in state and federal funds.

Republicans argued the program had grown out of control and eliminated it, effective Sept. 1, as part of a 2005 law that also cut or reduced Medicaid benefits for thousands of others.

When MAWD was eliminated, however, more than half the participants continued to receive Medicaid coverage by transferring to another prong of the program and, in many cases, paying money out of their own pockets.

This year's legislation is projected to cover 1,800 people under the revised MAWD program, including 1,136 who currently have no coverage and 664 who are now paying to participate in Medicaid. The bill also would restore or improve Medicaid coverage to 1,337 sheltered workshop employees. Those two changes together are projected to cost $19.7 million in state and federal funds next fiscal year, with the tab growing slightly in subsequent years.

"It's a fiscally conservative, very generous, compassionate program that fits exactly who we want it to fit," said sponsoring Rep. Chuck Portwood, R-Ballwin.

Some Democrats disagreed, suggesting the state could afford to serve more people under the renewed program. But they all voted for the bill nonetheless.

"This is a little bit, a trickle of where we need to go, but we're moving in the right direction," said Rep. Paul LeVota, D-Independence.

Advocates for the disabled were pleased that at least some people would regain their Medicaid coverage.

"We see it as a very important first step to really removing the barriers to employment for people with disabilities," said Kirsten Dunham, a spokeswoman for Paraquad Inc., a nonprofit St. Louis organization that serves the disabled.

Legislators last year heard testimony that some people qualified for the old MAWD program by doing only an hour or so of chores a month for friends or relatives.

This year's legislation requires the worker to have Medicare and Social Security taxes withheld for the job to count, and it gives the disabled an incentive to work more hours.

It does that by setting up a double test to determine eligibility. The working disabled could have a gross income of up to 250 percent of the federal poverty level, or $2,402 a month for an individual. But their net incomes could be no more than 85 percent of the poverty level, or $694 a month.

To reach that net figure, the bill deducts all of the workers' earned income from that gross figure, more than half of their spouses' earned income, as well as various other costs.

Many who qualify for the new MAWD program would be expected to pay to participate. Disabled employees whose gross income is more than the federal poverty threshold -- $817 a month for an individual -- would have to pay a premium of 7.5 percent of their income.

Rep. Doug Ervin, R-Kearney, was one of the two representatives who voted against the bill. Ervin said he wanted to restore Medicaid coverage to sheltered workshop employees, but preferred to wait to restart the MAWD program until the Legislature can consider a broader overhaul of the Medicaid system.