Medicaid Purchase Plan (MAPP) Updates

Megan Koch, Employment Resources, Inc. (ERI): Today I’m talking with David Pinno who was an important part of advocating for changes in the MAPP program. David was part of the work group who met to discuss changes they wanted to see. After lots of hard work, the law was passed in 2017. This law took a year to change and two years to implement.

Thanks for talking with me today, David. I look forward to hearing more of your perspective on the MAPP program!

Megan: David, tell me a little bit about MAPP. What is MAPP?

David: MAPP stands for Medicaid Purchase Plan and it is a way for people keep Medicaid health care coverage once they start earning more money from employment. This means you can work more, earn more and save more.

Megan: The MAPP program has a premium for some people in order to have coverage. In the past, this premium was often very high and unaffordable for some people. Tell me about how this has changed.

David: The MAPP program does have premiums for people who earn more than the federal poverty level. In 2020, changes were made to make premiums fairer and more affordable. Note that right now premiums are waived, not collected, because of the COVID19 pandemic.

Some people know their estimated premiums, and for most people it’s between $25 and $75 per month! This is much less than how high it used to be for some people. For example, $400 or more per month MAPP premiums weren’t unheard of under the old rules, but this isn’t the case anymore.

Megan: What happens if someone has unexpected expenses and can’t afford their MAPP premium?

David: There is a process to request a Temporary Hardship Waiver and if approved your coverage can continue for a limited period of time without a premium payment.

Megan: There are asset limits for Medicaid. MAPP is no different – it has an asset limit, but it’s higher than most. The asset limit for MAPP is $15,000. More and more, people are hearing about ABLE Accounts. Can you tell me how an ABLE account is considered when looking at someone’s asset eligibility for MAPP?

David: You can have more money in these types of savings accounts and still be MAPP Eligible. Savings in an ABLE account do not count towards the MAPP asset limit of $15,000. Other things may though. There are special rules about savings, money from inheritance and other assets. There are people who can help you figure this all out. You can contact a benefits specialist for more information about this. In some cases, you may need to work with an attorney to properly set up things like Special Needs Trusts so you can have those without changing your eligibility for Medicaid.

Special Note:

Another type of savings account is called an independence account. These are financial accounts set up through a bank or credit union and owned by the MAPP applicant or member. These accounts allow you to save money above the MAPP asset limit ($15,000) without affecting your MAPP eligibility. All new independence accounts must be registered. You must complete the MAPP Independence Account Registration form, F-10121, and return it to your local agency.

Megan: Sometimes people have too much unearned income to be eligible for Medicaid in another way. Can they still have MAPP even if they’re not working?

David: The MAPP program has a work requirement. Someone can meet the work requirement through having a job, being self-employed or doing something called in-kind work. In-kind work is a work activity that you do for someone else like a neighbor or friend. If they pay you in money, food or shelter, this could be in-kind work. An example is walking your neighbor’s dog twice a week when they work long days. This could be in-kind work as long as they pay you with cash or maybe a meal for helping out. So, even if you’re not working for an employer, you might still meet the work requirement.

You could also meet the work requirement for up to 9 months through the Health and Employment Counseling program. You do this by filling out an application talking about what work you’re looking for and how you’re working towards that goal and send it to the Department of Health Services.

Megan: What happens if someone is working and has MAPP but they have to stop working for a few months to have a surgery?

David: The work requirement can be temporarily suspended for a situation like this. There are rules and so you would need to work with your Income Maintenance Consortium or a benefit specialist to find out how this process works.

Megan: Sometimes people continue to have some medical costs out of pocket. Tell me a bit about how these medical costs might be considered for MAPP eligibility and premiums.

David: If you have medical costs greater than $500 per month, they can be deducted during the eligibility calculation.

Medical Remedial Expenses of any amount can be deducted during the premium calculation so this helps a lot of people in your situation. You need to report any expenses you pay related to your medical conditions to the Income Maintenance Consortium so they can verify them as needed and make sure they’re used in your premium calculation.

Megan: What about medical costs related to someone’s disability and working? Can someone’s income be adjusted for those too?

David: Yes, Impairment Related Work Expenses (IRWE) are deducted from your income during the premium calculation. You need to let the Income Maintenance Consortium know about any expenses you pay for that are related to a medical condition and needed by you to work. They will verify these expenses and make sure they’re applied in the premium calculation.

Megan: Thanks for all of the great information about MAPP! Someone might be watching this video and think MAPP is a great option for them. But, thinking about moving forward could be scary or someone might not know where to start. Where could someone go if they have more questions or want some help applying for MAPP?

David: A person can get started by contacting their local Aging and Disability Resources Center (ADRC). There an information and assistance specialist or benefit specialist will get all of the details about your individual situation and can assist you with the application process. They can also help if you need assistance such as sign language, large print or call captioning.