Working Healthy, WORK and STEPS�2022

Working Healthy Program

Working Healthy is KanCare Coverage: allows people with disabilities to return to or increase their work effort without losing critical KanCare Coverage.

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Working Healthy encourages people to work, increase their income and accumulate assets in order to reduce long term reliance on public supports.

Protect and improve the health and environment of all Kansans

Program Highlights

Working Healthy offers the following to working persons with disabilities:

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• Earn more income without loss of medical coverage
• Accumulate assets
• Elimination of spenddown
• KanCare coverage is the same as in the current KanCare program
• Help with Medicare expenses
• In some instances, employer premiums may be paid
• Personal assistance services under WORK
• Medically Improved provision
• Benefits planning and assistance available.

Eligibility Criteria

• 16-64 years of age.
• Meet the Social Security definition of disability.
• Verified earned income which is subject to Federal Insurance Contributions Act/Self Employment Contributions Act.
• $65.01 minimum income after Impairment Related Work Expense, Blind Work Expense, and income producing costs are deducted
• Earnings at or above the federal minimum wage (unless self-employed)
• Cannot be on an Home Community Based Services Waiver
• Cannot be a Supplemental Security Income cash recipient
• Kansas resident.

Assets and Resources

• Assets up to $15,000 per household.
• In addition to the $15,000 in savings, Working Healthy will allow participants to accumulate the following:
• Retirement related accounts, IRA’s, 401(k)s, pensions
• Keoghs
• Homes, certain vehicles, interest income up to $50/month, household goods, certain burial funds, and income producing property
• Individual Training accounts up to $3,000
• Individual Development Accounts (IDA’s)

Definition of “Competitive Employment”

Competitive Employment – Work performed in the competitive labor market compensated at or above federal minimum wage, and not less than the customary wage and benefits paid a person without a disability for the same level of work.

Definition of “Integrated Setting”

Integrated Setting – Community setting where individuals with disabilities work with individuals who do not have disabilities (not including individuals without disabilities who are providing services for them).

Medically Improved Provision

A person who is currently on Working Healthy may remain on Working Healthy even after SSA determines they are medically improved.

Medically Improved - Differences from Regular Working Healthy

• Social Security Administration or Disability Determination Services determination of medical improvement.
• Employed at least 40 hours per month.
• Medically determined severe impairment via ES‑3153 and Benefits Specialist review.
• Severe impairment reviewed annually.

Employment Plans

The participant must work with a WH Benefits Specialist to establish an Employment Plan to remain Working Healthy eligible.

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Participants may remain enrolled in Working Healthy for 4 months beginning with the month following the loss of employment. (Temporary Unemployment Plan)

Premiums

• Some people may be required to pay a monthly Premium for KanCare coverage.
• Premium amounts are based on the household’s countable income and are payable monthly.
• Premium amounts will be reviewed by the KanCare Eligibility Team every 6 months.
• Enrollees are expected to remain current with premium payments.
• Working Healthy may end if behind by 2 months or more.
• Premium billing is administered by Gainwell Technologies.
• Bills will be mailed monthly with the payment due by the end of the month.

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Role of the Benefits Specialists

• Benefits Planning.
• Collect data on individual’s current benefits status.
• Provide critical analysis of work, earning, and resources in these benefits.
• Provide options to the individual and their support network if appropriate about the impact of employment or increased employment on benefits.
• Work with the Clearinghouse to establish medical coverage and other benefits.
• Compare and contrast Working Healthy with other available programs.

What is WORK?

Personal assistance and other services for consumers eligible for Working Healthy whose functional limitations would otherwise make them eligible for the Developmental Disability, Physically Disabled, and Brain Injury waivers

“Cash and Counseling” Model

Goes a step beyond consumer self-direction

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Allows consumers to directly manage their funds

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Offers flexibility in terms of what services are purchased, and how they are purchased

Who is Eligible for WORK

Consumers must otherwise qualify for Working Healthy and also meet the following:

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• On the Physically Disabled, Developmentally Disabled, or Brain Injury Waivers, or

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• On the waiting lists for these waivers, or

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• Demonstrate the need for the same level of care as individuals on these waivers, and

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• Competitively employed in an integrated setting, earning minimum wage, paying FICA/SECA taxes, as well as earning a minimum of $65.01 monthly.

What services are included in WORK?

• Assessment
• Personal Services
• Assistive Services
• Independent Living Counseling

Assessment

To receive WORK services, an assessment is completed by your MCO.

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If eligible, the assessment will identify the needs and the supports that can be purchased through the WORK allocation.

What are Personal Services?

When one or more persons is needed for assisting, or cuing/prompting, consumers with activities of daily living and instrumental activities of daily living, in the home and community, and at work

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Alternative and cost-effective methods of obtaining assistance to the extent that expenditures would otherwise be used for human assistance, e.g., meal or laundry service, purchase of equipment that decreases the need for human assistance

What are Personal Services (cont’d)

Work related services may include cuing or prompting to understand job responsibilities; assisting in interacting appropriately with other employees and the general public; in appropriate work behavior; in practicing safety measures; in symptoms management.

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Work related services cannot go beyond the scope of the KanCare program or subsume an Employer’s responsibilities under Title I of the Americans with Disabilities Act or the Kansas Act Against Discrimination.

What are Personal Services? (cont.)

Personal Services may be self-directed or the consumer may choose an agency to direct their services for them.

The rate for agency-directed services is negotiated by the consumer with assistance, if needed.

How Are Personal Services Paid?

Personal Services are paid directly by the consumer using a monthly allocation that is determined during the assessment and further developed with the Independent Living Coordinator.

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The assessment looks at a person’s individualized need for support with ADL’s (activities of daily living), IADL’s (instrumental activities of daily living), and employment.

WORK Fiscal Manager

Under KanCare, the Managed Care Organizations are responsible for Work Opportunities Reward Kansans and they select their own Fiscal Agent.

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Aetna and United have contracted with PCG Public Partnerships, LLC (PPL).

Sunflower has contracted with Palco.

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The WORK participant is the employer of record under the PPL model. TILRC uses an Agency with Choice model, meaning TILRC is the employer of record.

What are Assistive Services?

Assistive Technology not covered under the Kansas KanCare State Plan

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Services that assist consumers to use assistive technology

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Home modifications

What is Independent Living Counseling

Assisting consumers to:

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• develop, and obtain approval for, their Individualized Budgets, Emergency Back-Up Plans
• access training
• locate service providers
• coordinate their services
• report problems
• etc.…

Independent Living Counselor

All Work Opportunities Reward Kansans participants must have an Independent Living Counselor (ILC) as of January 1, 2012.

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Current participants will need to meet face-to-face in their home with their Independent Living Counselor at least once per quarter.

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New participants will meet face-to-face in their home with their Independent Living Counselor monthly for the first 12 months, then quarterly beyond that.

HCBS Safety Net

Consumers who were on an Home Community Based Services waiver before switching to Work Opportunities Reward Kansans may return to the Home Community Based Services waiver without losing services.

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Consumers who were on an Home Community Based Services waiting list prior to Work Opportunities Reward Kansans will maintain their place on the waiting list.

STEPS

Support and Training for Employing People Successfully

STEPS is an employment incentive program and based on the premise that providing the right combination of supports will result in higher employment rates and independence. STEPS is:

a voluntary program

• operated under the KanCare 2.0 1115 demonstration
• a pilot up to 500 individuals with disabilities
• provided through Working Healthy
• for KanCare beneficiaries age 16 through 64

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Disability Eligibility

For those receiving SSDI/CDB or SSI Federal Benefits

• Schizophrenia
• Bipolar or Major Depression
• Delusional Disorders
• Personality Disorders
• Psychosis not otherwise specified
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder
• Substance Abuse Disorder with or without another behavioral disorder

Disability Eligibility

SSI recipients only:

On the waitlist or receiving waiver services from:

• Physical Disability HCBS
• Intellectual/Developmental Disorder HCBS
• Brain Injury HCBS

Definition of Employment

• An individual should not be working prior to referral to STEPS but may or may not have previous work experience
• Exception: If someone is already working and wants to find other employment, they can enroll in STEPS
• Employment is defined as:
• minimum of 40 hours per month
• in a competitive, integrated setting
• federal hourly minimum wage or above
• Federal Insurance Contributions Act (FICA) withdrawn

Employment and/or work experience in a sheltered workshop is not considered employment for STEPS.

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HCBS Safety Net

Those

• who choose to participate in STEPS and are currently on a waiver waitlist will not lose their place on that waitlist
• who are offered a slot on the waiver may choose to accept the waiver offer or remain on STEPS
• choosing to remain in STEPS will be considered waiver eligible in the event they disenroll from STEPS
• who choose to participate in STEPS and are currently on a waiver will be able to return to the waiver
• cannot receive HCBS services and STEPS at the same time; it’s one program or the other

Community Service Coordination

A CSC can be an existing case manager, such as I/DD Targeted Case Managers (TCM), and also be a STEPS CSC

However…

CSC is not TCM and the responsibilities of STEPS CSCs are not the same as a TCM

CSC replaces TCM once a participant enrolls in STEPS.

They can return to TCM once they disenroll from STEPS.

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Community Service Coordination

Community Service Coordination (CSC) will:

• provide choice counseling and education to the participant regarding self-direction
• develop the Service Plan with the participant
• monitor participant’s progress toward meeting their goals
• monitor the implementation of the Service Plan
• provide participant contacts and home visits
• provide referrals for community services such as education, employment, and housing

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Referrals and Enrollment

Referrals can come from any source, such as

MCO Employment Specialists

Vocational Rehabilitation Services

Schools

Community Mental Health Centers

Clearinghouse

I/DD or other community disability service agencies

Make a Referral to a Benefits Specialist

When an individual receiving Social Security Disability Income or Supplemental Security Income is:

• Working fewer hours than possible for fear of losing medical coverage;
• Working more hours than they are paid for in order to maintain KanCare benefits;
• On an HCBS Waiver or waiting list and wants to work, or increase work levels;
• Seriously considering employment and would like to make an informed choice based on benefits planning.

How do consumers enroll in WORKING HEALTHY?

Contact the Clearinghouse, who will refer you to a Working Healthy Benefits Specialist.

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OR

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Directly Contact a Working Healthy Benefits Specialist.

How do consumers enroll in WORK?

Contact the Clearinghouse, who will refer you to a Working Healthy Benefits Specialist.

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OR

Directly Contact a Working Healthy Benefits Specialist.

How do consumers enroll in STEPS?

Contact Erin Sanders-Hahs, STEPS Program Manager at:

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Erin.SandersHahs@ks.gov

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Benefits Specialists

• Earl Williams NE Region 785-330-8602 earl.williams@ks.gov
• Vacant KC Metro Region
• Shelli Nyambane SE Region 620-860-7240 shelli.nyambane.@ks.gov
• Vacant Wichita Region 316-337-6012
• Sarah Guardado SC Region 316-337-6409 sarah.guardado@ks.gov
• Vacant NC Region 785-515-6710
• Danielle Mowery SW Region 620-865-0170 danielle.mowery@ks.gov
• Billie Crawshaw NW Region 785-261-6122 billie.crawshaw@ks.gov

Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

Administrators

Web Site

To learn more about the Working Healthy Program, visit our web site at:

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https://www.kancare.ks.gov/consumers/working-healthy

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Thank you/Questions