Eligibility
To be eligible for MA-EPD, you must:
- Be certified disabled by either the Social Security Administration or the State Medical Review Team
- Be employed and have required taxes withheld or paid from earned income
- Have monthly earnings of more than $65
- Not be eligible for Medical Assistance under other, more beneficial categories
- Meet the asset limit
- Pay a premium
- Pay an unearned income obligation if required
What is the MA-EPD asset limit?
The asset limit for MA-EPD is $20,000. Some assets that do not count toward the limit are:
- Spouse's assets
- Homestead property
- One motor vehicle under certain conditions
- Household goods, clothing and personal items
- Retirement accounts
- Medical expense accounts set up through an employer
- Burial space items or burial funds (up to $1,500)
What is the MA-EPD premium and unearned income obligation?
For an estimated premium cost, go to the MA-EPD monthly premium estimator. You will need to enter information on earnings and household size. For an actual, accurate premium, please contact your county human services agency.
Premiums
Most people will have to pay a monthly premium for MA-EPD. Premiums are based on a sliding fee scale or a minimum of $35, whichever is greater. Income and household size are used to calculate the premium. American Indian enrollees are not required to pay a premium. There is no maximum income limit or maximum premium amount for MA-EPD.
People who have unearned income, such as Social Security Disability, must pay one-half of 1 percent of their unearned income. To calculate the monthly-unearned income obligation, multiply the total unearned income amount by .005. This cost is in addition to the monthly premium.
Can a person have other insurance and still get MA-EPD?
Yes, people may have private, group or employer subsidized health insurance in addition to MA-EPD. Many services that are not covered by other insurance policies may be paid for by MA-EPD. If a person has other health insurance, that insurance must be used first, following the rules of that primary plan (e.g., must use network providers, obtain referral or authorization as required, etc.). Then services not covered may be paid through MA-EPD.
What if a person loses their job or cannot work because of a medical condition?
Job loss
People on MA-EPD who lose their job through no fault of their own (they did not quit or get fired) may stay on MA-EPD for up to four months while looking for another job. If they do not have a job after four months, they cannot be on MA-EPD.
Medical leave
People on MA-EPD who become unable to work because of a medical condition may stay on MA-EPD for up to four months. They must have a written, signed doctor's statement that says they are expected to return to work within four months. If they cannot return to work within four months, they cannot be on MA-EPD.
How does working affect other benefits?
For information on how working may affect other benefits, such as Social Security Disability Insurance, Medicare, Social Security Income, Minnesota Supplemental Aid, private disability insurance, subsidized housing, food stamps and Veteran Benefits, go to Disability Benefits 101.
Services
MA-EPD pays for the same services as regular Medical Assistance, including:
- Home care
- Inpatient hospital
- Medical equipment
- Mental health services
- Personal care assistance
- Physical, occupational and speech therapy
- Physician and health clinic visits
- Prescription drugs (except enrollees who also have Medicare).
Some services, such as prescription drugs, non-preventive care visits and eyeglasses may have co-pays. See health care coverage.
In certain circumstances, MA-EPD may cover Medicare or other health insurance premiums, co-pays and deductibles.
What if a person has other health insurance?
If a person has other health insurance, that insurance must be used first, following the rules of that primary plan (e.g., must use network providers, get referrals or authorizations as required, etc.). Services not covered then may be paid through MA-EPD.
