Good Decision in MEAD Case
(Medicaid for Employed Adults with Disabilities)

September 2006: A Hearing Officer for the Department of Health and Human Services (DHHS) has ruled in favor of Nancy G. in her appeal of a DHHS decision that barred her from participating in a program designed to help people with disabilities return to work.

“I was very happy when I found out that I did win the case”, Nancy said.

MEAD is a program that allows individuals with severe disabilities to work and still qualify for Medicaid benefits. It provides the opportunity for people with significant health needs to become more independent and self sufficient, and to break the cycle of poverty experienced by many people with disabilities who cannot otherwise afford to go to work if it means losing their Medicaid coverage. Under the MEAD program, people with disabilities can go back to work and keep their Medicaid coverage, even if they make more than the Medicaid income limits.

Nancy, who is a client of an area agency, receives services under the Home and Community-Based Care Waiver for Developmental Disabilities (HCBC-DD). She was enrolled in the MEAD program and was working while maintaining her Medicaid coverage.

DHHS tried to claim that, unlike other MEAD recipients, people like Nancy who were receiving HCBC-DD benefits would have to make more than $1250 a month to be eligible for the MEAD program. Normally, a Medicaid recipient who made more than $600 a month would be eligible for the MEAD program. This meant that HCBC-DD beneficiaries would have to earn much more money than other people in order to qualify for the MEAD program. If the money HCBC-DD recipients earned wasn’t over $1250 dollars a month, they would have to pay all of their extra income to the state, thereby removing the incentive to return to work. In Nancy’s case, she might not have been able to afford her apartment without the money she saved by being on the MEAD program.

According to Nancy’s service coordinator, Diane Luszey, this change in DHHS policy meant that many area agency clients were unable to access the MEAD program or were removed from the program and put into a different Medicaid program that required them to pay a large part of their earnings to keep their Medicaid benefits.

Additionally, when the state kicked Nancy and other MEAD recipients out of the program, they did not give her notice of why she was kicked out or a chance to appeal. This was in violation of federal Medicaid regulations.

In Nancy’s case the Hearing Officer ruled that DHHS had not created any official regulations allowing it to have a $1250 minimum income requirement for HCBC recipients to join the MEAD program. The judge ruled that because DHHS did not make an official regulation as they were required to do under state law, the DHHS policy was illegal. Nancy was found to be still eligible for the MEAD program, and could keep her earnings.

For Nancy, this means a little extra money to pay for things Medicaid won’t cover, such as her Podiatrist and some of her dental expenses. She is happy to be able to save a small amount “for a rainy day.”

For more information, contact Disability Rights Center - NH (603) 228-0432 or (800) 834-1721.

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updated September 8, 2015