Is it Right for You?

Almost everyone should be able to get health coverage, so you just need to see which option is right for you and your family. This page helps you see if Medicaid for Employed People with Disabilities (MEPD) might be a good choice for you.

If you don’t qualify for MEPD, you may still qualify for Medicaid based on other rules or for other programs, like Medicare and private health insurance.

MEPD Basic Eligibility Requirements

To qualify for MEPD, you must:

• Be under 65 years old
• Be determined blind or disabled according to Social Security Administration rules
• Be a U.S. citizen or meet specific noncitizen requirements
• Be working and have earned income from your job or self-employment
• Have $12,000 or less in resources ($13,000 if you're married), and
• Have combined family countable income at or below 250% of the Federal Poverty Guidelines (FPG) for your family size.

Note: If you’re on Supplemental Security Income (SSI) or SSI’s 1619(b) provision, you automatically get Medicaid coverage, do not need to apply for MEPD, and do not need to worry about the rules discussed on this page. Read more in DB101’s Disability-Based Medicaid article.

Disability Determination

To qualify for MEPD, you must have a disability that meets Social Security’s definition of disability. If you currently get disability benefits, like Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards. If not, the state will check to see if your disability qualifies for MEPD.

Under these rules, you have a disability if:

• You have a physical or mental impairment or combination of impairments, and
• Your condition has lasted or is expected to last for at least 12 months.

Note: For MEPD, Social Security’s disability rules related to earned income do not apply.

Citizenship and Noncitizen Requirements

You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for MEPD:

• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get, including MEPD.
• Most immigrants who have been lawfully present for less than five years do not qualify for MEPD. However, they may qualify to get private coverage subsidized by the government through HealthCare.gov.
• Undocumented immigrants do not qualify for MEPD, but they may qualify for Emergency Medicaid. To learn more about this, contact your local Health and Human Services (HHS) office.

Resources

To qualify for MEPD, you must have $12,000 or less in resources ($13,000 if you're married). Money in an ABLE account, the house you live in, and one car are not counted.

You can also set money aside in separate bank accounts to pay for certain expenses, and MEPD won't count that money as part of your resources. This includes:

• Money in an assistive technology account, which can only be used to pay for assistive technology that helps you work,
• Money in medical savings accounts, like Health Savings Accounts (HSAs), and
• Money in retirement accounts.

Family Income

To qualify for MEPD, your family's countable income must be at or below 250% of the Federal Poverty Guidelines (FPG) for your household size. If you're single, that's $3,260 or less per month; for a family of four, that's $6,698 or less per month of countable income.

Your family's countable income is not the same as your family's real, full income. To see if someone qualifies for MEPD, MEPD counts their family's money the same way that SSI does: almost all of the family members' unearned income is counted, but less than half of their earned income is counted. For example, this means that if you live alone and don't have any unearned income, you could make as much as $6,605 per month at work and still qualify!

You may have to pay a monthly premium that is based on your own income, not your family's combined income. The higher your income, the more your premium will be. We'll discuss how much you may have to pay later in this article.

Use the tool below to figure out your family's countable income and see if you may qualify for MEPD.

Your MEPD Family Countable Income:

Your family size:	123456789101112
Your Family's Monthly Earned Income	$
Your Family's Monthly Unearned Income	$
	$1,305
	$20
	$65
Your Family's Monthly Countable Income
	$15,650
	$5,500
250% of Federal Poverty Guidelines
Your Countable Income as a Percent of FPG
(Over MEPD limit)	0.00
(Under MEPD limit)	0.00

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MEPD and Employer-Sponsored Health Coverage

You can have MEPD and employer-sponsored private coverage at the same time. There are two main advantages to this:

• Employer-sponsored private insurance may cover some benefits that MEPD doesn’t or vice versa.
• Employer-sponsored private coverage may let you choose from more doctors.

The disadvantage is that you would have to pay the premium for both programs. Private coverage usally has higher copayments than MEPD, so it may not be worth the expense. On the other hand, if your MEPD monthly premium is high, you may choose not to enroll in MEPD and only sign up for employer-sponsored coverage.

If your MEPD premium is less expensive but you prefer your employer's health plan, you may qualify for Iowa's Health Insurance Premium Payment (HIPP) program. If you have HIPP, Medicaid pays your plan's premium and the other costs of getting medical care, like the copayments and the deductible. (Note: For Medicaid to pay these extra costs, you must go to a Medicaid health care provider.) You are not enrolled in a Medicaid managed care plan; instead, your employer's health plan is your main health coverage, but the only cost you must pay is your MEPD premium.

You must apply separately for HIPP after you are approved for MEPD. If the state of Iowa determines that it is cost-effective to pay for your private coverage, you may qualify. Note: People who also have Medicare can't qualify for HIPP.

Learn more about HIPP and how to apply.

MEPD and Medicare

If you are eligible for both MEPD and Medicare, you can have both at the same time. This can help because MEPD will help pay for things that Medicare doesn't pay for.

MEPD will help pay your Part B premium. And, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay other Part B expenses (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.

Contact your local Iowa SHIIP and SMP counselor if you have questions about how your Medicaid and Medicare benefits work together. To learn more, read DB101’s Medicare article.