Are you worried about losing benefits if you go to work? Here’s a program that REWARDS work by giving you MORE benefits!
What is the EID Program?
The EID Program, administered by the Maryland Department of Health and Mental Hygiene (DHMH), provides Medical Assistance (also called Medicaid) to working Marylanders with disabilities who meet a few conditions. Medical Assistance:
- Covers most medical services for individuals who have no other health insurance,
- Saves individuals with Medicare $1,000 - $12,000 a year
- Supplements private insurance, paying for some services that the other insurance does not cover
Who is eligible for EID?
To be eligible, you must meet all of the following:
1. Be at least 18 years old but not yet 65 years old
2. Be a U. S. citizen or “qualified alien”
3. Have a disability that meets Social Security’s medical criteria
4. Be working for pay
5. Meet the income limit (may be as high as $69,972 per year for a single person and up to $94,092 per year for a married couple) EID has the highest income limit, by far, of any Medical Assistance program in Maryland.
6. Meet the resource (asset) limit of $10,000 if you are unmarried and $15,000 if you are married. Resources include cash, bank accounts, stocks, bonds, investments, some retirement accounts, some property, etc. Resources don’t include the home you live in, vehicles you own, or certain other retirement accounts.
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The monthly premium is $0, $25, $40 or $55. People who sign up for EID almost always save much more than they pay for premiums.
What is a “monthly premium”?
It’s the cost you need to pay each month to be enrolled in the EID program.
How much will my monthly premium be if I am approved?
That depends on your income. It may be $0, $25, $40 or $55 per month.
How can I pay my premium?
By check, money order or credit card. Just mail your payment to the address listed in your letter, or follow the instructions in the letter to pay by credit card. Be sure to keep a copy of your personal check or a money order receipt to prove you paid, just in case Medical Assistance doesn’t receive your payment. You will get a monthly bill, and must pay each month to stay enrolled.
Where should I send my payments?
Please use the payment envelope that comes with your bill each month. If you lose the payment envelope, please mail payment to:
P. O. Box 17032
Baltimore, MD 21298
If I am approved, will my first premium payment be higher than the monthly amount?
Your first premium payment may be higher if you did not return documents to DEWS in a timely manner and/or delayed the processing of your application in some way. This is because you must pay the premiums for each month since your application was received, and Medical Assistance will usually charge you for one or two months of premiums in advance as well. Your Medical Assistance will begin the first day of the month your application was received. If you cooperated with DEWS or were not asked to provide any additional documents or information, you will not be required to pay premiums for the month(s) you did not know you were eligible. You will have to start making regular premium payments once you receive a notice letting you know you are approved for Medical Assistance.
If you are temporarily unable to pay the EID monthly premium, you may qualify for a Claim of Hardship Exemption. For more information see the EID Hardship Exemption Fact Sheet.
To apply for a Claim of Hardship Exemption, complete and submit this EID Hardship Request Form.
How to Apply
You can apply for EID on your own or with help from other agencies. To apply on your own, complete the Shortened EID Application (accessible), following the EID Application Instructions. Gather the needed documents you have available (see EID Documents to Enclose ). Print the application, sign and date it on page 11, enclose the supporting documents, and mail to:
Division of Eligibility and Waiver Services/DHMH
6 St. Paul Street, 4th Floor
Baltimore, MD 21202
The electronic application can be downloaded, completed, printed, and saved. Although the application must be printed and mailed, it should also be saved on your computer. When you enroll in EID, you must reapply every six months. Having the saved application on your computer makes it easy to update the information every six months when you need to reapply.
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What if you need help applying or don’t have a computer?
If you are served by a disability agency in Maryland, that agency may be able to help you apply for EID. Ask them if they can assist you.
If you are not connected with a disability agency (or if the agencies you are connected with can’t help you apply), you can contact the Center for Independent Living closest to you for free assistance.
If you have questions about the status of your EID application, you can contact the Division of Eligibility and Waiver Services (DEWS) at 410-767-7090. DEWS determines eligibility for EID.
Centers for Independent Living
Allegany, Garrett & Washington Counties:
Resources for Independence, Inc.
30 North Mechanic Street, Unit B
Cumberland, MD 21502
Phone: 301-784-1774 Fax: 301-784-1776
TTY: 711 Toll Free: 800-371-1986
Anne Arundel & Howard Counties:
Accessible Resources for Independence, Inc.
Center for Independent Living for Anne Arundel and Howard County
810 Nursery Road, Suite I
Linthicum Heights, MD 21090
Baltimore City, Baltimore & Harford Counties:
Independent Marylanders Achieving Growth through Empowerment (The Image Center)
300 E. Joppa Road, Suite 302
Towson, MD 21286
Calvert, Charles & St. Mary’s Counties:
Southern MD Center for Independent Living, Inc.
38588 Brett Way, Suite 2
Mechanicsville, MD 20622
Phone: 301-884-4498/5110 TTY: 711
Caroline, Cecil, Dorchester, Kent, Queen Anne’s, Somerset, Talbot, Wicomico & Worchester Counties:
Holly Community, Inc. .
909 Progress Circle, Suite 300
Salisbury, MD 21804
Phone: 443-260-0822 TTY: 711; Fax: 443-260-0833
Carroll & Frederick Counties:
The Freedom Center, Inc.
14 W. Patrick Street, Suite 10
Frederick, MD 21701
Phone: 301-846-7811; Fax: 301-846-9070
Montgomery & Prince George’s Counties:
Independence Now, Inc.
12301 Old Columbia Pike
Silver Spring, MD 20904
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What Medical Assistance would do for you
- Medical Assistance:
Covers most medical services for individuals who have no other health insurance, including some services that people with disabilities need, but other health insurance rarely covers – such as transportation for medical appointments, some psychiatric rehabilitation services, and personal care services. Other than the premium to enroll in EID, the only costs for covered services – if you use providers who accept Medical Assistance - are small co-payments for prescriptions ($1 for generic drugs; $3 for name brand drugs). You pay nothing for any other covered services.
- If you lose your job due to medical reasons or through involuntary job loss while enrolled in the EID Program, you may request to stay on the program for up to six months within a one year period while unemployed. You must continue to make your premium payments and meet all other EID eligibility requirements in order to stay in the EID Program.
- Saves individuals with Medicare $1,000 - $12,000 a year by covering Medicare premiums, deductibles and co-insurance. You can keep Medicare, but pay much less. Click here for more Medicare details.
- Supplements private insurance, paying for some services that the other insurance does not cover.
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Before she discovered EID, Vicki limited her earnings to $60 per month. She wanted to stay eligible for Qualified Medicare Beneficiary (QMB), a program that pays most Medicare costs, but has a very low income limit. Vicki enrolled in EID – which also covers Medicare costs – to replace her QMB. Now she takes advantage of EID’s high income limit to earn much, much more.
Kim and Dianne
Kim was paying for very high Medicare costs. When he enrolled in EID (which covered his Medicare costs), his savings were so high that he and his wife, Dianne, had enough money to buy a house.
Ed was receiving Medical Assistance through a “spend down” – a method that required him to pay for thousands of dollars of medical expenses out of his pocket every six months in order to get Medical Assistance. When he found out about EID, Ed found a job so he could qualify. Now he pays $25 a month for Medical Assistance.
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Division of Eligibility Waiver Services (DEWS)
Maryland Department of Health and Mental Hygiene/Medical Assistance
6 St. Paul Street
Baltimore, MD 21202
Maryland Disability Law Center
1800 N. Charles Street
Baltimore, MD 21201
Maryland Work Incentives Network (MD-WIN) (formerly Benefits INfoSource)
Senior Health Insurance Assistance Program
The Senior Health Insurance Assistance Program (SHIP) informs Medicare beneficiaries (including people with disabilities who are under age 65) about a range of Medicare issues. The Maryland SHIP program provides trained staff and volunteer counselors in all 24 counties. SHIP counseling services are confidential and free of charge.
Counselors provide in-person and telephone assistance in the following general areas:
- Medicare Prescription Drug Coverage Program (Medicare Part D)
- Medicare supplements (Medigap Plans)
- Assistance for disabled Medicare beneficiaries (under age 65)
- Medicare Advantage Plans (HMOs, Private Fee-for-Service, etc.)
- Long Term Care Insurance
- Medical Assistance programs
- Assistance for low-income beneficiaries
- Assistance with denials, appeals and grievances
- Billing problems
- Health care fraud and abuse
- Volunteer counselor opportunities
- Free community presentations
Find contact information for the SHIP office in your area at http://www.aging.maryland.gov/senior.html#SeniorHealth.
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QUALIFIED ALIEN: A non-citizen who lives in the U. S. and who meets one or more of the following:
- Has permanent resident status
- Was granted parole for at least one year under §212(d)(5) of the Immigration and Naturalization Act (INA)
- Has been battered or treated with extreme cruelty by his/her spouse (who is a U. S. citizen or permanent legal resident) or the spouse’s family living with them
- Was lawfully admitted to the U. S. as an Amerasian immigrant with permanent legal resident status under §584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988
- Was admitted to the U. S. as a refugee under §207 of the INA
- Was granted asylum under §208 of the INA
- Is having deportation withheld under §243(h) of the INA as in effect prior to April 1, 1997; or §241(b)(3) of the INA, as amended
- Is a Cuban or Haitian entrants, as defined by §501(e) of the Refugee Education Assistance Act of 1980
- Was granted conditional entry under §203(a)(7) of the INA in effect before April 1, 1980
- Is a child receiving federal payments for foster care or adoption assistance under Part B or E of Title IV of the Social Security Act, if the child's foster or adoptive parent is considered a citizen or qualified alien
- Is a victim of a severe form of trafficking, in accordance with §107(b)(1) of the Trafficking Victims Protection Act of 2000, who has been subjected to:
- Sex trafficking if the act is induced by force, fraud, or coercion, or the individual who was induced to perform the act was younger than 18 years old on the date that the visa application was filed; or
- Involuntary servitude
Who has lived continuously in the U. S. for at least 5 years since becoming a qualified alien
The 5-year residency requirement does not apply to lawful aliens who meet any of the following:
• Meet any of conditions 4 – 11 above
• Is an honorably discharged veteran of the U. S. armed forces
• Is on active duty in the U. S. armed forces
• Is the lawfully admitted spouse (including a surviving spouse who has not yet remarried) or the lawfully admitted, unmarried dependent child of an active duty or honorably discharged member of the U. S. armed forces.
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SOCIAL SECURITY'S MEDICAL CRITERIA: Social Security has a list of disabilities and medical conditions called the “listing of impairments”. It describes how severe a condition must be for an adult to be considered “disabled” by Social Security:
How Do I Meet the Disability Definition? You meet the definition if:
- You get Social Security Disability benefits OR
- You lost Social Security Disability benefits or Supplemental Security Income (SSI) in the last several years, but your disability has not improved OR
- You have not received Social Security Disability or SSI benefits, but you have a disability that meets Social Security’s medical standards
If you’ve never received Social Security Disability or SSI, you will usually have to apply for Social Security Disability when you apply for EID. If you earn more than $1,040 per month gross wages (or, if you’re blind, if you earn over $1,740 per month), you will need to complete the non-disability portion of the Social Security Disability application, and receive a denial letter from Social Security. You may be able to get the denial letter in the Social Security office after applying, while you wait. If you earn more than $1,900 per month gross wages (or over $2,600 per month if you are blind), you don’t need to apply for Social Security Disability.
- Are denied Social Security Disability for financial reasons, OR
- Earn too much to have to apply for Social Security Disability,
then you will get a separate “disability determination”. A disability determination is an evaluation to see if you meet Social Security’s medical criteria. If you need this determination, you will be notified. The best way to speed up the determination is to get medical records from all doctors, clinics, hospitals, therapists, etc. that have treated you for your disability.
NOTE: The disability rules for EID are a bit different from the rules to qualify for Social Security Disability or SSI benefits. To be approved for Social Security Disability or SSI, a person’s work activity must be below a certain amount called “substantial gainful activity” (SGA). EID does not limit a person’s earnings, as long as she or he meets the income limit, which is quite high.
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WORKING FOR PAY: To qualify for EID, you may be employed or self-employed. There is no minimum amount you must earn to qualify, but your earnings must be subject to taxes; you can’t be working “under the table”. If you work for an employer, you should have pay stubs that show taxes withheld from your pay. If you are self-employed, you should pay estimated taxes.
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INCOME LIMIT: To qualify for EID, your “countable” income must be below:
- $2,873 per month if you are not married
- $3,878 per month for a married couple
Less than half of earned income counts, so you may be able to earn much more than the above limits.
RESOURCE (ASSET) LIMIT: Resources (assets) that are counted include:
- Bank accounts
- Stocks, bonds and investments
- Some kinds of life insurance and retirement accounts
- Property other than the home you live in and any vehicles you own
“Countable” resources do not include:
- The home you live in
- Any vehicles you own
- 401(k), 403(b), pension and Keogh retirement plans
- Certain trust accounts
- Certain burial funds
Only your resources and your spouse’s are counted. Resources of other family members or people who live with you are not counted.
For more detail, read EID Resource Fact Sheet.
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RETIREMENT ACCOUNTS: Most types of retirement accounts are counted toward the $10,000 resource (asset) limit for EID, including Individual Retirement Accounts (IRA’s). But four types of accounts are NOT counted: 401(k), 403(b), pension and Keogh funds.
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MEDICARE DETAILS: Most Medicare recipients who don’t receive Medical Assistance pay for some or all of the following costs related to Medicare:
For Medicare Part A (Hospital Insurance):
Deductibles ($1,184 for the first 60 days of hospitalization, $296/day for days 61 - 90 and $592/day for days 91 – 150 in 2013)
For Medicare Part B (Medical Insurance):
- Premium ($104.90/month) – usually deducted from Social Security Disability check
- Deductible ($170/year)
Co-insurance (20% for most services - Medicare covers other 80%; 50% for some psychiatric services – Medicare covers other 50%)
For Medicare Part D (Prescription Coverage):
- Premium (amount differs according to the plan you choose)
- Deductible (Usually $325/year)
Co-insurance (25% for costs from $326 - $2,970; 100% for costs from $2,971 - $6,733.75 (“donut hole”); 5% for costs over $6,733.75).
(NOTE: People in the “donut hole” receive 52.5% discounts on brand name drugs and 28% on generic drugs in 2013, and the discounts are applied to their out-of-pocket costs.)
If you receive both Medicare and Medical Assistance, you pay almost none of the above costs if your providers accept Medical Assistance. This may save you at least $1,000 per year, or many thousands. The only costs you pay are:
- A small co-payment for prescriptions ($1.00-$1.15 for generic drugs; $3.00-$3.50 for name brand drugs in 2013), and
- The difference between your Part D plan’s monthly premium and $34.96 in 2013. If your Part D plan’s premium is $34.96/month or less in 2013, you pay no premium for Part D.
If your health care providers accept Medicare but NOT Medical Assistance, you will have to pay the Medicare deductibles and co-insurance for their services. You will NOT have to pay the Medicare premiums.
If your health care providers do NOT accept both Medicare and Medical Assistance, you may find other providers who do – then you will not have to pay the Medicare deductibles and co-insurance.
When will I start saving on Medicare costs?
On the date your Medical Assistance begins. As of this date, most of your Medicare cost savings should start.
You will usually need to be enrolled in EID for two months before your Medicare Part B premium ($104.90 per month) will stop. However, if you had another benefit that covers the Part B premium just before you enrolled in EID, you won’t have to wait two months. The other benefits that cover the Part B premium are Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB) or another kind of Medical Assistance.
How much will I save on Medicare Part D?
If you are enrolled in a Medicare Part D prescription drug plan and receive Medical Assistance through EID, your Medicare Part D costs will be greatly reduced. If your Medicare Part D plan has a monthly premium of $34.96 or less in 2013, Medical Assistance will eliminate all out-of-pocket costs for your Part D plan except for a very small co-payment for prescriptions ($1.00-$1.15 for generic drugs; $3.00-$3.50 for name brand drugs in 2013). If your Part D plan’s premium is higher than $34.96 per month, Medical Assistance will reduce the premium by $34.96/month in 2013.
What if I want to change Medicare Part D plans?
Most people enrolled in Medicare Part D plans can only change plans during open enrollment periods. If you are enrolled in Medical Assistance, though, you can change Part D plans at any time.
If you enroll in Medical Assistance through EID and your Part D plan’s premium is higher than $34.96 per month in 2013, you may choose to switch to a Part D plan with a lower premium to reduce your out-of-pocket costs.
Can I choose not to enroll in Medicare Part D and just have Medical Assistance pay for my prescriptions?
No. If you are eligible for Medicare and you receive Medical Assistance, you must choose a Medicare Part D plan to get prescription coverage (unless you have other prescription coverage, such as through your employer). If you don’t choose a Medicare Part D plan, Medical Assistance will not cover your prescriptions.
What if my Medicare Part D plan does not cover all of my prescriptions?
Medical Assistance may pay for some prescriptions if your Medicare Part D plan does not. A partial list of prescription drugs that Medical Assistance may cover can be found at http://www.providersynergies.com/services/documents/MDM_PDL.pdf. Medical Assistance covers many other drugs as well – over 99% of those on the market.
When should I choose a Medicare Part D plan if I don’t already have one and I enroll in EID?
If you are eligible for Medicare, you haven’t chosen a Part D plan, and then you enroll in EID, a plan will be chosen for you automatically. If you don’t like the plan that is chosen for you, you can change plans.
Note: Oddly enough, you can’t really choose a Part D plan before the system chooses one for you. If you do, the system will most likely replace your choice with a plan it chooses automatically. You should wait until you are automatically enrolled in a Part D plan, then choose a different plan if you prefer.