You must be a Delaware resident and:

• a U.S. citizen or qualified non-citizen.
• at least 16 and under 65 years of age.
• have a disability, as defined by the Social Security Administration (SSA). Disabilities might include physical or developmental disabilities, mental health, or intellectual disabilities.
• be employed, either full-time or part-time.
• be paying the Federal Insurance Contributions Act (FICA) payroll tax.
• have unearned income at or below a certain monthly amount, determined annually by DMMA. This amount is adjusted each year based on the Social Security Cost-of-Living Adjustment (COLA). Unearned income may include payments from Social Security, Disability, Pensions, and Interest or Dividends.
• have total countable income at or below 275% of the Federal Poverty Level (FPL).

In determining countable income for eligibility, certain earned and unearned income disregards or exclusions apply.

You must have a disability, as defined by the Social Security Administration. Disabilities might include physical or developmental disabilities, mental health, or intellectual disabilities. Your disability must significantly limit or prohibit your ability to do basic work-related activities, such as lifting, standing, walking, sitting, or remembering. Your disability or health condition is expected to last at least a year or result in death. If you are not able to initiate a disability determination with the SSA, we can assist in initiating one for you.

There are two income standards used to determine income eligibility for the Medicaid for Workers with Disabilities Program:

• Unearned income of the applicant must be at or below a certain monthly amount determined annually by the Division of Medicaid and Medical Assistance. The amount is adjusted each year based on the Social Security Cost-of-Living Adjustment (COLA). Unearned income may include payments from social security, disability, pensions, and interests and dividends.

Monthly Unearned Income Limit:

If the applicant’s unearned income is above this amount, then the individual is not eligible for the Medicaid for Workers with Disabilities Program.

Up to this amount is disregarded for eligibility purposes.

Monthly Countable Income Limits:

Student Earned Income Disregard Limits:

• Total countable income must be at or below 275% of the Federal Poverty Level (FPL). The FPL is determined annually by the U.S. Department of Health and Human Services.

The following standard allowances may be subtracted from your earned wages:

• Student earned income exclusion (SEIE) for children under age 18 (if applicable)
• $20 general income disregard
• $65 earned income disregard
• Expenses the working individual paid for work accommodations
• ½ of the remaining income

No. Disability as defined by the Social Security Administration is a total disability determination expected to last at least a year or resulting in death.

No, you do not have to apply for or receive SSI or SSDI benefits to be eligible for this program.

Medicaid for Workers with Disabilities allows for monthly earned income exclusions, in this order, as follows:

1. Earned income of disabled student children (under age 18) can be excluded up to the current limit. These limits are updated annually by SSA. Click here to see the current Student earned income exclusion (SEIE);
2. $20.00 general income exclusion;
3. An additional $65.00 of earned income;
4. Earned income of a disabled individual used to pay for work expenses that are directly related to their impairment. These are the costs paid by the individual for certain items and services that are needed to maintain employment;
5. One-half of remaining earned income.

Yes, your spouse’s income will be calculated and may be considered in the total countable income when determining your income eligibility for MWD.

No. Employment may be part time or full time, but you must be paying the Federal Insurance Contributions Act (FICA) payroll tax.

No. There is no resource test for eligibility.

Yes, but you must provide documentation of self-employment and that you are paying Federal Insurance Contributions Act (FICA) payroll tax.

No. As of July 1, 2024, Delaware Medicaid elected to discontinue the premium requirement for all recipients in this program.

Yes. You can have other health insurance coverage. Your other health insurance would be your primary coverage. MWD benefits would be secondary as Medicaid is always the payer of last resort.

Medicare would be your primary insurance. MWD benefits would be secondary to Medicare. MWD will also cover your Medicare premiums and deductibles.

No. Individuals who apply for the Medicaid for Workers with Disabilities Program do not have to apply for, or receive, SSI or SSDI benefits.

To be eligible for this program, you must be paying the Federal Insurance Contributions Act (FICA) payroll tax. If you lose your job, you will need to inform Medicaid by the 10th day of the month following the month in which the change in your circumstances occurred. Medicaid will screen to see if you are eligible for any other Medicaid program prior to terminating your coverage.

No. Each state has different eligibility requirements. You must apply for and meet Delaware’s eligibility requirements to qualify for this program.

You may be eligible for retroactive coverage for up to three months prior to your application date! If you received services before you applied to the program, please let us know when you submit your application.

Yes. If you have medical expenses within the three months prior to the month you submit your application, you can request a determination of retroactive eligibility. If you meet all eligibility requirements, you may be determined eligible for retroactive coverage.

When your application is approved, you are enrolled in a Managed Care Organization (MCO). If you prefer a different MCO, you do have 90 days to change your enrollment. Your services begin when you are enrolled with an MCO.