Frequently Asked Questions

For help with Health Coverage for Workers with Disabilities (HCWD):

• If you have a disability, talk to a benefits planner to learn more about health programs for people with disabilities.
• Visit or call your local Department of Social Services (DSS) office.
• Get local help from HealthCare.gov.
• Talk to a health insurance navigator. Make an appointment online or by calling 1-855-733-3711.

There are different ways to apply for Health Coverage for Workers with Disabilities (HCWD):

• Online using North Carolina ePASS. North Carolina ePASS lets you apply for other programs, like Food and Nutrition Services (FNS) or Work First (WF), at the same time. Note: On the ePASS website, NC Medicaid is called "Medical Assistance."
• In person at your local Department of Social Services (DSS) office. You can also call them to apply over the phone.
• Using a paper application and faxing or mailing it in to your local Department of Social Services (DSS) office.
• Online using HealthCare.gov, an online one-stop shop where you can learn about your public and private coverage options.

Note: If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get NC Medicaid coverage. You do not need to apply for NC Medicaid and do not have to pay a premium.

North Carolina ePASS is the easiest way to apply for Health Coverage for Workers with Disabilities (HCWD) if you think you might qualify. North Carolina ePASS also lets you apply for other benefits, like FNS (Food Stamps), at the same time.

HealthCare.gov is an option if you don’t think you will qualify for HCWD, because it will also check if you can get private coverage with subsidies. If HealthCare.gov sees that you are eligible for HCWD, your local Department of Social Services (DSS) office will contact you about enrolling.

NC Medicaid is a public health coverage program. There are different ways to qualify for NC Medicaid, depending on things like your age, income, resources, and whether you have a disability. One of those ways to qualify is through Health Coverage for Workers with Disabilities (HCWD).

If you qualify for regular NC Medicaid coverage:

• You only pay small copayments for medical services.
• You may qualify based on the income-based rules described in DB101’s Income-Based NC Medicaid article or based on disability rules, if you have low income and low resources. You automatically qualify for NC Medicaid if you get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision.

If you qualify for HCWD coverage:

• You pay small copayments and may pay a small annual fee and a monthly premium based on your income.
• You have to be working. There is no limit on earned income, which means you can make as money as you want at work and still qualify.
• You must have unearned income at or below $1,956 per month for individuals ($2,644 per month for couples).
• There is a resource limit of $30,828. Money in an ABLE account, the house you live in, and a car are not counted.
• You must have a disability that meets Social Security's disability rules (except for the rules related to work). If you aren't sure if your disability qualifies, you can apply and the state will review your disability.

To qualify for Health Coverage for Workers with Disabilities (HCWD), you must:

• Be age 16 to 64
• Have a disability
  • Note: For HCWD, Social Security’s disability rules related to earned income do not apply.
• Be working
• Be a U.S. citizen or meet specific noncitizen requirements
• Have $30,828 or less in resources, and
• Have $1,956 or less in unearned income per month.

There is no limit on earned income! However, you may have to pay some money for coverage depending on your countable income, which includes both your earned and unearned income:

• If your countable income is more than 150% of the Federal Poverty Guidelines (FPG) ($1,956 per month for individuals or $2,644 per month for couples), you have to pay a $50 annual fee.
• If your countable income is more than 200% of FPG ($2,608 per month for individuals or $3,525 per month for couples), you also have to pay a monthly premium. The premium amount depends on your income.

To see if you have to pay an annual fee and premium, HCWD counts your money the same way that Supplemental Security Income (SSI) does: almost all of your unearned income is counted, but less than half of your 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 $5,305 per month at work and still not have to pay a premium.

In most cases, it does not matter how you qualify for NC Medicaid, because the actual medical coverage you get from NC Medicaid will be the same. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn more while still getting NC Medicaid coverage.

DB101 has information about different ways to get NC Medicaid:

• DB101's Income-Based NC Medicaid article explains the most common way to qualify, which does not require you to have a disability.
• DB101's Disability-Based NC Medicaid article explains a common way for people with disabilities who have low incomes to qualify.
• DB101's Health Coverage for Workers with Disabilities (HCWD) article explains a way that people with disabilities who work can get NC Medicaid coverage by paying a premium, even if their income is higher than the usual NC Medicaid income limits.
• DB101's Supplemental Security Income (SSI) article explains how people with disabilities who get SSI qualify for NC Medicaid automatically.

With Health Coverage for Workers with Disabilities (HCWD), you may have to pay some money for coverage depending on your countable income, which includes both your earned and unearned income:

• If your countable income is more than 150% of the Federal Poverty Guidelines (FPG) ($1,956 per month for individuals or $2,644 per month for couples), you have to pay a $50 annual fee.
• If your countable income is more than 200% of FPG ($2,608 per month for individuals or $3,525 per month for couples), you also have to pay a monthly premium. The premium amount depends on your income.

To see if you have to pay an annual fee and premium, HCWD counts your money the same way that Supplemental Security Income (SSI) does: almost all of your unearned income is counted, but less than half of your earned income is counted.

No, countable income is not the same as how much you make. When public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.

When Health Coverage for Workers with Disabilities (HCWD) reviews your income to see if you have to pay an annual fee and monthly premium, only about half of your earned income (money you get from work you do) is counted. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.

Try this tool to get an idea of how much countable income you have:

Your Countable Income:

Your Monthly Earned Income	$
Your Monthly Unearned Income (not including SSI)	$
Your Monthly Impairment Related Work Expenses (IRWEs)	$
	$1,305
	$20
	$65
	$967
Your Monthly Countable Income
Your Annual Countable Income
	$15,650
Federal Poverty Guideline
Your Countable Income as a Percent of FPG

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Yes, Health Coverage for Workers with Disabilities (HCWD) pays for the same services that standard NC Medicaid pays for, including doctor visits, medical equipment, and Personal Assistance Services. For a listing of services covered under Health Coverage for Workers with Disabilities (HCWD), go to the NC Medicaid website.

If you are eligible for both Health Coverage for Workers with Disabilities (HCWD) and Medicare, it is helpful to have both at the same time because HCWD will help pay for things that Medicare doesn't pay for and will help pay your Part B premium.

In addition to HCWD, 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 the Seniors' Health Insurance Information Program (SHIIP) if you have questions about how your NC Medicaid and Medicare benefits work together. To learn more, read DB101’s Medicare article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.