Example

Melanie’s Story

Melanie is 35 years old and has cerebral palsy. She hasn’t been able to work for the past six months due to her disability and been living on the $850 in Social Security Disability Insurance (SSDI) benefits she gets every month. NC Medicaid covers her health care expenses.

She’s been feeling better recently and wants to go back to work. So she talks to some friends and passes her resume around. Soon enough, a former coworker offers her a part-time job at his new start-up company. Unfortunately, the job does not come with health insurance and she’d be earning too much money to keep her NC Medicaid. She really wants to take this job, but she cannot risk going without health insurance. Between her prescription drugs, physical therapy, and Personal Assistance Services (PAS), her total medical cost is several thousand dollars per month.

Melanie wants to see what getting an individual plan on HealthCare.gov would cost. She puts in her information and the income she'd be making so that she can preview her options. It turns out that she could sign up for a plan that would cost her about $150 a month for the premium. The problem is that the plan has a deductible and also has copayments that are way higher than her NC Medicaid copayments were. Furthermore, it wouldn’t pay for the PAS she needs like NC Medicaid does. She hopes to find another option.

She talks about the problem with her personal assistant, Samantha, who mentions Health Coverage for Workers with Disabilities (HCWD).

"It’s designed for people like you," Samantha says. "You can go back to work and earn as much money as you want, while still keeping your NC Medicaid health coverage."

“But what about my savings? Can I keep them?” Melanie asks.

“I think so,” says Samantha, “but you should talk to your NC Medicaid caseworker to find out more.”

Melanie calls her caseworker to ask about HCWD. Her caseworker explains that with HCWD, Melanie can have up to $30,828 in resources. The other requirement is that Melanie must have $1,956 or less in monthly unearned income, like SSDI benefits, which she does.

Her caseworker tells her, “Health Coverage for Workers with Disabilities (HCWD) pays for all the same services that your NC Medicaid coverage has been paying for. You may have to pay a small annual fee and a monthly premium, depending on how much income you have. You’ll also be responsible for small copayments for some services.”

“Plus,” her caseworker tells her, “if your condition gets worse and you have to take some time off work, you won’t necessarily lose your coverage as long as you are an employee.”

“This all sounds great,” says Melanie. “I can go back to work! So what do I do now?”

“Take that job,” says her caseworker, “and when you get your first check, call me within 10 days to report your earnings. Once you do that, I'll be able to switch your coverage to HCWD."

Melanie is ecstatic. She’ll be able to go back to work, doing something she really enjoys. And she’ll be able to keep her health coverage for a reasonable monthly cost.