Ticket to Work Health Assurance Program

The purpose of the Ticket to Work Health Assurance (TWHA) program is to provide medical care for persons with disabilities, age 16 through 64, who are employed.

The income of the spouse is included when determining eligibility for the TWHA program. 

TWHA has two components, a Basic Coverage Group and a Medically Improved Group:

  • The Basic Coverage Group is for persons who have earnings but are determined to be permanently and totally disabled.
  • The Medically Improved Group is for persons who have lost their eligibility for the Basic Coverage Group solely due to medical improvement. Both groups provide full Medicaid benefits.

How do I apply?

To apply for the Ticket to Work Health Assurance Program, use the MO HealthNet application links below. You can apply online or use a paper application. If you want a paper application mailed to you, call the FSD Information Center at 855-FSD-INFO (855-373-4636).

How do I know if I’m eligible?

To qualify for the TWHA Program, the following criteria must be met: 

What are the Age requirements?

Recipients must be age 16 through age 64. This includes the month the person turns 16 and 65.

Is there a Citizenship/Alien status requirement?

Yes, any person must be a United States citizen or an eligible qualified non-citizen.

Do I need a Social Security Number to participate?

Yes, persons requesting coverage must provide a Social Security Number, or proof of application for a Social Security Number.

Are there Residence Requirements?

Yes, persons must live in Missouri and intend to remain.

What are the Disability Requirements?

  • Basic Coverage Group: The participant must meet the definition of Permanent and Total Disability used for MO HealthNet, except earnings are not considered in the disability determination.
  • Medically Improved Group: The participant must continue to have a severe medical impairment, but have lost eligibility in the Basic Coverage Group due solely to an improvement in his or her medical condition.

What are the Employment Requirements?

  • Basic Coverage Group: An individual must have earnings from employment or self-employment. For income to be considered earned income it must be documented that Medicare and Social Security taxes are withheld from such income. Self-employed persons must provide proof of payment of Medicare and Social Security taxes for income to be considered earned. There is no minimum level of hours of employment or amount of earnings required. 
  • Medically Improved Group: An individual has earnings from employment or self- employment in an amount equal to at least 40 hours per month at minimum wage. For income to be considered earned income it must be documented that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.

How much in Available Resources can I have?

The resource limit is the same as it is for MO HealthNet which is $3,000 for a single individual and $6,000 for a couple.  In addition to the regular MO HealthNet resource exclusions, the following additional exclusions apply: 

  • Exclude medical savings accounts for the participant. The exclusion of medical savings accounts is limited to deposits of the individual’s earnings while participating in this program up to $5,000 per year and earnings on such deposits. 
  • Exclude independent living accounts. An independent living account is an account established and maintained to provide savings for transportation, housing, home modification, and personal care services and assistive devices associated with the participant’s disability. The exclusion of independent living accounts is limited to deposits of the individual’s earnings while participating in this program up to $5,000.00 per year and earnings on such deposits. 

Is there an income limit?

Yes, the TWHA Program includes both a gross and net income limit.

Gross Income

The individual must have a gross income of 300% or less of the federal poverty level (FPL).  

Effective 04-01-18; the TWHA gross income Standard for a single individual is $3,035.00 and $4,115.00 for a couple.

Income Includes

  • The participant’s gross income, both earned and unearned.
  • The spouse’s gross income, both earned and unearned. 

Net Income

The participant’s net income cannot exceed the limit for permanently and totally disabled individuals to receive non-spend down MO HealthNet benefits.

To determine net income the following shall be disregarded: 

  • All earned income of the disabled worker.
  • The first $65 and one-half of the remaining earned income of a non-disabled spouse’s earned income.
  • A twenty dollar standard exemption.
  • Health insurance premiums.
  • A seventy-five dollar a month standard deduction for the disabled worker’s dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars. If the total dental and optical insurance premiums exceed $75, allow the actual premium.
  • All Supplemental Security Income (SSI) payments received.
  • The first fifty dollars ($50) of the disabled worker’s SSDI payment.
  • A standard deduction for impairment-related employment expenses equal to one-half of the disabled employee’s earned income. The disabled worker is entitled to this deduction even if the earned income is excluded from the gross income test as sheltered workshop income.

Is there a Premium?

Any individual whose gross income (as computed above) exceeds 100% FPL must pay a premium to participate in this program. 

  • A participant whose gross income exceeds 100% FPL but is less than 150% FPL must pay a premium equal to 4% of income at 100% FPL.
  • A participant whose gross income equals or exceeds 200% FPL but is less than 250% FPL must pay a premium in an amount equal to 5% of income at 200% FPL.
  • A participant whose income equals or exceeds 250% FPL but is not more than 300% FPL must pay a premium equal to 6% of income at 250% FPL.

Current premium amounts can be found on page 2 in the attached Adult Standards Chart.

Additional Resources