Eligibility for workers with disabilities

1. An individual shall be enrolled as a member of the workers with disabilities coverage if that individual: a. Is gainfully employed; b. Is at least sixteen, but less than sixty-five, years of age; c. Is disabled as determined by the social security administration or the state review team; d. Meets the requirements of this section; and e. Is not in receipt of any other Medicaid benefits under this chapter other than coverage as a qualified Medicare beneficiary or a special low-income Medicare beneficiary. 2. An individual may be regarded as gainfully employed only if, taking all factors into consideration, the individual shows that the activity asserted as employment: a. Produces a product or service that someone would ordinarily be employed to produce and for which payment is received; b. Reflects a relationship of employer and employee or producer and customer; c. Requires the individual's physical effort for completion of job tasks, or, if the individual has the skills and knowledge to direct the activity of others, reflects the outcome of that direction; and d. The employment setting is not primarily an evaluative or experiential activity. 3. Asset considerations provided under section 75-02-02.1-25, asset limits provided under section 75-02-02.1-26, and excluded assets provided under section 75-02-02.1-28.1 are applicable to the workers with disabilities coverage except that each individual enrolled as a member of the workers with disabilities coverage group is allowed an additional ten thousand dollars in assets. 4. Except for Indians who are exempt from cost-sharing under federal law, an individual who has not paid a one-time enrollment fee of one hundred dollars may not be enrolled. 5. Any individual who fails to pay the premium established under this section for three months shall be disenrolled and may not be reenrolled thereafter without first reestablishing eligibility under this section and paying all outstanding enrollment fees and premiums. Any month in which no premium is due shall not be counted as a month in which the individual failed to pay a premium. 6. Payments received by the department from an individual claiming eligibility under this section shall be credited first to unpaid enrollment fees and then to the oldest unpaid premium. The department shall credit payments on the day received, provided that credit for any payment made by an instrument that is not honored shall be reversed. The department may require any individual who has attempted payment by a dishonored instrument to make subsequent payments in a specified manner. 7. A monthly premium is due on the tenth day of each month for which coverage is sought and shall be equal to five percent of the individual's gross countable income. This requirement does not apply to Indians who are exempt from cost-sharing under federal law. 8. No individual may be found eligible under this section if the individual and the individual's family have total net income equaling or exceeding two hundred twenty-five percent of the poverty level. 9. This section becomes effective on the effective date of approved amendments to the Medicaid state plan sufficient to secure federal financial participation in the cost of services provided to individuals found eligible under this section, remains effective as long as federal financial participation continues to be available and state law authorizes such coverage, and is thereafter ineffective. 10. The department may not require the payment of a premium or disenroll an individual for failure to pay a premium or enrollment fee for workers with disabilities coverage during a federally declared emergency if collection of the premium or enrollment fee may impact the receipt of federal funds.