Updates to the Ticket to Work Program in Missouri

For years, people with disabilities in Missouri were limited in their ability to pursue work due to concerns over keeping their health insurance coverage. Medicaid previously imposed severe limits on eligibility — factoring in elements such as spousal income and retirement savings. Missouri Senate Bill 106 pushed the state to create more inclusive healthcare standards to increase the number of working adults with disabilities through various legal protections. 

Paraquad breaks down how Senate Bill 106 changes the landscape of healthcare coverage for people with disabilities and what to expect for the Ticket to Work Program in Missouri. 

The Barriers in Previous Legislation 

The Ticket to Work Health Assurance Program provides Medicaid coverage for working adults with disabilities who meet certain qualifications. However, previous legislation in Missouri upheld strict asset limits and income calculations. 

Workers with disabilities were required to pay a premium if their income exceeded the federal poverty level (FPL), which is currently around $14,000 per year for an individual. These regulations effectively capped the earning potential of workers with disabilities — many worried that if they increased their income, they would no longer be able to afford the care they needed or keep up with the costs of a premium.

This limit was particularly harmful, as many people with disabilities require costly medical care and daily personal assistance only covered by Medicaid. Without affordable options for inclusive healthcare, medical expenses would become overwhelming. All affected individuals had to carefully consider accepting a raise or getting better-paying jobs if it would push them over the federal poverty threshold and make them ineligible for Medicaid.

Moreover, the legislation factored in retirement savings and spousal income in their calculations for Medicaid eligibility. The regulations ended up having broader implications as well — many people with disabilities would avoid marrying their partners so they could keep their benefits. 

The Benefits of Senate Bill 106 

While Senate Bill 106 modified several provisions relating to public health — our team will focus on how it strengthens the Ticket to Work Health Assurance Program. The act changed the Ticket to Work Program in Missouri by:

Excluding retirement accounts from calculations. 

The program no longer factors retirement savings in eligibility calculations. With this inclusive healthcare change, workers with disabilities have an increased ability to save for the future. 

Broadening income calculations. 

The Ticket to Work Health Assurance Program modifies income calculations from a net/gross calculation to a broader definition that considers incomes of those with disabilities up to 250% FPL — about $36,000 a year. With income disregard considerations also at play, workers with disabilities are no longer limited to earning at or below the poverty level while maintaining coverage. 

Protecting spousal income. 

Eligibility calculations primarily focus on individual earnings rather than factoring in their spouse’s income. Through the Ticket to Work Program in Missouri, the first $50,000 of a spouse's income will factor into the list of disregards in income determinations.

Reducing the harm of the “benefit cliff.” 

Senate Bill 106 creates more inclusive healthcare coverage by allowing claimants to lose part, instead of all of their benefits if they are between 250-300% FPL. This makes the loss of support gradual and attuned to a more realistic level of income. 

While people with incomes over 100% FPL must pay a premium, the changes create more inclusive eligibility standards. Senate Bill 106 creates more robust healthcare coverage and encourages equity through increased economic participation. Ultimately, the Ticket to Work Program in Missouri broadens the horizons for what people with disabilities can do — individuals can get married, take a better job and save for the future without fear of losing their insurance coverage. 

Explore Advocacy Work at Paraquad 

At Paraquad, we lead the community through training in civic engagement, advocacy and community organizing. Our Public Policy and Advocacy Team researches, develops and implements systemic changes that will reduce barriers for those with disabilities.

Interested in our work with inclusive healthcare? Explore our mission in advocacy and public policy.