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.

What is Ticket to Work Health Assurance?

Ticket to Work Health Assurance (or TWHA) allows disabled individuals age 16-64 years old who are employed get or keep MO HealthNet (Medicaid) coverage. TWHA has different income rules than MO HealthNet for Disabled which allows disabled workers to qualify for coverage even if their earnings put them above the usual MO HealthNet income limits for people with disabilities. 

TWHA uses the ME codes 85 and 86. This coverage is the same “limited benefit package” as MO HealthNet for Disabled coverage (ME Code 13).  The coverage limitations are:  

  • dental is limited to specific services;
  • diabetes self-management training is not covered;
  • hearing aids are not covered;
  • physical, occupational, and speech therapy are not covered;
  • eye exams are only covered once every two years.
Applying for Ticket to Work Health Assurance

There is only one application for MO HealthNet. Please review our Applying for MO HealthNet page for more information on the application process. 

When the application is processed the processing worker will screen for eligibility in different programs, including TWHA. If the client is eligible for both TWHA and Spend Down the processing worker will reach out to the applicant or authorized representative/legal guardian to pick between the two programs. 

There is no longer any way to indicate a preference on the application.

Ticket to Work Health Assurance Calculator

This tool can be used to see how different earned income amounts impact the consumer's premium and eligibility for the Ticket to Work Health Assurance program.

Spend Down and Ticket to Work Health Assurance Calculator

By entering the amounts of income the individual has if not working and the anticipated amount of earned income, the calculator will show:

  • If the person is spend down when not working and the amount.
  • If the amount of earned income will qualify the individual for TWHA and the amount of a premium (if any)
  • If the individual does not qualify for TWHA, the amount the spend down will increase to.

How do I pay the Ticket to Work Health Assurance Premium?

When the individual is approved they should receive a letter/invoice from the MO HealthNet Division with instructions on where to send the premium. There is an option to sign up for automatic withdraw: information on that will be included with the paperwork sent to the client upon approval. Automatic withdrawals are taken on the 15th of the current month for the next month's coverage. It can take up to 30 days for automatic withdrawal to begin: until it begins payment must be made by check or money order. 

You can also send your payment to:

MO HealthNet Division - Premium Payments

PO Box 809020

Kansas City, MO 64180-9020

Include the DCN and the month you are paying for with the check or money order. 

SSDI Recipients

SSDI recipients who go to work and continue to receive SSDI will qualify for TWHA  if, without the earned income, they would:

  • be non-spend down Medicaid OR  have a spend down of $50 or less
  • have a spend down above $50 and are earning double the amount the spend down exceeds $50 
    • (the amount of earnings needed is reduced by $150 if dental/optical insurance is purchased)

SSDI recipients whose SSDI ends due to earning above the SGA will be eligible for Medicaid in the TWHA category as long as gross income does not exceed 300% FPL