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 (TWHA) is a Medicaid category for disabled individuals age 16-64 years old who are employed (and paying Social Security/Medicare taxes) that provides coverage without a spend down if countable income does not exceed 250% of FPL ($3,261 single, $4,407 couple).
A premium must be paid if the participant’s income is above 100% FPL ($1,305 / $1,763) must pay a monthly premium. Premiums range from $52-$196 for single individuals, $71-$264 for married couples.
TWHA has different income rules than MO HealthNet for the Disabled which allows disabled workers to qualify for coverage even if their earnings put them above the substantial gainful activity limit ($1,620 per month in 2025.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).
- 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.
- ONLINE
- MAIL
- 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.
- AUTOMATIC WITHDRAWAL
- 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.
- TWHA Countable Income Determination
The following income deductions are allowed:
- A $20 personal income exemption
- All SSI payments
- $50 of the disabled worker’s SSDI
- A $75 standard deduction for optical and dental insurance costing less than $75
- All other health insurance premiums
- A standard deduction for Impairment Related Employment Expenses (IREE) equal to half the disabled worker’s earned income
- $50,000 per year ($4,166.77/ month) of a non-disabled spouse’s earned income
- Disabled worker’s earned income between 250 & 300% of FPL is excluded of FPL
- A $20 personal income exemption