Medi-Cal 101:

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Medi-Cal 101 The 250 Working Disabled
Program... ...and other ways to maintain Medi-Cal
eligibility while working! Michael J. Van
Essen Benefits Establishment Specialist Pacific
Clinics mvanessen_at_pacificclinics.org

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Training Sponsor
California Health Incentives Improvement Project (CHIIP) Funded by a Medicaid Infrastructure Grant from the federal Centers for Medicare and Medicaid Services (grant number 11P-92399/9-04) Administered by the San Diego State University Interwork Institute (www.interwork.sdsu.edu) and the San Diego State University Research Foundation

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• Continued Medi-Cal Eligibility

• Three Options
• SSIs 1619(b) program
• Aged Disabled Federal Poverty Level
• 250 Working Disabled Program

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Continued Medi-Cal Eligibility 1619(b) Program

• A provision to Supplemental Security Income (SSI)
  linked Medi-Cal
• Allows working SSI recipients to keep full-scope
  Medi-Cal
• Medi-Cal retained when SSI payment is reduced to
  0.00 per month due to wages

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Continued Medi-Cal Eligibility 1619(b) Program

• Earned income threshold for 1619(b) program in
  California is 34,346 (2008)
• Individualized Earnings Threshold threshold can
  be adjusted on a case-by-case basis
• http//www.ssa.gov/disabilityresearch/wi/1619b.htm
  

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Continued Medi-Cal Eligibility 1619(b)

• Higher Individualized Earnings Threshold if
• Blind Work Expenses (BWE)
• Impairment Related Work Expenses (IRWE)
• PASS Plan
• Publicly Funded Personal Attendant (i.e.
• In-Home Supportive Services)
• Medical Expenses above State Average

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Continued Medi-Cal Eligibility 1619(b)

• All Blind and Impairment Related Work Expenses
  must be verified by your local Social Security
  field office
• Provide them with original receipts or canceled
  checks of the expenses

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Continued Medi-Cal EligibilityAged Disabled
FPL Medi-Cal

• Aged Disabled Federal Poverty Level Medi-Cal
  provides free, full scope Medi-Cal services for
  disabled or aged individuals who meet the income
  and asset requirements of the program
• Blind people are also eligible, but must be
  determined disabled
• Typical income threshold is 1097/month for a
  single individual

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Continued Medi-Cal EligibilityAged Disabled
FPL Medi-Cal

• Assets may not exceed 2,000 in value (3,000 for
  a couple)
• Assets, like the home you live in and one car,
  are not counted for this program
• Assets may include
• checking and savings accounts
• the value of stocks, bonds, and trust deeds
• additional cars or recreational vehicles
• promissory notes and loans that are payable to
  you

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Continued Medi-Cal Eligibility

• Medi-Cal 250 Working Disabled Program
• (became effective April 1, 2000)Provides choice
  and opportunity to hundreds of Californians with
  disabilities who would otherwise be ineligible
  for No-Share-of-Cost, full scope Medi-Cal
  coverage due to earned income and work activity

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Medi-Cal Working Disabled Program

• Allows people with disabilities, who otherwise
  qualify for Medi-Cal, the ability to work and
  purchase Medi-Cal coverage by paying an
  affordable monthly premium based on their
  countable income
• Individuals can make up to 53,028/year and still
  qualify for Medi-Cal!

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Medi-Cal Working Disabled Program

• Assembly Bill 155 (Migden) California
  legislation passed in 1999 which created the CA
  250 Working Disabled Program program
  implemented April 2000
• Medicaid buy-in program allows individuals to
  buy-in to full-scope Medi-Cal
• Monthly premiums range from 20-250 for
  individuals (30-375 for couples)

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Medi-Cal Working Disabled Program

• To qualify for this program, one must
• Be a resident of the United States living in
  California
• Meet Social Securitys definition of disability
  (medical definition only, does not count the
  ability to earn income)
• Be employed full-time or part-time, including
  self-employment, with countable earnings below
  250 of the Federal Poverty Level
• No minimum work requirement can find a job that
  fits with your disability

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Medi-Cal Working Disabled Program

• To qualify you must also
• Meet the same asset and resource limitations for
  Medi-Cal
• Own less than 2,000 in assets (or less than
  3,000 for a couple)
• One car and the home you live in are exempt
• Also exempt IRS-approved retirement accounts
  (i.e. 401k, 403b, etc.)
• Unique to the Working Disabled Program

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Medi-Cal Working Disabled Program

• What is work?
• While individuals must be working in order to
  qualify, work is undefined
• Work activity can be as simple as pet-sitting,
  domestic support services, research activities,
  clerical work
• No minimum earnings - earned income can be as
  little as 20 per week

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Medi-Cal Working Disabled Program

• Proof of Employment
• Pay Stubs
• Written verification of employment from an
  employer
• If self-employed
• A contract be used
• W-2s can be used or
• If an applicant is an independent contractor, the
  1099 IRS form can be used

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Medi-Cal Working Disabled Program

• Earnings
• A working individual with a disability can earn
  approximately 53,000 (or more) per year
• 4,400/month!
• An eligible couple with disabilities can earn
  approximately 71,000 (or more) per year
• 5,900/month!

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Medi-Cal Working Disabled Program

• Earnings, cont.
• ALL Disability income is exempt in this program
  and not counted when determining premium amount
  and maximum earnings
• Includes income from Social Security Disability
  Insurance (SSDI, Childhood Disability Benefits),
  State and Private Disability Insurance, and
  Workers Compensation

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Medi-Cal Working Disabled Program

• Income Eligibility
• SSIs countable income calculation is applied to
  all wages/salaries
• All disability income is excluded when
  determining countable income
• However, keep in mind that earned income may
  impact cash benefits

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Medi-Cal Working Disabled Program
Earned Income Exclusion Example w/IRWE Earned Income Exclusion Example w/IRWE
Based on 24,000 annual earnings and 1,200/month SSDI cash benefits (3,200 total monthly income) Based on 24,000 annual earnings and 1,200/month SSDI cash benefits (3,200 total monthly income)
Gross earnings /month 2,000.00
Earned income exclusion (65) - 65.00
Unearned income exclusion (20) -20.00
Impairment Related Work Expenses (IRWE) -100.00
Sub Total 1,815.00
Sub Total is divided by 2 / 2
Total Countable Income 907.50
Premium 75 per month (see premium calculation table) Premium 75 per month (see premium calculation table)
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Medi-Cal Working Disabled Program
Earned Income Exclusion Example w/ BWE (Blind Work Expense) Earned Income Exclusion Example w/ BWE (Blind Work Expense)
Based on 24,000 annual earnings and 1,200/month in SSDI cash benefits (3,200 total monthly income) Based on 24,000 annual earnings and 1,200/month in SSDI cash benefits (3,200 total monthly income)
Gross earnings/month 2,000.00
Earned income exclusion (65) - 65.00
Unearned income exclusion (20) -20.00
Sub Total (1) 1,915.00
Sub Total is divided by 2 / 2
Sub Total (2) 957.50
Blind Work Expenses -100.00
Total Countable Income 857.50
Premium 50 per month (see premium calculation table) Premium 50 per month (see premium calculation table)
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Medi-Cal Working Disabled Program Premium
Calculation Table
Countable Income From Countable Income To Premium for Eligible Individual Premium for Eligible Couple
1 600 20 30
601 700 25 40
701 900 50 75
901 1,100 75 100
1,101 1,300 100 150
1,301 1,500 125 200
1,501 1,700 150 225
1,701 1,994 200 275
1,995 2,100 250 300
2,101 2,673 N/A 375
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Medi-Cal Working Disabled Program

• Total gross income 3,200/month
• Working Disabled Program monthly premium
  75/month
• If in Medically Needy Share of Cost Program,
  share of cost 2097/month (approx.)

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Medi-Cal Working Disabled Program - BENEFITS

• No large share of cost
• Medi-Cal or IHSS
• Can save for retirement
• IRS-approved retirement accounts exempt from
  asset limit

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Medi-Cal Working Disabled Program - BENEFITS

• If also on Medicare are fully
  dually-eligible
• Automatically qualify for Medicare Part D Low
  Income Subsidy (LIS) prescription co-pays
  between 1.10-6.00 (in 2009, depending on Rx
  plan and whether income is below 100 of the FPL
  google LIS Co pay Medicare D).
• Medi-Cal pays Medicare Part B premium
• Medi-Cals co-pay and premium payment programs
  for Qualified Medicare Beneficiaries (QMB)

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Medi-Cal Working Disabled Program - BENEFITS

• Medi-Cals Health Insurance Premium Payment
  program (Medi-Cal/HIPP)
• Denti-Cal and Vision services
• In Home Supportive Service (IHSS) Personal Care
  (includes workplace assistance)
• Student Earned Income Exclusion (SEIE) Anyone
  under 22 years of age and attending school on a
  regular basis can exclude a certain amount of
  earnings from countable income

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Medi-Cal Working Disabled Program - Enrollment

• Currently eligible beneficiaries should call
  their eligibility case worker and ask to be
  switched to the Working Disabled Program (WDP)
• If line staff are unfamiliar with the procedures
  they may speak to an in-office WDP liaison or
  coordinator, contact the local Medi-Cal field
  office
• If not already enrolled in Medi-Cal, they should
  call the Beneficiary Unit for Medi-Cal
  (916-636-1980), or download and application from
  www.dhcs.ca.gov/services/medi-cal

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Medi-Cal Working Disabled Program - Enrollment

• Completed application should be submitted in
  person with
• Latest SSA award letter confirming medical
  disability determination is still active
• Disability determinations will need to be
  completed for individuals not already on Social
  Security benefits or Medi-Cal disability programs
• Copies of two most recent payroll checks or
  stubs (or letter from employer)
• Copies of two most recent bank statements
• The above list is required of all WDP
  applicants and enrollees

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Take Home Message

• The Medi-Cal 250 Working Disabled Program
  provides choice and opportunity to hundreds of
  Californians with disabilities who would
  otherwise be ineligible for Medi-Cal coverage due
  to earned income and work activity.

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Organizational Resources

• Disability Rights California (formerly Protection
  and Advocacy)
• [phone]
• www.pai-ca.org
• Department of Health Care Services
• [phone]
• www.dhcs.ca.gov
• California Health Incentives Improvement Project
• [phone]
• www.chiip.org and www.talentknowsnolimits.org

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Organizational Resources

• World Institute on Disability Ca. Work
  Incentives Initiative
• [phone]
• www.wid.org and www.db101.org

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Benefits Planning Resources

• DisabilityBenefits101.org (www.db101.org)
• Easy to use and understand online resource for
  information on disability benefits and programs
  (Social Security, Medi-Cal, Medicare, IHSS,
  workers comp, etc.)
• 5 Benefits Planning Calculators Great tools for
  determining how working (or changing jobs) will
  impact benefits connects the dots

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Benefits Planning Resources

• Local Independent Living Center (www.cfilc.org)
• A benefits counselor can further explain the
  variety of work incentives available to people
  with disabilities
• Community Work Incentives Coordinators
  (www.ssa.gov/work or https//secure.ssa.gov/apps10
  /oesp/providers.nsf/bystate)
• Benefits counselors funded by Social Security

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Thank you!

• Any additional questions?
• Presenters contact info
• Michael Van Essen
• mvanessen_at_pacificclinics.org
• Sponsors/CHIIPs contact info
• Rachel Stewart
• [phone]
• rstewart_at_interwork.sdsu.edu