The 250% Working Disabled Program and Options to Maintain Medi-Cal While Working

Presented by:Karla Bell, Project SpecialistCalifornia Health Incentives Improvement Project

May 6, 2010Independent Living Center of Southern California

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California Health Incentives Improvement Project (CHIIP) Funded by a Medicaid Infrastructure Grant

from the Federal Centers for Medicare and Medicaid Services

Goal:To increase the employment rate of people with disabilities by making sure necessary supports are in place, such as access to health care and the ability to use personal assistance services at work

Collaborative effort

Overview

Supplemental Security Income (SSI) 1619(b) program

Aged & Disabled Federal Poverty Level Medi-Cal Program

250% Working Disabled Program AB 1269 Resources Disability Benefits 101 Calculator

Example

Options for Continued Medi-Cal Eligibility while Working

1. SSI’s 1619(b) program2. Aged & Disabled Federal Poverty

Level Medi-Cal Program 3. 250% Working Disabled Program

How earnings affect SSI payments

SSA counts less than half of your earned income

For example: $500 in wages $208 counts against SSI

Certain Impairment Related Work Expenses and Blind Work Expenses can also be deducted from your gross wages

SSI Countable Income Calculation Example

SSI Payment $845.00/month

$500 Gross Earnings/month-$20 General Income Exclusion-$65 Earned Income Exclusion $415.00 Remainder÷ 2$208.00 Total Countable Income

 $845.00 Maximum SSI Rate-$208.00 Total Countable Income$637.00 Adjusted SSI Payment

$500.00 Gross Earnings+$637.00 SSI$1137.00 Total Income

1619(b) Program

1619(b) is a work incentive that allows working SSI recipients to keep FREE Medi-Cal (No Share-of-Cost)

Medi-Cal retained when SSI payment is reduced to $0.00 per month due to earned income

Bottom Line: You won’t “lose” your Medi-Cal if you are on SSI and you earn income

1619(b) Program

Medi-Cal continues until you earn above a Threshold

2010 California 1619(b) Threshold Amounts: Disabled = $34,324.00 Blind = $37,252.00

People with high medical costs can earn even more (Individualized Threshold)

Benefits can start again if you stop working or your earnings decrease (Reinstatement)

1619(b) Program

To qualify: Have been eligible for an SSI cash payment for at least 1

month; Would be eligible for cash payment except for earnings; Still be disabled or blind; Still meet all other eligibility rules, including the resources

test; Need Medi-Cal in order to work; Have gross earned income that is insufficient to replace

SSI, Medi-Cal, and any publicly funded attendant care.

1619(b) Program

Individualized Threshold: threshold can be adjusted on a case-by-case basis

Higher Individualized Threshold if: Blind Work Expenses (BWE)

Impairment Related Work Expenses (IRWE)

Plan to Achieve Self-Support (PASS Plan)

Publicly Funded Personal Attendant

(i.e. In-Home Supportive Services)

Medical Expenses above State Average

http://www.ssa.gov/disabilityresearch/wi/1619b.htm

1619(b) Program

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

SSA will determine if the expense may be deducted

Request in writing in order to use appeal rights (if necessary)

Aged & 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 $1133/month* for a single individual or $1525* for a married couple

*All $ amounts subject to change*All $ amounts subject to change

Aged & 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

Medi-Cal 250% Working Disabled Program

Provides choice and opportunity to 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

California legislation implemented the 250% Working Disabled Program in April 2000

Medi-Cal 250% Working Disabled Program

Individuals can earn up to $55,188 gross per year and still qualify for full scope, no share of cost Medi-Cal

A working couple can earn up to $73,884 gross per yearHigher gross wages possible when

there are Impairment Related Work Expenses (IRWEs)

Medi-Cal 250% Working Disabled Program

Allows the purchase of full scope Medi-Cal Recipient pays a premium Affordable premiums:

$20 - $250 (Single Person) $30 - $375 (Couples)

SSI’s countable income calculation is applied to all wages/salaries

SSA’s NESE standards used for Self-Employment calculation

Medi-Cal 250% Working Disabled Program

To qualify for the program, individuals must:

Be a United States resident and living in California

Meet Social Security’s definition of disability (medical definition only, does not count the ability to earn income)

Medi-Cal 250% Working Disabled Program

Earnings can be as little as $20 per week Work activity can be full-time or part-time,

including self employment Work activity can be as simple as pet

attending, driving, domestic support services, research, light clerical work

Work is undefined: No minimum earnings criteria for eligibility No set amount of hours required

Medi-Cal 250% Working Disabled Program

Assets must be less than: $2000 for an individual $3000 for a couple

One home and one car are not counted for this program

Any IRS approved retirement products (Individual Retirement Accounts (IRAs), 401K, 403B, etc) are allowed and not counted towards the typical $2000 (or $3000) asset/resource limits for Medi-Cal

Medi-Cal 250% Working Disabled Program Countable Income cannot exceed 250% of Federal

Poverty Level (FPL): For individuals: $2257/month For couples: $3036/month

Gross earned income limits For individuals: approx. $4599/month For eligible couples: approx $6157/month

Disability income not included in countable income when determining eligibility and premium amount (Social Security Disability Insurance-SSDI, State Disability Insurance, Workers Comp., Childhood Disability Benefits, private disability insurance, Veterans’ benefits etc.)

Countable Income Example Mary

$1,500/month in gross earned income $900/month in SSDI (exempt) $100/month in Impairment-Related Work

Expenses (IRWEs)

Mary’s Countable Income:$1,500 (earned income) - 20 (general income exclusion) - 65 (earned income exclusion) -100 (IRWE)$1,315 ÷ 2 = $657.50 (countable income)

Countable Earned Income From:

Countable Earned Income To:

Premium for Eligible Individual

Premium for Eligible Couple

$1 $600 $20 $30

$601 $700 $25 $40

$701 $900 $50 $75

$901 $1100 $75 $100

$1101 $1300 $100 $150

$1301 $1500 $125 $200

$1501 $1700 $150 $225

$1701 $1900 $175 $275

$1901 $2100 $200 $300

$2101 $2257 $250 $375

$2258 $3036 N/A $375

250% Medi-Cal Working Disabled Program – Premium Chart

Medically Needy Share of Cost vs.250% Working Disabled Program

Mary’s Total Income = $2400

Mary’s Working Disabled Program Premium = $25/month

If in Medically Needy Share of Cost Program, share of cost = $950

Medi-Cal 250% Working Disabled Program Benefits Medi-Cal Working Disabled Program

is NO SHARE OF COST Medi-Cal Continues the Medicare Part B

premium “Buy-In” program for the beneficiary

Beneficiaries maintain Medicare Part D “LIS” (Low Income Subsidy)

http://www.cahealthadvocates.org/_pdf/facts/E-003-CHAFactSheet.pdf

Access IHSS services (not covered by Medicare)

Medi-Cal 250% Working Disabled Program

To begin enrollment, contact Eligibility Worker

County Coordinator may be contacted if Eligibility Worker or Supervisor are unfamiliar with the program:

Roberto Vera(562) 908-4338robertovera@dpss.lacounty.gov

Medi-Cal 250% Working Disabled Program

Completed application should be submitted in person with:

Latest SSA award letter confirming medical disability determination is still active

Copies of two most recent payroll checks or stubs (or letter from employer)

Copies of two most recent bank statements

250% Working Disabled ProgramFuture Changes

Assembly Bill 1269 was signed into law by our Governor on 10/11/09

The new rules will not be implemented until ARRA funds run out

250% Working Disabled ProgramFuture Changes

AB 1269 policy changes improves the 250% WDP:

Eliminate Age 65 restriction Eliminating the asset limit when money is

placed in a separate account Change premium structure Grace period of 26 weeks if employment

ends

Resources

Disability Benefits 101http://www.disabilitybenefits101.org

Talent Knows No Limitshttp://www.talentknowsnolimits.info

World Institute on Disability(510) 763- 4100http://www.wid.org/

SSA Red Book-Guide to Work Incentiveshttp://www.ssa.gov/redbook/

Resources

Medi-Cal Office LocationsDepartment of Public Social Services (DPSS)http://www.ladpss.org/new_portal/dpss_locations.cfm

Los Angeles DPSS 250% County Coordinator (for assistance with enrollment):Roberto Vera(562) 908-4338robertovera@dpss.lacounty.gov

http://www.chiip.org/wdp_county_coordinators.html

Resources

Department of Health Care Services(916) 552-9100http://www.dhcs.ca.gov/

Free Medicare Counseling (HICAP)Center for Health Care Rights1-800-824-0780(213) 251-7920 (TTY)http://www.cahealthadvocates.org/HICAP/

Resources

Health Consumer Center of Los Angeleshttp://healthconsumer.org/(800) 896-3203(818) 834-7575 (TDD)

Disability Rights Californiahttp://www.disabilityrightsca.org/(213) 427-8747800-776-5746 (Toll free)800-719-5798 (TTY)

Resources

Work Incentives Planning and Assistance (WIPA) Projects https://secure.ssa.gov/apps10/oesp/providers.nsf/bystateSeveral WIPA projects serve the Los Angeles area:Verdugo Workforce Investment Board

(818) 409-0476Familia Unida

(877) 298-3267Goodwill Southern California

323-223-1211 x2251Human Potential Consultants

310-756-1560

Resources

Department of RehabilitationVan Nuys/Foothill District(818) 901-5024(818) 901-5086 (TTY)5900 Sepulveda Blvd., Suite 240Van Nuys, CA 91411

Resources

For more information on outreach and training activities or questions, contact Karla Bell at 619-594-5381, kbell@interwork.sdsu.edu

Contact Teddie-Joy Remhild at (818) 848-2475 or teddiejoy@att.net

To order brochures or promotional materials, contact Nicholas Moore at 916-654-8194, Nicholas.Moore@edd.ca.gov

Medi-Cal Working Disabled Brochure I Can Work Brochure