WORK AND PERSONAL ASSISTANCE SERVICES:

MAINTAINING AND USING IHSS IN THE WORKPLACE

Presenters:

Karla Bell and Rachel Stewart

California Health Incentives Improvement Project

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Getting Started

Who can be eligible for In-Home Supportive Services?

Any California resident, living in his/her own home, who is already eligible for Medi-Cal can be eligible for IHSS

The four eligibility categories people with disabilities most often use to get on Medi-Cal are: SSI-linked Medi-Cal Aged and Disabled Federal Poverty Level Medi-Cal Medi-Cal Working Disabled Program Aged, Blind, and Disabled Medically Needy Medi-Cal

See DB101 Medi-Cal Program description for more information on these programs: www.db101.org

IHSS ServicesIn-Home Supportive Services (IHSS):

services to help individuals remain safely in their home, including:HousecleaningMeal preparationLaundryPersonal care services (bowel/bladder care,

bathing, grooming, dressing, etc.)Accompaniment to medical appointmentsProtective supervision

Myth: If I go back to work I’ll lose my Medi-Cal and IHSS

Medi-Cal While Working--Section 1619b

Medi-Cal Working Disabled Program

Supplemental Security Income (SSI) Work Incentives

Section 1619(b): SSI work incentive that allows working SSI recipients

keep free Medi-CalFree Medi-Cal coverage continues until earnings reach a

threshold amount:$35,023 (non-blind)$35,716 (blind) These are 2011 amounts for California

People with high medical costs or publicly funded attendants (i.e. IHSS) can earn even more (“Individualized Threshold”)

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

1619(b)

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 (SSI resource limit: $2000 individual/$3000 couple); 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) 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

Social Security’s Programs Operation Manual reference:

SI 02302.050 Individualized Threshold Calculation

https://secure.ssa.gov/apps10/poms.nsf/lnx/0502302050

Area Work Incentives Coordinators

http://www.ssa.gov/sf/awic.htm

Medi-Cal Working Disabled Program

The 250% Medi-Cal Working Disabled Program allows individuals to earn up to $55,476/year and keep their Medi-Cal!Eligible couples can earn up to $74,580/yearEven higher wages are allowed with IRWEs

Affordable monthly premiums to access Medi-Cal and IHSS without a share-of-cost$20-$250 for individuals$30-$375 for couples

Medi-Cal Working Disabled Program

Disability-based income is exempt when determining eligibility for program and maximum earningsi.e. SSDI, Workers Comp, State Disability

Insurance, private disability insuranceAllowed to have IRS-approved retirement accounts –

these do not count towards the typical $2000 (or $3000 for couples) asset limit for Medi-Cal i.e. Individual Retirement Accounts (IRAs), 401(K),

403(B), Profit Sharing, Individual (K), Solo DB, Safe Harbor 401(K), ROTH IRA, 457, ROTH 403(B), KEOGH Plans, TSA Tax Sheltered Annuities, Stretch IRA, Thrift Savings Plan (TSP)

Medi-Cal Working Disabled Program

If also on Medicare – are fully “dually-eligible”: Medi-Cal pays Medicare Part B premiumMedi-Cal’s co-pay and premium payment

programs for Qualified Medicare Beneficiaries (QMB)

Access IHSS services (not covered by Medicare or private insurance)

Automatically qualify for Medicare Part D Low Income Subsidy (LIS)

Medi-Cal Working Disabled ProgramTo qualify:

Meet Social Security’s 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 LevelAn applicant may be employed by a business, or be

self employed or an independent contractor Work is undefinedNo set amount of hours requiredNo minimum earnings criteria

Medi-Cal Working Disabled Program – Improvements

Assembly Bill 1269 was signed into law by Governor Schwarzenegger on 10/11/09 This Bill improves the Medi-Cal 250% Working

Disabled ProgramAllows additional income and resource exemptionsExtends work stoppage protection to 26 weeksChanges current premium calculation

As of August 1, 2011 the less restrictive changes will be implemented

Department of Health Care Services will send a notice to all current Working Disabled Program enrollees

ACWDL will also be issued to the Counties

Medi-Cal Working Disabled Program - ImprovementsAs of August 1, 2011 – the following “less

restrictive” changes will be implemented:Eliminates retirement age restriction by

exempting retirement income that converts from Social Security Disability Insurance (SSDI) income

All exempt IRS-approved retirement accounts allowed under the 250% Working Disabled Program will continue to be exempt when transferring to other Medi-Cal Programs

Less Restrictive Changes, cont.Allows Earnings to be saved in separately identifiable

account with no cap These earnings cannot be combined with other resources Account must be separate from your regular savings and

checking accounts Earned income that is in your separate identifiable account will

not be counted as a resource for the WDP Program

Allows enrollees who are temporarily unemployed to remain in the program for up to 26 weeks during their work transition Enrollees are required to pay their monthly premium during time

of unemployment

Future Changes

In 2019 (after MOE provisions to ACA expire), the more restrictive changes will be implemented

Premium calculation will be changed to 5% of countable incomeMinimum and maximum premium amounts will

remain the same:$20-$250 for individuals$30-$375 for couples

Disability-based income and retirement income will also be included in the 5% premium calculation.

Myth: I’ll lose my Medi-Cal and IHSS

Myth: In-Home Supportive Services hours can only be used while at homeIn-“HOME” Supportive ServicesOld Thinking

People with disabilities are not able to workTherefore, they are only allowed to use their

IHSS hours in the home (or for occasional trips to the doctor)

New ThinkingWork opportunities are expanding for people

with disabilitiesIHSS hours can now be used at work as well

as home

IHSS at Work

IHSS in the Workplace – AB 925 (effective 2003):Allows the transfer of previously authorized IHSS hours to use in the workplaceImportant: No new hours or new services

Limited to services currently authorized for use in the home

Cannot receive additional hours for employment purposes

Services (or hours) transferred are to enable the recipient to “obtain, maintain, or return to, work”

Services must be “relevant and necessary in supporting and maintaining employment”

IHSS at Work

Services needed to “obtain, retain, or return to, work”:Obtain: traveling to job interviews, pre-employment

testing, and personal care during these activities (does not include college or vocational courses)

Retain/return to work: includes personal care on the job

Must be “relevant and necessary”:Paramedical servicesPersonal careRelated Services, as defined in WIC 12300

Workplace Personal Assistance Services

Two types of Workplace Personal Assistance Services:1.Personal care-related assistance

Assistance in the restroom, on lunch breaksCan use IHSS hours

2.Job-related assistanceInterpreting, lifting or reaching work materials, travel

assistance between work sitesCannot use IHSS hours (employer may have a

responsibility under the ADA to provide reasonable accommodations for job-related tasks)

Using IHSS in the WorkplaceBefore you start using IHSS hours in the

workplace, you must contact your social worker to discuss the transfer of hours (how many, for what services, etc.)Refer IHSS Social Worker to Dept of Social Services

All County Letter (ACL) # 04-43Currently, we have no knowledge of how many

people are taking advantage of the IHSS at work option (Dept. of Social Services does not track this in their system)

Myth: In-Home Supportive Services hours can only be used while I am at

home

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Contact informationKarla Bell:

kbell@interwork.sdsu.edu

Rachel Stewart:rstewart@interwork.sdsu.edu

www.talentknowsnolimits.info