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

The 250% Working Disabled Program and Options to Maintain Medi-Cal While Working. Presented by: Karla Bell, Project Specialist California Health Incentives Improvement Project May 6, 2010 Independent Living Center of Southern California.

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

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  1. The 250% Working Disabled Program and Options to Maintain Medi-Cal While Working Presented by: Karla Bell, Project Specialist California Health Incentives Improvement Project May 6, 2010 Independent Living Center of Southern California

  2. 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

  3. 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

  4. Options for Continued Medi-Cal Eligibility while Working • SSI’s 1619(b) program • Aged & Disabled Federal Poverty Level Medi-Cal Program • 250% Working Disabled Program

  5. 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

  6. 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

  7. 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

  8. 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)

  9. 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.

  10. 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

  11. 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)

  12. 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

  13. 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

  14. 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

  15. 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 year • Higher gross wages possible when there are Impairment Related Work Expenses (IRWEs)

  16. 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

  17. 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)

  18. 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

  19. 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

  20. 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.)

  21. 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)

  22. 250% Medi-Cal Working Disabled Program – Premium Chart

  23. 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

  24. 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)

  25. 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) 908-4338 robertovera@dpss.lacounty.gov

  26. 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

  27. 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

  28. 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

  29. Resources Disability Benefits 101 http://www.disabilitybenefits101.org Talent Knows No Limits http://www.talentknowsnolimits.info World Institute on Disability (510) 763- 4100 http://www.wid.org/ SSA Red Book-Guide to Work Incentives http://www.ssa.gov/redbook/

  30. Resources Medi-Cal Office Locations Department 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) 908-4338 robertovera@dpss.lacounty.gov http://www.chiip.org/wdp_county_coordinators.html

  31. Resources Department of Health Care Services (916) 552-9100 http://www.dhcs.ca.gov/ Free Medicare Counseling (HICAP) Center for Health Care Rights 1-800-824-0780 (213) 251-7920 (TTY) http://www.cahealthadvocates.org/HICAP/

  32. Resources Health Consumer Center of Los Angeles http://healthconsumer.org/ (800) 896-3203 (818) 834-7575 (TDD) Disability Rights California http://www.disabilityrightsca.org/ (213) 427-8747 800-776-5746 (Toll free) 800-719-5798 (TTY)

  33. Resources Work Incentives Planning and Assistance (WIPA) Projects https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate Several WIPA projects serve the Los Angeles area: • Verdugo Workforce Investment Board • (818) 409-0476 • Familia Unida • (877) 298-3267 • Goodwill Southern California • 323-223-1211 x2251 • Human Potential Consultants • 310-756-1560

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

  35. 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

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