WORK AND PERSONAL ASSISTANCE SERVICES: MAINTAINING AND USING IHSS IN THE WORKPLACE

1. WORK AND PERSONAL ASSISTANCE SERVICES: MAINTAINING AND USING IHSS IN THE WORKPLACE Presenters: Karla Bell and Rachel Stewart California Health Incentives Improvement Project

2. Getting Started • To use the Captioning window: • Click the Window pulldown menu and select Show Closed Captioning • A Captioning window will appear at the bottom of your screen • You may resize and move this window to meet your viewing needs • Asking Questions: • The presenter will take your questions at the end of the presentation using the Chat window • We will provide links to the CRC quiz and survey at the end of the Webinar

3. 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

4. IHSS Services • In-Home Supportive Services (IHSS): services to help individuals remain safely in their home, including: • Housecleaning • Meal preparation • Laundry • Personal care services (bowel/bladder care, bathing, grooming, dressing, etc.) • Accompaniment to medical appointments • Protective supervision

6. 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

7. Supplemental Security Income (SSI) Work Incentives • Section 1619(b): • SSI work incentive that allows working SSI recipients keep free Medi-Cal • Free 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)

8. 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.

9. 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

10. 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/year • Even 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

11. Medi-Cal Working Disabled Program • Disability-based income is exempt when determining eligibility for program and maximum earnings • i.e. SSDI, Workers Comp, State Disability Insurance, private disability insurance • Allowed 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)

12. Medi-Cal Working Disabled Program • If also on Medicare – are fully “dually-eligible”: • Medi-Cal pays Medicare Part B premium • Medi-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)

13. Medi-Cal Working Disabled Program • To 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 Level • An applicant may be employed by a business, or be self employed or an independent contractor • Work is undefined • No set amount of hours required • No minimum earnings criteria

14. 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 Program • Allows additional income and resource exemptions • Extends work stoppage protection to 26 weeks • Changes 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

15. Medi-Cal Working Disabled Program - Improvements As 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

16. 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

17. 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 income • Minimum 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.

18. Myth: I’ll lose my Medi-Cal and IHSS

19. Myth: In-Home Supportive Services hours can only be used while at home In-“HOME” Supportive Services • Old Thinking • People with disabilities are not able to work • Therefore, they are only allowed to use their IHSS hours in the home (or for occasional trips to the doctor) • New Thinking • Work opportunities are expanding for people with disabilities • IHSS hours can now be used at work as well as home

20. IHSS at Work IHSS in the Workplace – AB 925 (effective 2003): • Allows the transfer of previously authorized IHSS hours to use in the workplace • Important: 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”

21. 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 services • Personal care • Related Services, as defined in WIC 12300

22. Workplace Personal Assistance Services Two types of Workplace Personal Assistance Services: • Personal care-related assistance • Assistance in the restroom, on lunch breaks • Can use IHSS hours • Job-related assistance • Interpreting, lifting or reaching work materials, travel assistance between work sites • Cannot use IHSS hours (employer may have a responsibility under the ADA to provide reasonable accommodations for job-related tasks)

23. Using IHSS in the Workplace • Before 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) # 04-43 • Currently, 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)

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

25. Question and Answer • The webinar Chat window is now open for your questions • Type your question into the text entry area below the Chat window • Click enter or return on your keyboard to submit your question

26. Survey and CRC Credits Please give us feedback on today’s webinar by completing our survey: • http://www.surveymonkey.com/s/RZX7VYZ Certified Rehabilitation Counseling (CRC) Credits are available for this webinar: • To receive CRC credits please complete this short quiz and survey: • http://interwork.sdsu.edu/chiip/webinar/archive/crc_credits/111007/webinar.html • We will also follow up with an email with links to the CRC quiz, survey and archive of the webinar so you can listen to it again

27. Contact information • Karla Bell: • kbell@interwork.sdsu.edu • Rachel Stewart: • rstewart@interwork.sdsu.edu www.talentknowsnolimits.info