Medi-Cal 101: The 250% Working Disabled Program... ...and other ways to maintain Medi-Cal eligibility while working! M

1. 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@pacificclinics.org

2. Training Sponsor

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

4. 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

5. 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

6. Continued Medi-Cal Eligibility1619(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

7. 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

8. Continued Medi-Cal Eligibility: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 $1097/month for a single individual

9. Continued Medi-Cal Eligibility: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

10. 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

11. 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!

12. 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)

13. Medi-Cal Working Disabled Program To qualify for this program, one must: • Be a resident of the United States living in California • 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 • No minimum work requirement – can find a job that fits with your disability

14. 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

15. 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

16. 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-2’s can be used or • If an applicant is an independent contractor, the 1099 IRS form can be used

17. 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!

18. 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

19. Medi-Cal Working Disabled Program Income Eligibility: SSI’s 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

20. Medi-Cal Working Disabled Program

21. Medi-Cal Working Disabled Program

22. Medi-Cal Working Disabled Program Premium Calculation Table

23. 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.)

24. 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

25. 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-Cal’s co-pay and premium payment programs for Qualified Medicare Beneficiaries (QMB)

26. Medi-Cal Working Disabled Program - BENEFITS Medi-Cal’s 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

27. 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

28. 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

29. 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. Take Home Message

30. Organizational Resources Disability Rights California (formerly Protection and Advocacy) • (800) 776-5746 • www.pai-ca.org Department of Health Care Services • (916) 449-5280 • www.dhcs.ca.gov California Health Incentives Improvement Project • (916) 552-9491 • www.chiip.org and www.talentknowsnolimits.org

31. Organizational Resources World Institute on Disability – Ca. Work Incentives Initiative • (510) 251-4304 • www.wid.org and www.db101.org

32. 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”

33. 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

34. Thank you! Any additional questions…? Presenter’s contact info: Michael Van Essen mvanessen@pacificclinics.org Sponsor’s/CHIIP’s contact info: Rachel Stewart (916) 552-9491 rstewart@interwork.sdsu.edu