Medi-Cal

WORK INCENTIVES

1
 TRAINING SPONSORS/RESOURCES
Disability Benefits 101
www.db101.org
LA DPSS County Coordinator
Roberto Vera 562-908-4338
California Health Incentives
Improvement Project (CHIIP)
www.chiip.org

Disability Rights California

www.disabilityrightsca.org

World Institute on
Disability www.wid.org

Pacific Clinics of So. Cal

www.pacificclinics.org
 MEDI-CAL & DISABILITY
WORK INCENTIVES

SSI’s 1619-b

Aged & Disabled,

Federal Poverty Level
250% Working
Disabled Program
Medically Needy
with Share of Cost
MEDI-CAL & DISABILITYWORK INCENTIVES
SSI’s Provision1619-b
A provision to Supplemental
Security Income Title XVI (SSI)
linked Medi-Cal

Allows Working SSI recipients

to keep full-scope, No-Share-
of-Cost Medi-Cal

Medi-Cal remains intact even

when earned income reduces SSI
payment to $0.00 per month

Bottom Line: You won’t “lose”

your Medi-Cal if you’re on SSI
and you earn income
 MEDI-CAL & DISABILITY WORK INCENTIVES
SSI’s Provision1619-b
Earned income threshold in California:
$34,324*
For the Blind and/or visually impaired:
$37,252*
Threshold can be adjusted on a case-
by-case basis

http://www.ssa.gov/disabilityresearc
h/wi/1619b.htm

* Subject to change due to California Budget

Crisis
MEDI-CAL & DISABILITY WORK INCENTIVES
SSI’s Provision1619-b
Example: SSI’s Earned Income Exclusion
SSI Payment $845.00
Gross earnings /month $500.00
Earned income exclusion ($65) - $65.00
Unearned income exclusion ($20) -$20.00
Sub Total: $415.00
Sub Total is divided by 2: /2
Total Countable Income: $208.00
Subtract from SSI Payment $637.00
Add to Earned Income $1137.00
MEDI-CAL & DISABILITYWORK INCENTIVES
SSI’s Provision1619-b
Expenses Excluded from Countable
Income include

Blind Work Expenses (BWE)

Impairment-Related Work
Expenses

PASS (Plan for Achieving Self

Support) Plan

Publicly Funded Personal

Medical Expenses above State

Average

See SSA’s Redbook

www.ssa.gov/redbook for more information
 MEDI-CAL & DISABILITY
WORK INCENTIVES
SSI’s Provision1619-b
All Blind (BWE) and Impairment
Related Work Expenses (IRWE)
must be verified by Social Security

Provide them with original

receipts or canceled checks of
the expenses
MEDI-CAL & DISABILITY WORK INCENTIVES
A&D, FPL – No Share of Cost
Aged and Disabled Federal Poverty Level
Medi-Cal provides
free, full scope Medi-Cal qualified individuals

Blind people are also eligible, but must

be determined to be disabled according
to SSA Definition of Disability

Income threshold for a

individual is $1,133*

*All $ amounts subject to

change
MEDI-CAL & DISABILITY WORK INCENTIVES
A&D, FPL – No Share of Cost
Assets more than $2,000 –$3,000
couples

One home and one car are exempt

All non-exempt assets may include:

Checking and savings accountsStocks, Bonds

Trust Deeds
Additional autos
Recreational vehicles

Promissory notes and loans

 MEDI-CAL & DISABILITY
WORK INCENTIVES

MEDI-CAL 250% WORKING

DISABLED PROGRAM
(effective April 1, 2000)
 MEDI-CAL & DISABILITY WORK INCENTIVES
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
 MEDI-CAL & DISABILITY WORK INCENTIVES
Medi-Cal 250% Working
Disabled Program
Earn approximately
$55,000 (or more) per
year and keep No
Share of Cost Medi-Cal

A working couple can earn

approximately $74,000 (or
more) and keep Full Scope,
No-Share-of-Cost Medi-Cal
 MEDI-CAL & DISABILITY WORK INCENTIVES
Medi-Cal 250% Working
Disabled Program
Allows the purchase of
full-scope Medi-Cal

Recipient pays a
premium

Lowest monthly
premium is $20

SSI’s Earned Income Calculation

applied to earnings only

Social Security Administration (SSA) Net

Earnings from Self-Employment (NESE)
standards used for Self Employment calculation
 MEDI-CAL & DISABILITY WORK INCENTIVES
Medi-Cal 250% Working
Disabled Program
Medical eligibility based
according to SSA
Disability Determination
Guidelines

Work Activity
Is Excluded!
 MEDI-CAL & DISABILITY WORK INCENTIVES
Medi-Cal 250% Working
Disabled Program
Earnings can be as
little as $20 per
week

Work activity can be as simple

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

No minimum
earnings criteria
for eligibility
 MEDI-CAL & DISABILITY WORK INCENTIVES

Medi-Cal 250%
Working Disabled Program
Assets:
 $2,000 or less
 $3,000 or less in assets (couple)

 Retirement accounts authorized under the IRS

codes are excluded
 MEDI-CAL & DISABILITY WORK INCENTIVES

Medi-Cal 250%
Working Disabled Program
Asset Exemptions:
 One Home (primary residence)
 One Car (personal transportation)
Income Exceptions:
 Disability income (SDI, SSI, SSDI, STD,
LTD, Worker’s Comp., etc.) is excluded
 MEDI-CAL & DISABILITY WORK INCENTIVES

Medi-Cal 250%
Working Disabled Program
Income Eligibility Requirement:
 SSI’s countable income calculation is applied
to all wages/salaries
 Countable Income Cannot Exceed 250 % of Federal Poverty
Level (2009 250% FPL = $2257/mo for individual, $3036/mo
for a couple)
 Special countable income circumstances in
excess of 250% FPL are negotiable
 2009 Poverty Guidelines for the
48 Contiguous States
Monthly Guidelines

Percent of
Family Size        
Poverty

  100% 120% 135% 150% 200% 250%

1 $902.50 $1,083.00 $1,218.33 $1,353.75 $1,805.00 $2,256.25

2 $1,214.17 $1,457.00 $1,639.08 $1,821.25 $2,428.33 $3,035.43

3 $1,525.83 $1,831.00 $2,059.83 $2,288.75 $3,051.67 $3,814.57

4 $1,837.50 $2,205.00 $2,480.58 $2,756.25 $3,675.00 $4,593.75

5 $2,149.17 $2,579.00 $2,901.33 $3,223.75 $4,298.33 $5,372.93

6 $2,460.83 $2,953.00 $3,322.08 $3,691.25 $4,921.67 $6,152.08

7 $2,772.50 $3,327.00 $3,742.83 $4,158.75 $5,545.00 $6,931.25

8 $3,084.17 $3,701.00 $4,163.75 $4,626.25 $6,168.33 $7,710.43

 Medi-Cal Working Disabled Program Premium
Calculation Table
Countable Earned Countable Earned Premium for Eligible Premium for Eligible
Income From: Income To: Individual Couple

$1 $600 $20 $30

$601 $700 $25 $40
$701 $900 $50 $75
$901 $1,100 $75 $100
$1,101 $1,300 $100 $150
$1,301 $1,500 $125 $200
$1,501 $1,700 $150 $225
$1,701 $1,900 $175 $275
$1,901 $2,100 $200 $300
$2,101 $2,257 $250 $375
$2,258 $3,036 N/A $375
 MEDI-CAL WORKING DISABLED PROGRAM

ENROLLMENT
 Currently eligible beneficiaries should call their eligibility
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 coordinator, contact the local
Medi-Cal field office (DPSS in
L.A. & Orange Co.)
 If not already enrolled in Medi-Cal call the Beneficiary Unit
for Medi-Cal (916-636-1980) or download and application
from: www.dhcs.ca.gov/formsandpubs/forms/Pages/Medi-CalForms.aspx
 MEDI-CAL WORKING DISABLED PROGRAM

ENROLLMENT (continued)
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
 Copies of two most recent bank statements
(The above list is required of all WDP applicants and enrollees)
MEDI-CAL WORKING DISABLED PROGRAM (continued)

 The Medi-Cal Working Disabled Program does not use a “Share of Cost”
structure
 Continues the Medicare Part B premium “Buy-In” program for the
beneficiary
 Beneficiaries remain “Dual Eligible” with uninterrupted access to the
Medicare Part D “Extra Help”, Low Income Subsidy (LIS) program
 Retaining LIS eligibility allows beneficiary to have prescription co-pays
between $1.10 generic /$6.00 brand name depending on their
Medicare D Rx plan and whether income is below or above 100% FPL
 http://www.cahealthadvocates.org/_pdf/facts/E-003-
CHAFactSheet.pdf
MEDI-CAL WORKING DISABLED PROGRAM
(continued)

 Medi-Cal’s Health Insurance Premium Payment

program (Medi-Cal/HIPP)
 In Home Supportive Service (IHSS) Personal Care
(includes workplace assistance)
 Medi-Cal’s co-pay and premium
payment programs for Qualified Medicare
Beneficiaries (QMB)
 Student Earned Income Exclusion (SEIE)
 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

SEIE 2008 2009 & 2010

Monthly Limit $1,550 $1,640
Annual Limit $6,240 $6,600
https://secure.ssa.gov/apps10/poms.nsf/lnx/0500820510!opendocument
 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
 RESOURCES & SPONSORS
AIDS Project Los Angeles
Disability Rights California
Department of Health Care
Services
World Institute on Disability
California Health
Incentives Improvement
Project
Westside Center for
Independent Living
Disability Benefits 101
(213) 201-1365 www.apla.org
(213) 427-8747 www.disabilityrightsca.org
(916) 552-9100 www.dhs.ca.gov
(510) 763-4100 www.wid.org
www.chiip.org
(916) 654-2561
www.talentknowsnolimits.info
(888) 851-9245
www.wcil.org
http://www.disabilitybenefits101.org/