Aged & Disabled Federal Poverty Level Program
Worksheet and Explanation for
Eligible Couples Not Living in Board & Care

The Step numbers below correspond to the steps listed on the blank worksheet. The Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal program follows SSI income rules.

Under the A&D FPL program, as under the Federal Poverty Level programs for children and pregnant women, you qualify only if your income is within allowable limits. You cannot “spend down” excess income on medical expenses to qualify as you can under the medically needy programs. However, you can deduct any health plan premiums, such as for a dental or vision policy.

Step 1:

Enter the combined total of the husband’s and wife’s unearned income before any deductions for health insurance premiums or tax withholding. For instance, if either or both receive Social Security benefits from which Medicare premiums are deducted, the Medi-Cal program counts the amount of Social Security benefits before any Medicare premium deduction. (However, if you are eligible for the A&D FPL program or any other Medi-Cal program, Medi-Cal will pay for your Medicare premium directly.) Unearned income includes pensions, state disability insurance and unemployment benefits.

Step 2:

Deduct the $20 any-income deduction.

Step 3:

Enter the balance, if any. The balance is the total countable unearned income.

Step 4:

Enter the combined total of the husband’s and wife’s gross earned income before any deductions. If you are self-employed, your gross earned income means your adjusted gross income – that is, your gross income receipts less IRS allowable deductions.[1] Earned income includes any income on which Social Security taxes are paid or are payable, honoraria, and book royalties. Gross income does not include earned income put into a cafeteria plan for child care or medical expenses, because that income is not subject to Social Security taxes.[2] Gross Income does include earned income put into a retirement account, because that income is subject to Social Security taxes.

Step 5:

Deduct the balance (any amount left over) of the $20 any income deduction. Look at Step 2 and see if any part of the $20 deduction was unused.

Step 6:

Deduct the $65 earned income work incentive deduction.

Step 7:

Deduct any Impairment Related Work Expenses or IRWEs from the applicant’s earnings. IRWEs are out-of-pocket expenses you have both because you work and you have a disability. Examples include attendant care for help before, after and during work; transportation when you cannot use or reliably use public transportation because of your disability. IRWEs also include out-of-pocket medical expenses needed to work even if you would have the same expenses if you were not working. You are eligible to take this deduction if you are under age 65. If you are age 65 or older, you can take this deduction if you qualified for Medi-Cal or other benefits on the basis of disability before you were 65.

Step 8:

Enter the subtotal after deducting the unused portion of the $20 any income deduction (Step 5) and the $65 earned income deduction (Step 6), any IRWE deductions from the gross earned income (Step 4).

Step 9:

Deduct 50% of the subtotal entered at Step 8. This is an additional work incentive deduction.

Step 10:

Enter the balance after deducting the amount in Step 9 from the amount in Step 8. This is your total countable earned income. The amounts in Steps 9 and 10 should be the same.

Step 11:

Add together your total countable unearned income and your total countable earned income.

Step 12:

Deduct any health insurance premium payments paid including Medi-Gap, dental or vision insurance. Department of Health Services (DHS) All-County Letter (ACL) 01-18; MC 176 Aged/Disabled FPL group spreadsheet (10-17-00)

Step 13:

The remainder is the couple’s countable income for purposes of determining eligibility under the A&D FPL program.

Authority: Welfare & Institutions Code § 14005.40; DHS ACLs Nos. 00-57, 00-68, 01-18, 02-38.

Note: If one of you does not need Medi-Cal every month, look to see if the spouse who needs Medi-Cal every month would qualify using the form for persons with an ineligible spouse. The “ineligible” spouse could qualify for Medi-Cal under the ABD MN program.

Example: Jane receives $800 in Social Security benefits (unearned income) and Joe receives $700 in a pension (also unearned income). Their countable income is too high to qualify for the A&D FPL program as a couple. However, if Joe were the spouse with the greatest need for Medi-Cal, he could qualify for Medi-Cal as an individual under the A&D FPL program using the A&D FPL worksheet for an adult with an “ineligible” spouse: The combined countable income of $1480 less $600 maintenance allowance for Joan leaves a balance of $880 which is less than the A&D FPL ceiling for an individual.

Joan could also qualify for ABD MN Medi-Cal although with a share of cost of $546 a month, the amount the couple’s countable income exceeds the maintenance need level for a couple ($934). That would be the monthly share of cost if both qualified for Medi-Cal under the ABD MN program.

Blank A&D FPL Worksheet for Couples

Step 1	Total unearned income from both Husband & Wife before any Medicare or other deductions
Step 2	Less $20 any income deduction	- 20.00
Step 3	Total countable unearned income for couple
Step 4	Gross earned income from both Husband and Wife before any deductions
Step 5	Less balance of the $20 any income deduction from step (2) above, if any	-
Step 6	Less $65 earned income deduction	- 65.00
Step 7	Less any Impairment Related Work Expenses	-
Step 8	Subtotal
Step 9	Less 50% of the subtotal in step (5) as an additional work incentive deduction
Step 10	Total Countable Earned Income for couple
Step 11	Add together the total countable unearned income (step 3) and total countable earned income (step 10) for total countable income.
Step 12	Deduct any health insurance premium payments except Medicare premiums[3]
Step 13	Income counted for determining eligibility of couple seeking A&D FPL Medi-Cal

Is the amount in Step 13 equal to or less than $1472? [The statute says that the income ceiling will be either 100% of the FPL ($1100 for two in 2006) for a couple plus $310 ($1410) or the aged-disabled SSI/SSP couple rate ($1472 in 2006 whichever is higher). In 2006 the SSI/SSP couple rate is higher.] If yes, then you qualify for Medi-Cal with no share of cost. If your income is above the couple ceiling, see the note on page 3 above and the cover on alternatives for those whose countable income is above the A&D FPL ceiling.

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[1] You estimate what your current monthly income is based on last year’s income tax return and the comparison between last year’s adjusted gross income and last year’s gross receipts. If last year your adjusted gross income was 50% of your gross receipts (i.e., $20,000 based on receipts of $40,000), Social Security in determining your income this year will presume that this year your monthly adjusted gross income would be 50% of your total receipts.

[2] 20 CFR § 416.1110(a); Social Security Program Operations Manual System (POMS) ¶ SI 00820.100-C.1.

[3] The Medi-Cal program will pay for your Medicare Part B premium directly if you qualify. You will then get your full Social Security check without any deduction for Medicare.