Aged & Disabled Federal Poverty Level Program
Worksheet and Explanation for
An Adult with an Ineligible Spouse

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. As explained under Step 4, earned income put in a cafeteria plan does not count as income at all. You can deduct any out-of-pocket health plan premiums for you (such as a dental or vision insurance) or for any other members of the family from their income.

If there are children in the family, then the ineligible spouse and children, if not eligible for no-share-of-cost Medi-Cal under another program, would be eligible for Medi-Cal (MN) program using the income counting rules of the Aged-Blind-Disabled (ABD) MN program which counts earned income after first deducting $65 and 50% of the remainder. See steps 6 and 9 below.

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. (If you are eligible for any Medi-Cal program, Medi-Cal will pay for your Medicare premiums directly.) Unearned income includes interest, annuities, 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. Earned income also includes 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. 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 and have a disability. 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), the $65 earned income deduction (Step 6), and any IRWE deductions from the gross earned income (Step 7).

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 premiums paid for anyone in the household. Department of Health Services (DHS) All-County Letter (ACL) 01-18; MC 176 Aged/Disabled FPL group spreadsheet (10-17-00)

Step 13:

Deduct a maintenance allowance for family members other than the eligible spouse using the figures in the Maintenance Need Level or MNL chart below. Children are included if they are under 18 or, if 18, 19 or 20, if they are full-time students. A family of two parents and three children would be a family of five. Exclude the spouse seeking A&D FPL benefits and you have a family of four. You would deduct $1100 as the MNL for a family of four.

Step 14:

The remainder is the countable income of the spouse seeking Medi-Cal under the A&D FPL program for purposes of determining eligibility.

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

Maintenance Need Allowances – Maintenance Need Level (MNL) (unchanged since July 1, 1989):

1 - $600, 2 - $750, 2 adults - $934, 3 - $934, 4 - $1100, 5 - $1259, 6 - $1,417, 7 - $1,550, 8 - $1,692

Blank A&D FPL Worksheet for an
Adult with an Ineligible Spouse

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 for eligible spouse
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	Deduct the applicable MNL based on family size minus the spouse seeking A&D FPL
Step 14	Income counted for determining eligibility of spouse seeking A&D FPL Medi-Cal

Is the amount in Step 14 equal to or less than $1047 for 2006? That amount is 100% of the FPL ($817 in 2006) for an individual plus $230. If yes, then you qualify for Medi-Cal with no share of cost.

Maintenance Need Allowances: 1 - $600, 2 - $750, 2 adults - $934, 3 - $934, 4 - $1100, 5 - $1259, 6 - $1,417, 7 - $1,550, 8 - $1,692

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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 adjusted 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.