This program provides no-share-of-cost Medi-Cal to many seniors and persons with disabilities who currently pay a share of cost under Medi-Cal program or pay a share of cost for Medi-Cal personal care services. "A&D" means "aged and disabled."
You qualify for this program if your countable income using SSI rules does not exceed 100% of the federal poverty level plus $230 if you are an individual or plus $310 if you are a senior/disabled couple. The federal poverty level (FPL) for an individual is $696; for a couple or two people, the FPL is $938.
The SSI rules for counting income differ depending on whether the income is earned or unearned. Earned income is salary or wages or self-employment income. It is income subject to Social Security tax deductions (called "FICA" on the pay stub). Earned income also includes honoraria (such as speaker’s fees) and book royalties. Everything else is unearned income. Unearned income includes Social Security benefits and other pensions.
Earned and unearned income is reduced by the $20 any-income deduction. You can use the $20 deduction only once in a month. There are no further unearned income deductions. Earned income deductions include a $65 earned income deduction, deductions for Impairment Related Work Expenses you pay for, and a 50% additional earned income deduction. Married couples get only one $20 any income deduction and one $65 earned income deduction.
If you receive $800 in unearned income, your countable income using SSI rules would be $780. If you receive $800 in earned income and you had no Impairment Related Work Expenses, your countable income using SSI rules would be $357.50. If you received $400 in unearned income and $400 in earned income and you had no Impairment Related Work expenses, your countable income using SSI rules would be $557.50.
Seniors and persons with disabilities will qualify for Medi-Cal under this program if their total countable income before any Medicare premium deductions is $926 or less. Because of the $20 any-income deduction, persons with Social Security benefits of $946 a month or less before any Medicare premium deductions will qualify for no share of cost Medi-Cal.
Married couples consisting of seniors and persons with disabilities will qualify for Medi-Cal under this program if their total countable income before any Medicare premium deductions is $1248 or less. Because of the $20 any-income deduction, couples with Social Security benefits of $1268 a month or less before any Medicare premium deductions will qualify for no share of cost Medi-Cal.
Children like adults may qualify for no-share-of-cost Medi-Cal under this program just as they may qualify for ABD (aged, blind, disabled) Medically Needy Medi-Cal with a share of cost if they meet the SSI disability standard. The state is using a modified Medically Needy methodology. The first step is determining the Family countable income. From that you deduct the maintenance need level for other members of the family. If what is left over is not more than 100% of the FPL level plus $230, then the child qualifies.
Example: Disabled child in a family where there is a single parent and another child and parent’s earned income is $3000 a month, child qualifies.
Question: What happens when my Social Security increases January 1 because of the cost of living?
The Medi-Cal program will not take into consideration any COLA increase in your Social Security benefits until the new federal poverty level figures go into effect in April of 2000. Beginning in April your eligibility will be determined by the new federal poverty levels.
Question: Are there any people who will be eligible in January but not eligible when the new federal poverty level figures come out?
Yes, a few people. Although what constitutes 100% of the federal poverty level will increase effective April 1, 2000, the additional amount of income not counted - $230 for individuals and $310 for couples – is not adjusted for the cost of living increases. This year these amounts added to 100% of the FPL for individuals and couples equal approximately 133% of the FPL. Next April the true percentage will be less.
However, disability advocates will be trying to change the ABD Medically Needy program so that persons with income above 100% of the FPL plus $230 for individuals and $310 for couples will be able to spend down to those amounts to qualify for Medi-Cal rather than spending down to $600 for individuals and $934 for couples.
Question: You don’t mention people who are blind. Are they covered?
The federal law that authorized this program covers only seniors and persons with disabilities. Most persons who are blind will also be covered as disabled except perhaps for some persons who are blind and who are earning more than the disabled SGA level ($700 a month) when they first apply or seek to transfer to this program from the ABD MN program.
Question: How does this program relate to the 250% working disabled program?
For some working persons, the total countable income will not be more than the countable income ceilings under the 133% program. For instance, someone whose title II Social Security benefits are$750 a month and has earnings of $400 a month would qualify for Medi-Cal with no share of cost under this program.
Question: Can I use medical expenses to bring my income down to below the income ceilings for the A&D program?
No. You either qualify for this program or you do not. However, if any of the income counted is earned income, check with the employer to see if there is a "cafeteria plan" for paying for child care or medical expenses with pre-tax dollars. Money set aside in a "cafeteria plan" is not counted as income because you do not pay Social Security tax on that income.
Question: What if I am the one who is disabled and my spouse works. How will my eligibility under this program be determined?
You would determine your wife’s countable income and then deduct $600, the maintenance need allowance for one person. You would qualify if the balance is not more than the individual FPL plus $230.