Publication #5450.01
September 2006

(1) Individual, (2) Couple, and (3) One member of a married couple

Note: If the source of your income is Social Security, your eligibility next year will be based on this year’s Social Security income until April when the new federal poverty levels go into effect.  At that time the A&D FPL ceilings will be increased and your current income would be used to determine eligibility.

If your income is above the ceiling for qualifying for the A&D FPL program, here are options:

(a) Consider buying health insurance such as dental insurance or vision insurance or even Medigap insurance. Insurance for long-term care coverage does not count.  The amount you pay out of pocket each month is deducted from your income.  For instance, if your countable income per month is $1,100 before any Medicare premium deduction, you would qualify for the A&D FPL program in 2006 if your health benefit premium equaled $53 or more per month.  Because your Social Security benefits go up more each year than does the A&D FPL ceiling, you may be better off paying a health benefit premium of more than $53 per month. “Countable income” is income after allowable deductions.  For unearned income like Social Security benefits, your countable income would be your income after the $20 any-income deduction.

(b) Do you (or your eligible spouse) have any earned income?  If so, you (or your eligible spouse) may be eligible for Medi-Cal under the 250% Working Disabled Program.  Seniors may also qualify for this program if they were receiving disability benefits or Medi-Cal on the basis of disability prior to receiving benefits based on being age 65 or older.

(c) Did you (or your eligible spouse) ever qualify for SSI and Social Security at the same time?[1] Social Security benefits include dependent benefits received by children.  If so, you (and/or your eligible spouse) may be eligible for Medi-Cal with no share of cost under the Pickle Program.

(d) You (and other members of your family otherwise eligible for Medi-Cal even if not disabled) would be eligible for Medi-Cal under the Aged-Blind-Disabled (ABD) Medically Needy (MN) program.  There would be a share of cost equal to the countable income over the applicable maintenance need level based on family size – i.e., $600 for one person, $750 for an adult and child, $934 for a couple or three-person family, etc.

(e) If you are authorized attendant care services (In-Home Supportive Services or Medi-Cal Personal Care Services) to live safely in your own home, your share of cost under the ABD MN program will be reduced.  At the first of the month the State will pay to reduce your share of cost under the ABD MN program.  The State will pay an amount equal to the difference between the Maintenance Need Level (MNL) ($600 for an individual and $934 for a couple) and the applicable 2006 SSI grant level:  $836 disabled or aged adults, $901 blind; $1472 disabled or aged couples, $1,614 disabled/aged and blind couple, $1699 blind couple.  What that means is that your share of cost will be the difference between the applicable SSI/SSP grant level and your countable income and not the difference between your countable income and the lower MNL.

(f) If there is earned income, see if the employer has a cafeteria plan to pay for unreimbursed medical expenses. Money put in a cafeteria plan does not count as income under Social Security and Medi-Cal rules because those funds are exempt from Social Security (FICA) withholding taxes.

(g) If you are an eligible couple and your combined countable income (i.e., after deducting health premiums, $20 any-income deduction, earned income deductions) is not more than $1647 in 2006, one member of the couple may qualify for no share-of-cost Medi-Cal under the A&D FPL program.  See DHS ACWDL No. 02-38, Question 7.  This probably would not be a good option if one of you needs attendant care services because the state would pay the difference between the couple MNL ($934) and the applicable SSI/SSP couple rate ($1472 aged/disabled couple, $1614 age/disabled and blind couple, $1699 blind couple):

(h) If you are ineligible because your couple income and/or resources are too high or because you are a child and the parental income and/or resources are too high and you are someone whose disability is severe enough to qualify for Medi-Cal funded long-term care, you may be able to qualify for Medi-Cal through one of the Home and Community Based Services waivers:  If you are a client of a regional center serving persons with developmental disabilities and would qualify for services through an intermediate care facility for persons with developmental disabilities (ICF/DD), talk to your service coordinator about qualifying for Medi-Cal through the waiver for persons with developmental disabilities.  If you are a senior or person with a disability who would qualify for care in a nursing facility, subacute nursing facility or a hospital, call Medi-Cal In-Home Operations in Sacramento at (916) 322-2771 or (916) 324-5892 to get on one of the waiver waiting lists.  If you are a senior (65 and older) who would qualify for care in a nursing facility, call 1-800-510-2020 for information about applying for the MSSP waiver and about where to apply.

Attachments:

Worksheet 1: For an Individual

Worksheet 2: For a Couple

Worksheet 3: For One Member of a Married Couple