The 250% Working Disabled Program and Options to Maintain Medi-Cal While Working Presented by: Karla Bell, Project Specialist California Health Incentives Improvement Project May 6, 2010 Independent Living Center of Southern California

California Health Incentives Improvement Project (CHIIP) Funded by a Medicaid Infrastructure Grant from the Federal Centers for Medicare and Medicaid Services Goal: To increase the employment rate of people with disabilities by making sure necessary supports are in place, such as access to health care and the ability to use personal assistance services at work Collaborative effort

Overview Supplemental Security Income (SSI) 1619(b) program Aged & Disabled Federal Poverty Level Medi-Cal Program 250% Working Disabled Program AB 1269 Resources Disability Benefits 101 Calculator Example

Options for Continued Medi-Cal Eligibility while Working SSI’s 1619(b) program Aged & Disabled Federal Poverty Level Medi-Cal Program 250% Working Disabled Program When a person with a disability goes to work, there are three options for them to continue with their Medi-Cal eligibility. Supplemental Security Income’s 1619(b) program, the Aged and Disabled Federal Poverty Level Medi-Cal Program and the 250% Working Disabled Program.

How earnings affect SSI payments SSA counts less than half of your earned income For example: $500 in wages $208 counts against SSI Certain Impairment Related Work Expenses and Blind Work Expenses can also be deducted from your gross wages

SSI Countable Income Calculation Example SSI Payment $845.00/month $500 Gross Earnings/month -$20 General Income Exclusion -$65 Earned Income Exclusion $415.00 Remainder ÷ 2 $208.00 Total Countable Income  $845.00 Maximum SSI Rate -$208.00 Total Countable Income $637.00 Adjusted SSI Payment $500.00 Gross Earnings +$637.00 SSI $1137.00 Total Income Break Even Point: $845 X 2 + $85= $1775 Your BEP could be different if you receive a different SSI payment amount or if you receive both SSDI and SSI. Talk to a CWIC to learn more. 2010 California SSI payment rates: $845.00 (Individual-own household) $639.66 (Individual-household of another) $929.00 (Individual-no cooking facilities) $908.00 (Blind individual) $1407.00 (Couple) $1554.20 (Blind Couple)

1619(b) Program 1619(b) is a work incentive that allows working SSI recipients to keep FREE Medi-Cal (No Share-of-Cost) Medi-Cal retained when SSI payment is reduced to $0.00 per month due to earned income Bottom Line: You won’t “lose” your Medi-Cal if you are on SSI and you earn income

1619(b) Program Medi-Cal continues until you earn above a Threshold 2010 California 1619(b) Threshold Amounts: Disabled = $34,324.00 Blind = $37,252.00 People with high medical costs can earn even more (Individualized Threshold) Benefits can start again if you stop working or your earnings decrease (Reinstatement)

1619(b) Program To qualify: Have been eligible for an SSI cash payment for at least 1 month; Would be eligible for cash payment except for earnings; Still be disabled or blind; Still meet all other eligibility rules, including the resources test; Need Medi-Cal in order to work; Have gross earned income that is insufficient to replace SSI, Medi-Cal, and any publicly funded attendant care.

1619(b) Program Individualized Threshold: threshold can be adjusted on a case-by-case basis Higher Individualized Threshold if: Blind Work Expenses (BWE) Impairment Related Work Expenses (IRWE) Plan to Achieve Self-Support (PASS Plan) Publicly Funded Personal Attendant (i.e. In-Home Supportive Services) Medical Expenses above State Average http://www.ssa.gov/disabilityresearch/wi/1619b.htm

1619(b) Program All Blind and Impairment Related Work Expenses must be verified by your local Social Security field office Provide them with original receipts or canceled checks of the expenses SSA will determine if the expense may be deducted Request in writing in order to use appeal rights (if necessary)

Aged & Disabled FPL Medi-Cal Aged & Disabled Federal Poverty Level Medi-Cal provides free, full scope Medi-Cal services for disabled or aged individuals who meet the income and asset requirements of the program Blind people are also eligible, but must be determined disabled Typical income threshold is $1133/month* for a single individual or $1525* for a married couple *All $ amounts subject to change $1133 individual $1525 married couple Total countable earned and unearned income Maintenance needs allowance deducted for family members OTHER than person applying for program SSI income deductions apply Health insurance premiums are deducted

Aged & Disabled FPL Medi-Cal Assets may not exceed $2,000 in value ($3,000 for a couple) Assets, like the home you live in and one car, are not counted for this program Assets may include: checking and savings accounts the value of stocks, bonds, and trust deeds additional cars or recreational vehicles promissory notes and loans that are payable to you Exempt property includes a home, clothing, one car and certain other things such as items necessary for self-employment (building, inventory, bank account) or that you use on the job (tools, second car, etc.). Individual Development Accounts (IDAs) are also exempt.

Medi-Cal 250% Working Disabled Program Provides choice and opportunity to Californians with disabilities who would otherwise be ineligible for No-Share-of-Cost, full scope Medi-Cal coverage due to earned income and work activity California legislation implemented the 250% Working Disabled Program in April 2000

Medi-Cal 250% Working Disabled Program Individuals can earn up to $55,188 gross per year and still qualify for full scope, no share of cost Medi-Cal A working couple can earn up to $73,884 gross per year Higher gross wages possible when there are Impairment Related Work Expenses (IRWEs)

Medi-Cal 250% Working Disabled Program Allows the purchase of full scope Medi-Cal Recipient pays a premium Affordable premiums: $20 - $250 (Single Person) $30 - $375 (Couples) SSI’s countable income calculation is applied to all wages/salaries SSA’s NESE standards used for Self-Employment calculation

Medi-Cal 250% Working Disabled Program To qualify for the program, individuals must: Be a United States resident and living in California Meet Social Security’s definition of disability (medical definition only, does not count the ability to earn income) Do not have to currently receive SSDI or SSI. For anyone with a disability.

Medi-Cal 250% Working Disabled Program Earnings can be as little as $20 per week Work activity can be full-time or part-time, including self employment Work activity can be as simple as pet attending, driving, domestic support services, research, light clerical work Work is undefined: No minimum earnings criteria for eligibility No set amount of hours required COLLECT CANS

Medi-Cal 250% Working Disabled Program Assets must be less than: $2000 for an individual $3000 for a couple One home and one car are not counted for this program Any IRS approved retirement products (Individual Retirement Accounts (IRAs), 401K, 403B, etc) are allowed and not counted towards the typical $2000 (or $3000) asset/resource limits for Medi-Cal Any IRS approved retirement products, Individual Retirement Accounts (IRAs), 401K, 403B, etc are allowed and not counted towards the typical $2000 (or $3000) asset/resource limits for Medi-Cal Disability income (Social Security Disability Insurance-SSDI, State Disability Insurance, Workers Comp., Childhood Disability Benefits, private disability insurance, Veterans’ Benefits, etc.) not included in countable income when determining eligibility and premium amount

Medi-Cal 250% Working Disabled Program Countable Income cannot exceed 250% of Federal Poverty Level (FPL): For individuals: $2257/month For couples: $3036/month Gross earned income limits For individuals: approx. $4599/month For eligible couples: approx $6157/month Disability income not included in countable income when determining eligibility and premium amount (Social Security Disability Insurance-SSDI, State Disability Insurance, Workers Comp., Childhood Disability Benefits, private disability insurance, Veterans’ benefits etc.) Gross earned income limits For individuals: approx. $4599/month For eligible couples: approx $6157/month

Countable Income Example Mary $1,500/month in gross earned income $900/month in SSDI (exempt) $100/month in Impairment-Related Work Expenses (IRWEs) Mary’s Countable Income: $1,500 (earned income) - 20 (general income exclusion) - 65 (earned income exclusion) -100 (IRWE) $1,315 ÷ 2 = $657.50 (countable income)

250% Medi-Cal Working Disabled Program – Premium Chart Countable Earned Income From: Countable Earned Income To: Premium for Eligible Individual Premium for Eligible Couple $1 $600 $20 $30 $601 $700 $25 $40 $701 $900 $50 $75 $901 $1100 $100 $1101 $1300 $150 $1301 $1500 $125 $200 $1501 $1700 $225 $1701 $1900 $175 $275 $1901 $2100 $300 $2101 $2257 $250 $375 $2258 $3036 N/A

Medically Needy Share of Cost vs. 250% Working Disabled Program Mary’s Total Income = $2400 Mary’s Working Disabled Program Premium = $25/month If in Medically Needy Share of Cost Program, share of cost = $950

Medi-Cal 250% Working Disabled Program Benefits Medi-Cal Working Disabled Program is NO SHARE OF COST Medi-Cal Continues the Medicare Part B premium “Buy-In” program for the beneficiary Beneficiaries maintain Medicare Part D “LIS” (Low Income Subsidy) http://www.cahealthadvocates.org/_pdf/facts/E-003-CHAFactSheet.pdf Access IHSS services (not covered by Medicare) There are so many benefits for a person who is dually enrolled in Medicare and the WDP. They can qualify for the Medicare Part D Low Income Subsidy. This can help with their Part D prescription plan costs such as lower copays between $1-$6. Also Medi-Cal will pay for the Medicare Part B premium which puts about $100 back in a person’s pocket each month Also a recent change made it so individuals with a SOC over $500 will no longer have the State pay for their Part B premium. If they enroll in the WDP they can get that back

Medi-Cal 250% Working Disabled Program To begin enrollment, contact Eligibility Worker County Coordinator may be contacted if Eligibility Worker or Supervisor are unfamiliar with the program: Roberto Vera (562) 908-4338 robertovera@dpss.lacounty.gov Currently the WDP is not automated in the LEADER computer system... Meaning that unless the eligibility worker is aware of the program and does a manual workaround to enroll someone in the program, the individual will be placed into a share of cost program.  Once automated, if the EW inputs earned income, they will be placed into the WDP. 

Medi-Cal 250% Working Disabled Program 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 (or letter from employer) Copies of two most recent bank statements If self-employed: A contract may be used W-2’s can be used or: If an applicant is an independent contractor, the 1099 IRS form can be used

250% Working Disabled Program Future Changes Assembly Bill 1269 was signed into law by our Governor on 10/11/09 The new rules will not be implemented until ARRA funds run out

250% Working Disabled Program Future Changes AB 1269 policy changes improves the 250% WDP: Eliminate Age 65 restriction Eliminating the asset limit when money is placed in a separate account Change premium structure Grace period of 26 weeks if employment ends Assembly Bill 1269 was signed into law by our governor on 10/11/09. AB 1269 will improve the WDP in several ways. The new rules will not be implemented until ARRA funds run out. For individuals previously on SSDI and reach full retirement age, their Social Security retirement income will be exempt for ELIGIBILITY, but not premiums Eliminating the asset limit when money is placed in a separate account Each individual will pay a monthly premium that is equal to 5% of his or her individual or spousal countable income (premium will keep the same minimum and maximum range of $20-$250 for individuals and $30-$375 for couples) Disability Income will be exempt for ELIGIBILITY, but not premiums Same three eligibility tests will apply If a person on the program becomes unemployed, they can elect to remain on Medi-Cal for a period up to 26 weeks as long as premiums are still paid and extend resource exemptions to apply under any other Medi-Cal program under which the person later becomes eligible

Resources Disability Benefits 101 http://www.disabilitybenefits101.org Talent Knows No Limits http://www.talentknowsnolimits.info World Institute on Disability (510) 763- 4100 http://www.wid.org/ SSA Red Book-Guide to Work Incentives http://www.ssa.gov/redbook/

Resources Medi-Cal Office Locations Department of Public Social Services (DPSS) http://www.ladpss.org/new_portal/dpss_locations.cfm Los Angeles DPSS 250% County Coordinator (for assistance with enrollment): Roberto Vera (562) 908-4338 robertovera@dpss.lacounty.gov http://www.chiip.org/wdp_county_coordinators.html

Resources Department of Health Care Services (916) 552-9100 http://www.dhcs.ca.gov/ Free Medicare Counseling (HICAP) Center for Health Care Rights 1-800-824-0780 (213) 251-7920 (TTY) http://www.cahealthadvocates.org/HICAP/

Resources Health Consumer Center of Los Angeles http://healthconsumer.org/ (800) 896-3203 (818) 834-7575 (TDD) Disability Rights California http://www.disabilityrightsca.org/ (213) 427-8747 800-776-5746 (Toll free) 800-719-5798 (TTY)

Resources Work Incentives Planning and Assistance (WIPA) Projects https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate Several WIPA projects serve the Los Angeles area: Verdugo Workforce Investment Board (818) 409-0476 Familia Unida (877) 298-3267 Goodwill Southern California 323-223-1211 x2251 Human Potential Consultants 310-756-1560

Resources Department of Rehabilitation Van Nuys/Foothill District (818) 901-5024 (818) 901-5086 (TTY) 5900 Sepulveda Blvd., Suite 240 Van Nuys, CA 91411

Resources For more information on outreach and training activities or questions, contact Karla Bell at 619- 594-5381, kbell@interwork.sdsu.edu Contact Teddie-Joy Remhild at (818) 848-2475 or teddiejoy@att.net To order brochures or promotional materials, contact Nicholas Moore at 916-654-8194, Nicholas.Moore@edd.ca.gov Medi-Cal Working Disabled Brochure I Can Work Brochure