1. 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

2. 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

3. 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

4. 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.

5. 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

6. SSI Countable Income Calculation Example
SSI Payment $845.00/month
$500 Gross Earnings/month
-$20 General Income Exclusion
-$65 Earned Income Exclusion
$ Remainder
÷ 2
$ Total Countable Income
 $ Maximum SSI Rate
-$ Total Countable Income
$ Adjusted SSI Payment
$ Gross Earnings
+$ SSI
$ 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:
$ (Individual-own household)
$ (Individual-household of another)
$ (Individual-no cooking facilities)
$ (Blind individual)
$ (Couple)
$ (Blind Couple)

7. 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

8. 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)

9. 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.

10. 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

11. 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)

12. 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

13. 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.

14. 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

15. 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)

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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 = $ (countable income)

22. 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

23. 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

24. 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)
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

25. 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)
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. 

26. 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

27. 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

28. 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

29. Resources
Disability Benefits Talent Knows No Limits World Institute on Disability (510) SSA Red Book-Guide to Work Incentives

30. Resources Medi-Cal Office Locations
Department of Public Social Services (DPSS)
Los Angeles DPSS 250% County Coordinator (for assistance with enrollment):
Roberto Vera
(562)

31. Resources
Department of Health Care Services (916) Free Medicare Counseling (HICAP) Center for Health Care Rights (213) (TTY)

32. Resources Health Consumer Center of Los Angeles
(800)
(818) (TDD)
Disability Rights California
(213)
(Toll free)
(TTY)

33. Resources Work Incentives Planning and Assistance (WIPA) Projects
Several WIPA projects serve the Los Angeles area:
Verdugo Workforce Investment Board
(818)
Familia Unida
(877)
Goodwill Southern California
x2251
Human Potential Consultants

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

35. Resources
For more information on outreach and training activities or questions, contact Karla Bell at ,
Contact Teddie-Joy Remhild at (818) or
To order brochures or promotional materials, contact Nicholas Moore at ,
Medi-Cal Working Disabled Brochure
I Can Work Brochure