SSA and Medi-Cal Work Incentives: Earning Income and Eliminating Share of Cost

SSA and Medi-Cal Work Incentives: Earning Income and Eliminating Share of Cost

Presented by:Karla Bell, Project Specialist&Michael Van Essen, Benefits Establishment SpecialistCalifornia Health Incentives Improvement Project

April 27, 2010San Diego, CA

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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

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Talent Knows No Limits-social marketing campaign Website & Facebook Promotional Videos: Employer video, I Can Work

video

Sustainable disability youth transition activities Transition Toolkit targeting youth with disabilities

aged 12-21+ CA Youth Leadership Forum YO! Disabled and Proud Initiative GRADS pilot social marketing project-transition of

college graduates into competitive employment

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Sustainable work incentives & benefits planning technical assistance Disability Benefits 101 Veterans Benefits 101 in development Work incentives brochures in 7 languages In-person trainings for consumers & service

providers Monthly Webinars Periodic Benefits Planning Summits Train-the-Trainer Club

Overview

SSI’s 1619(b) program SSDI Work Incentives Aged & Disabled Federal Poverty Level

Medi-Cal Program 250% Working Disabled Program AB 1269 Resources Disability Benefits 101 Calculator

Example

Medi-Cal Programs and Social Security Work Incentives

1. SSI’s 1619(b) program2. Aged & Disabled Federal Poverty

Level Medi-Cal Program 3. 250% Working Disabled Program4. Medically Needy with Share of Cost

1619(b) Program

A provision to Supplemental Security Income Title XVI (SSI) linked Medi-Cal

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

Earned income threshold in California: $34,324*

For the Blind and/or visually impaired: $37,252*

Threshold can be adjusted on a case-by-case basishttp://www.ssa.gov/disabilityresearch/wi/1619b.htm

* Subject to change due to California Budget Crisis

SSI’s Earned Income ExclusionSSI 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

1619(b) Program

Expenses excluded from countable income include:

• 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

• See SSA’s Red Book for more information:

• http://www.ssa.gov/redbook/

SSI Calculation Example-IRWE$500 Gross Wages-$20 General Income Exclusion-$65 Earned Income Exclusion $415 Remainder-$100 Impairment Related Work Expense$315÷ 2$158.00 Total Countable Income


$500.00 Gross Wages+$687.00 SSI-$100 IRWE$1087.00 Total Income

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

SSI Calculation Example-SSDI & SSI Benefits

$520 Unearned Income (SSDI payment)-$20 General Income Exclusion $500 Countable Unearned Income

$885 Gross Wages-$65 Earned Income Exclusion $820 Remainder÷ 2$410.00 Countable Earned Income

$500.00 Countable Unearned Income+$410.00 Countable Earned Income$910.00 Total Countable Income


SSDI Work Incentives

Trial Work Period (TWP) Allows beneficiary to test work for at least 9 months

while receiving full SSDI benefits 2010: $720 gross earnings or 80 hours in self-

employment = TWP month

Extended Period of Eligibility Starts after TWP ends Automatic reinstatement for the first 3 years 2010 SGA is $1000/month ($1640 for a Blind individual)

Expedited Reinstatement Additional 5 years of reinstatement if work stops and

there is no medical improvement

What happens to Medicare if SSDI benefits stop?

Medicare coverage uninterrupted during Trial Work Period

Continues for at least 93 months after the 9 month Trial Work Period

After that you may be able to purchase Medicare coverage

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*All $ amounts subject to change

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

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


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 yearHigher gross wages possible when

there are Impairment Related Work Expenses (IRWEs)


Allows the purchase of full scope Medi-Cal Recipient pays a premium Affordable premiums:

$20 - $250 (Single Person) $30 - $375 (Couples)

SSI Earned Income Calculation applied to earnings

SSA’s NESE standards used for Self-Employment calculation


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)


Earnings can be as little as $20 per week 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


Assets must be less than: $2000 for an individual $3000 for a couple

One home and one car are not counted for this program

All IRS approved retirement accounts are exempt (IRAs, 401K, 403B, etc)

Income Exemptions: Disability income is excluded (SSDI, CDB, SDI, Workers Comp., STD, LTD, Veterans’ Benefits, etc.)


SSI’s countable income calculation is applied to all wages/salaries

Countable Income cannot exceed 250% of Federal Poverty Level (FPL): For individuals: $2257/month For couples: $3036/month

Special countable income circumstances in excess of 250% FPL are negotiable

2009 Poverty Guidelines for the

48 Contiguous States

Monthly Guidelines

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)

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 $75 $100

$1101 $1300 $100 $150

$1301 $1500 $125 $200

$1501 $1700 $150 $225

$1701 $1900 $175 $275

$1901 $2100 $200 $300

$2101 $2257 $250 $375

$2258 $3036 N/A $375

250% Medi-Cal Working Disabled Program – Premium Chart

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)


To begin enrollment, contact Eligibility Worker

County Coordinator may be contacted if Eligibility Worker or Supervisor are unfamiliar with the program:

Katherine Trinh(858) [email protected]


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

250% Working Disabled ProgramFuture 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 ProgramFuture 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

Resources

Disability Benefits 101http://www.disabilitybenefits101.org

Talent Knows No Limitshttp://www.talentknowsnolimits.info

World Institute on Disability(510) 763- 4100http://www.wid.org/

Resources

Medi-Cal San Diego(866) 262-9881http://www.sdcounty.ca.gov/hhsa/programs/

ssp/medi-cal_program/index.html

San Diego 250% County Coordinator (for assistance with enrollment):Katherine Trinh(858) [email protected]

http://www.chiip.org/wdp_county_coordinators.html

Resources

Department of Health Care Services(916) 552-9100http://www.dhcs.ca.gov/

Free Medicare Counseling (HICAP)1-800-434-0222 http://www.cahealthadvocates.org/HICAP/

Resources

Advocacy Resources:

Health Consumer Alliancehttp://healthconsumer.org/877-734-3258 (Consumer Center for Health

Education and Advocacy)

Disability Rights Californiahttp://www.disabilityrightsca.org/800-776-5746/TTY 800-719-5798

Resources

SSA Red Book-Guide to Work Incentiveshttp://www.ssa.gov/redbook/

San Diego County Work Incentives Planning and Assistance Project

Project Independence Steve Stover, CWIC6505 Alvarado Rd. Suite 207

San Diego, CA 92120 [email protected]

Resources

For more information on outreach and training activities or questions, contact Karla Bell at 619-594-5381, [email protected]

Contact Michael Van Essen at (626) 744-5230 Ext. 273 or [email protected]

To order brochures or promotional materials, contact Nicholas Moore at 916-654-8194, [email protected]

Medi-Cal Working Disabled Brochure I Can Work Brochure

Documents

SSA and Medi-Cal Work Incentives: Earning Income and Eliminating Share of Cost