SSA and Medi-Cal Work
Incentives: Earning Income and
Eliminating Share of Cost
Presented by:
Karla Bell, Project Specialist
&
Michael Van Essen, Benefits Establishment Specialist
California Health Incentives Improvement Project
April 27, 2010
San Diego, CA

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
2
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Talent Knows No Limits-social marketing
campaign
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Website & Facebook
Promotional Videos: Employer video, I Can Work
video
Sustainable disability youth transition
activities
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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
3

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
4
Overview
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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.
2.
3.
4.
SSI’s 1619(b) program
Aged & Disabled Federal Poverty
Level Medi-Cal Program
250% Working Disabled Program
Medically Needy with Share of Cost
1619(b) Program
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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 MediCal 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 basis
http://www.ssa.gov/disabilityresearch/wi/1619b.htm
* Subject to change due to California Budget Crisis
SSI’s Earned Income Exclusion
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
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
$845.00 Maximum SSI Rate
-$158.00 Total Countable Income
$687.00 Adjusted SSI Payment
$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
$845.00 Maximum SSI Rate
-$910.00 Total Countable Income
$0.00 Adjusted SSI Payment
SSDI Work Incentives
Trial Work Period (TWP)
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Allows beneficiary to test work for at least 9 months
while receiving full SSDI benefits
2010: $720 gross earnings or 80 hours in selfemployment = TWP month
Extended Period of Eligibility
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Starts after TWP ends
Automatic reinstatement for the first 3 years
2010 SGA is $1000/month ($1640 for a Blind
individual)
Expedited Reinstatement
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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
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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
Aged & Disabled FPL Medi-Cal
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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
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Provides choice and opportunity to
Californians with disabilities who
would otherwise be ineligible for
No-Share-of-Cost, full scope MediCal 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
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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
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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 SelfEmployment calculation
Medi-Cal 250% Working Disabled
Program
To qualify for the program,
individuals must:
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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)
Medi-Cal 250% Working Disabled
Program
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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
Medi-Cal 250% Working Disabled
Program
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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.)
Medi-Cal 250% Working Disabled
Program
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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
Family
Size
Percent of
Poverty
100%
120%
135%
150%
200%
250%
1
$902.50
$1,083.00
$1,218.33
$1,353.75
$1,805.00
$2,256.25
2
$1,214.17
$1,457.00
$1,639.08
$1,821.25
$2,428.33
$3,035.43
3
$1,525.83
$1,831.00
$2,059.83
$2,288.75
$3,051.67
$3,814.57
4
$1,837.50
$2,205.00
$2,480.58
$2,756.25
$3,675.00
$4,593.75
5
$2,149.17
$2,579.00
$2,901.33
$3,223.75
$4,298.33
$5,372.93
6
$2,460.83
$2,953.00
$3,322.08
$3,691.25
$4,921.67
$6,152.08
7
$2,772.50
$3,327.00
$3,742.83
$4,158.75
$5,545.00
$6,931.25
8
$3,084.17
$3,701.00
$4,163.75
$4,626.25
$6,168.33
$7,710.43
Countable Income Example
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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
$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
Medically Needy Share of Cost vs.
250% Working Disabled Program
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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
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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)
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:
Katherine Trinh
(858) 492-2236
Katherine.Trinh@sdcounty.ca.gov

Medi-Cal 250% Working Disabled
Program
Completed application should be submitted in
person with:
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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 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:
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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 101
http://www.disabilitybenefits101.org
Talent Knows No Limits
http://www.talentknowsnolimits.info
World Institute on Disability
(510) 763- 4100
http://www.wid.org/
Resources
Medi-Cal San Diego
(866) 262-9881
http://www.sdcounty.ca.gov/hhsa/programs/
ssp/medi-cal_program/index.html
San Diego 250% County Coordinator (for
assistance with enrollment):
Katherine Trinh
(858) 492-2236
Katherine.Trinh@sdcounty.ca.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)
1-800-434-0222
http://www.cahealthadvocates.org/HIC
AP/
Resources
Advocacy Resources:
Health Consumer Alliance
http://healthconsumer.org/
877-734-3258 (Consumer Center for Health
Education and Advocacy)
Disability Rights California
http://www.disabilityrightsca.org/
800-776-5746/TTY 800-719-5798
Resources
SSA Red Book-Guide to Work Incentives
http://www.ssa.gov/redbook/
San Diego County Work Incentives Planning
and Assistance Project
Project Independence
Steve Stover, CWIC
6505 Alvarado Rd. Suite 207
San Diego, CA 92120
619-840-6616
Sstover@proindependence.org
Resources
For more information on outreach and training
activities or questions, contact Karla Bell at 619594-5381, kbell@interwork.sdsu.edu
Contact Michael Van Essen at (626) 744-5230 Ext.
273 or Mvanessen@pacificclinics.org
To order brochures or promotional materials,
contact Nicholas Moore at 916-654-8194,
Nicholas.Moore@edd.ca.gov
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Medi-Cal Working Disabled Brochure
I Can Work Brochure