A program that pays for some or all of the costs associated with HIV/AIDS medications. ADAP only covers Federal Drug Administration (FDA) approved medications on its formulary (list of covered prescriptions).
Someone who can help you understand or apply for benefit programs when you become disabled or turn 65. Their goal is to help you avoid financial complications while developing a sustainable plan for the future. To find a benefits planner in California, use the DB101 Benefits Planner Directory.
The federal government pays benefits planners in communities around the country to help people think ahead about work incentives and benefits issues. CWIC'S are benefits planners who are trained by the Social Security Administration to assist beneficiaries with programs including Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI) in addition to other related programs.
The formula used to determine income and to consider eligibility for SSI-Linked, Medically Needy, and Aged and Disabled Medi-Cal programs.
Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.
Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide by two.
Step 3: Add your countable unearned income to your countable earned income to find your total countable income.
Different Medi-Cal programs may include more deductions or exclude certain types of income. See the program descriptions for details.
Rules used by Social Security and Medi-Cal that determine an individual’s eligibility when living with a non-disabled spouse. If the individual is a minor, deeming rules apply to the parents.
The inability to engage in any Substantial Gainful Activity (SGA) due to any medically determinable physical or mental impairment which can be expected to result in death or last for a continuous period of at least 12 months.
A person must not only be unable to do his/her previous work but cannot, considering age, education, and work experience, engage in any other kind of SGA which exists in the national economy. It doesn't mattter whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he/she applied for work. The worker’s impairment(s) must be the primary reason for his/her inability to engage in SGA.
Salaries, wages, tips, professional fees and other amounts received as pay for physical or mental work actually performed. Funds received from any other source are not included. (Contrast unearned income.)
Income received from work that is disregarded in the countable income calculation. This calculation evaluates an individual’s financial eligibility for Aged and Disabled Federal Poverty Level (ADFPL), Breast and Cervical Cancer Treatment Program (BCCTP), In Home Supportive Services (IHSS), Medically Needy (MN) and 250% California Working Disabled Program (250% CWD) Medi-Cal.
One of several types of health coverage programs that Medi-Cal offers. Each eligibility category has specific requirements, and an individual may be eligible for more than one category.
A table of income amounts used to determine financial eligibility for federal and state programs. Each year, the Department of Health and Human Services (HHS) issues the Federal Poverty Guidelines in the Federal Register. The Federal Poverty Level for one person is $10,830. For each additional person, add $3,480. For Medi-Cal programs, these figures go into effect in March or April of each year.
A program that provides domestic, paramedical, and personal assistance services for people with disabilities so that they can live independently or maintain employment safely. The IHSS program provides an alternative to living in an institution for many people.
A personal income limit that enables an individual to retain Supplemental Security Income-Linked Medi-Cal coverage when their earnings go above the state's threshold amount. Social Security will determine an Individual Threshold Amount if the individual has Impairment Related or Blind Work Expenses, a Plan to Achieve Self Support, a publicly funded personal attendant, or medical expenses above the state average amount.
Accessible cash resources that include: individual/joint checking and savings accounts, retirement accounts, stocks, bonds, mining rights and cash value in a life insurance policy.
A program that allows individuals working with a disability to retain Medi-Cal (Medicaid) coverage through premium payments. In California, this program is called the 250% California Working Disabled Program.
An evaluation that measures an individual's ability to complete activities of daily living (dressing, toileting, bathing, eating, respiration, getting around in the house) and instrumental activities of daily living (housekeeping, shopping, taking medication, meal preparation, managing finances, and getting around out of the house). The needs assessment determines an individual’s level of need for the In Home Supportive Services Program.
Household goods and personal effects that have a total value of $2000 or less
One car if it is: necessary for employment, or necessary fro medical treatment, or modified for use by a disabled person, or it provides necessary transportation to perform essential daily activities, or has a current market value less than $4500
Property of a trade or business that is essential for self support
Non-business property which is essential to self support
Resources of a blind or disabled individual necessary to fulfill an approved PASS
Certain stocks held by Alaskan natives
Life insurance, if the total face value of all policies on one person do not exceed $1500. Otherwise, the cash surrenders values of life insurance policies will count as a resource
Restricted allotted Native American lands
Payments or benefits paid under other Federal statutes
Disaster relief assistance
Burial space of any value, and burial funds up to $1500
Title XVI (SSI) or Title II (SSDI) retroactive payments for 6 months
Provisions that allow Supplemental Security Income (SSI) beneficiaries to retain Medi-Cal coverage when their combined income is too high to receive any SSI cash benefit. To continue receiving Medi-Cal, an individual must meet all of the following 1619(b) provisions:
Received an SSI benefit payment in the past twelve months
Meet medical disability requirements
Meet non-disability requirements
Need Medi-Cal health coverage to continue working
Have wages below the 1619(b) threshold amount of $34,788 annually ($36,348 if blind) as of 2009 in California
Funds received from sources for which no paid work activity is performed.
Disability benefits such as SSDI, SSI, short term disability insurance, and long term disability insurance; VA benefits; Workers' Compensation; income from a trust or investment; spousal support; dividends, profits, or funds received from any source other than work are all usually considered unearned income.
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