ADAP (AIDS Drug Assistance Program) |
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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).
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Any Income Deduction |
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Beneficiary |
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The person who is receiving a benefit.
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Benefits Planner |
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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 Minnesota, contact the Work Incentives Connection at 800-976-6728.
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Community Work Incentives Coordinator (CWIC) |
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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.
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Countable Earned Income (CEI) |
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Countable Income Calculation (CIC) |
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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.
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Deeming Rules |
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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.
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Disability (Definition used by Social Security for Adults) |
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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 is immaterial 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.
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Disregard |
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A specified amount of earned or unearned income that is excluded from consideration in the financial eligibility requirements for a Medi-Cal program.
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Earned Income (EI) |
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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.) |
Earned Income Deduction |
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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. |
Eligibility Category |
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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.
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Federal Poverty Level (FPL) |
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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 $10,210. For each additional person, add $3,480. For Medi-Cal programs, these figures go into effect in March or April of each year. |
Full-Scope Medi-Cal |
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Complete medical services offered to beneficiaries such as:
Inpatient hospital services (tests, surgeries, procedures) Outpatient hospital services Physician services Medical and surgical dental services Nursing services Home health care Family planning and supplies Rural health clinic and ambulatory services Laboratory and x-ray services Pediatric and family nurse practitioner services Nurse-midwife services Early and periodic screening Diagnosis and treatment (EPSDT) services Prenatal and delivery services Ambulatory services for individuals in an institution Home health services Clinic services Nursing facility services (under 21 years old) Intermediate care facility/mentally retarded services Optometrist services and eyeglasses Prescribed medication TB-related services for TB infected persons Prosthetic devices Dental services Preventative and rehabilitative services Case management Private duty nursing Home respiratory care services Personal care services Home and community based waivers Medical equipment and appliances Diagnostic screening
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General Income Exclusion (Supplemental Security Income Program) |
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The $20 of earned or unearned income that is not considered when determining the amount for the Supplemental Security Income (SSI) benefit.
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Gross Income |
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Income before taxes and other deductions are made.
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Hunt v. Kizer |
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A case law that allows a Medi-Cal recipient to use prior unpaid medical expenses to meet their monthly share of cost.
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In Home Supportive Services (IHSS) |
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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.
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Income Disregard |
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Incurring Medical Expenses |
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Being responsible for medical expenses before Medi-Cal coverage begins.
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Individual Threshold Amount |
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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. |
Liquid Assets |
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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.
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Maintenance Need Level (MNL) |
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The amount of an individual’s income that Medi-Cal determines is used to cover living expenses such as food, clothing and housing.
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Medicaid Buy-In |
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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.
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Medi-Cal/HIPP (Medi-Cal/Health Insurance Premium Payment) |
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A state program that pays for private health insurance premiums. For information on application procedures, call (866) 298-8443.
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Needs Assessment |
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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.
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Net Countable Earned Income |
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The portion of an individual's earned income that is taken into account when evaluating financial eligibility for Medi-Cal.
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Notice of Action (NOA) |
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The official name for correspondence between Medi-Cal and beneficiaries.
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Payer of Last Resort |
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The insurer who pays medical claims last when an individual has multiple sources of health coverage.
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Premium |
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A regularly scheduled payment to an insurer or health care plan.
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Share of Cost (SOC) |
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The amount of money an individual pays for health care costs before Medi-Cal coverage begins.
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Social Security's 1619(b) Provisions |
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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 $34,346 annually ($35,906 if blind) as of 2008 in California
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Unearned Income (UI) |
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Funds received from sources for which no paid work activity was performed. (Examples: Disability benefits such as SSDI, SSI, STD, and LTD; VA benefits; Worker's Compensation; income from a trust or investment; dividends, profits, or funds received from any source other than work.) |
Work
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Physical or mental activity that is actually performed and results in earned income. |
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