 |
|
|
| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
|
|
 |
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).
|
|
|
The person who is receiving a benefit.
|
|
|
A trained expert who can help you understand or apply for benefit programs. 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.
|
|
|
A specified amount of earned or unearned income that is excluded from consideration in the financial eligibility requirements for a Medi-Cal program.
|
|
|
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. |
|
|
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
|
|
|
The $20 of earned or unearned income that is not considered when determining the amount for the Supplemental Security Income (SSI) benefit.
|
|
|
Income before taxes and other deductions are made.
|
|
|
A case law that allows a Medi-Cal recipient to use prior unpaid medical expenses to meet their monthly share of cost.
|
|
|
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.
|
|
|
Being responsible for medical expenses before Medi-Cal coverage begins.
|
|
|
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.
|
|
|
The amount of an individual’s income that Medi-Cal determines is used to cover living expenses such as food, clothing and housing.
|
|
|
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.
|
|
|
| California's Medicaid program. It offers health coverage for people with low incomes who are either disabled, blind, or at least 65 years old. |
|
|
A state program that pays for private health insurance premiums. For information on application procedures, call (866) 298-8443.
|
|
|
| Programs that have Medi-Cal pay for Medicare premiums. The types of Medicare costs that Medi-Cal pays for in these programs depends on your income. |
|
|
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.
|
|
|
The portion of an individual's earned income that is taken into account when evaluating financial eligibility for Medi-Cal.
|
|
|
| Medi-Cal that you don't have to pay for. |
|
|
The official name for correspondence between Medi-Cal and beneficiaries.
|
|
|
The insurer who pays medical claims last when an individual has multiple sources of health coverage.
|
|
|
A regularly scheduled payment to an insurer or health care plan.
|
|
|
The following items do not count as resources:
The home, and any adjoining land Household goods and personal effects that have a total value of $2,000 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 Housing assistance Nine months of payments received as compensation for expenses or losses suffered as a result of a crime Nine months of reallocation assistance
|
|
|
The amount of money an individual pays for health care costs before Medi-Cal coverage begins.
|
|
|
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 $34,324 annually ($37,252 if blind) as of 2010 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.
|
|
|
Physical or mental activity that is actually performed and results in earned income. |
|
|
|
|
| |
Print This Page
