PURPOSE

Aged and Disabled Federal Poverty Level is a Medi-Cal eligibility category (program) for California residents, under age 65, who meet disability and financial eligibility requirements. It provides Medi-Cal with no share of cost. An individual may consider applying for this eligibility category when their income, after certain deductions, is not more than $1,047 for an individual or $1,472 for a couple during the year 2006.

MEDICAL ELIGIBILITY

An individual, under age 65, must meet Social Security’s medical rules for disability.

FINANCIAL ELIGIBILITY

Asset Requirements

An individual may not have liquid assets (accessible money) in excess of $2,000 ($3,000 for a couple). Ownership of one house, occupied by the individual, and one car will not be considered when determining the individual’s resource levels.

Income and Earnings

To qualify for Aged and Disabled Federal Poverty Level Medi-Cal, your countable income minus a maintenence need allowance deduction can be up to $1,047 for an individual and $1,472 for a couple for 2006:

The figure $1,047 for an individual is calculated by adding 100% of the monthly Federal Poverty Level ($817, as of 4/2006) and a $230 disregard. This figure does not include a $20 "any income deduction" applied to calculate total countable income.

For couples, the income limit is the higher of two amounts: the Supplemental Securtiy Income/State Supplemental Payment for couples ($1,472 in 2006) or the Federal Poverty Level plus a $372 disregard ($1,100 + $372 = $1,472 in 2006). This year, the SSI/SSP level of $1,472 is higher.

COST

The individual is not responsible for any cost for this Medi-Cal eligibility category.

RESIDENCY REQUIREMENT

An individual must be a legal United States and California resident. Current provisions regarding immigrants can be found in the federal Welfare Reform Act.

Medi-Cal uses the same residency requirement rules as Social Security. The Supplemental Security Income (SSI) program provides an explanation of the rules on the Social Security Administration's website.

BENEFIT

This eligibility category of coverage allows the recipient to participate in full-scope Medi-Cal and access additional Medi-Cal programs such as:

• Medi-Cal’s Health Insurance Premium Payment program (Medi-Cal/HIPP)
• Medi-Cal’s Medicare premium payment programs for Qualified Medicare Beneficiaries (QMB) and
• In-Home Supportive Service (IHSS) or Personal Care Service Program (PCSP), if found eligible for these services by means of a needs assessment.

The Centers for Medicare and Medicaid Services (CMS) provide an explanation of many of the services covered by full-Scope Medi-Cal (Medicaid) on their website under the heading of Scope of Medicaid Services.

INTEGRATION

If an individual has other health coverage, Medi-Cal (all eligibility categories) becomes the secondary payer. In this case, the other health coverage must be used before Medi-Cal coverage is available to supplement that coverage.

APPLICATION

Processing takes an average of between 30 to 60 days from the date of application.

The eligibility worker may enroll an individual without conducting a medical determination of disability if the individual already has met the medical rules for disability. For example, a Social Security Disability Insurance (SSDI) beneficiary has already met the medical rules for this program.

Medi-Cal currently provides a printable application in eleven languages online which can be mailed after being completed.

Information regarding local Medi-Cal offices and telephone numbers can be obtained on the California Department of Health Care Services website or by calling the Beneficiary Unit for Medi-Cal, 916-636-1980.

RETROACTIVE PAYMENTS

Medi-Cal can pay medical bills incurred up to three months prior to the application date.

ADDITIONAL INFORMATION

There are a limited number of doctors who accept new Medi-Cal patients. Treatment and prescription limitations may exist.

Medi-Cal has the ability to recover costs from the estate of deceased individuals over age 55.

Medi-Cal/HIPP, a Medi-Cal program, exists to help qualified individuals pay their private health insurance premiums.

As an individual’s circumstances change, it is important to review the most cost effective eligibility category of Medi-Cal available. Here are five additional Medi-Cal eligibility categories:

1. SSI-linked Medi-Cal is medical coverage an individual automatically receives if he or she qualifies for a cash benefit from Supplemental Security Income (SSI) in a given month. When an individual receives no SSI cash benefit due to earnings, Medi-Cal coverage may continue under Social Security’s 1619(b) provisions.

2. Medically Needy Medi-Cal is medical coverage for which an individual applies if his or her monthly unearned income and/or Countable Earned Income is above SSI limits and those of the Aged, Blind, or Disabled category of Medi-Cal. This coverage requires the individual to incur a monthly co-payment known as a share of cost.

3. Breast and Cervical Cancer Treatment Program (BCCTP) is a Medi-Cal program, available since February 2002, for California residents with a diagnosis of breast or cervical cancer and who meet financial eligibility criteria.

4. In-Home Supportive Services (IHSS) is a Medi-Cal program that provides personal assistance services an individual can use to live at home or maintain employment safely.