 | SSI-Linked Medi-Cal: Frequently Asked Questions | |
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If you qualify for SSI, then you are eligible for SSI-Linked Medi-Cal. You can qualify for SSI if you meet income and asset requirements and are either over 65 years or older, blind, or disabled. |
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To qualify financially for SSI-Linked Medi-Cal, you have to meet SSI's financial eligibility requirements.
When you initially qualify, your earnings must be below Social Security’s Substantial Gainful Activity (SGA) amount: $1,000 for the year 2010 ($1,640 for blind beneficiaries).
After you have met the SGA requirements, SSI counts a portion of your earned and unearned income to see if you qualify for the program. SSI calculates this using the countable income calculation.
To qualify financially for the Supplemental Security Income (SSI) program and access SSI-Linked Medi-Cal, your total countable income must not be greater than the current SSI monthly benefit in California. For 2010, the monthly SSI benefit is $845 for an individual and $1,407.20 for a couple.
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Yes. You are allowed to have assets up to $2,000 in value ($3,000 for a couple). Some of your assets, like your home and car, are not counted for this program. Click here for a list of additional exemptions. Assets may include:
- checking and savings accounts;
- the value of stocks, bonds, and trust deeds;
- additional cars or recreational vehicles; and
- promissory notes and loans that are payable to you.
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Yes. There are different ways you can qualify for Medi-Cal. Each Medi-Cal eligibility category has unique requirements. Besides the SSI-Linked program, Db101 has detailed information on the following Medi-Cal programs:
For information on other eligibility categories, speak with a Benefits Planner or a Medi-Cal eligibility worker.
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Nothing. There are no premiums or deductibles for SSI-Linked Medi-Cal. To maintain eligibility in this program, you must remain eligible to receive the Supplemental Security Income (SSI) benefit.
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Yes, but there are limits to how much income you can have.
Social Security does not consider all of your earnings when they determine your eligibility for SSI (and therefore SSI-Linked Medi-Cal). Instead, they use a countable income calculation. See the program description or glossary entry for more information.
If you lose your SSI because of a return to work, you may be able to keep your Medi-Cal through Social Security's 1619(b) Provisions.
If you are working, Medi-Cal’s 250% California Working Disabled (250% CWD) Program may be a way to access Medi-Cal while earning income.
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You may also have access to other Medi-Cal programs, including:
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You will be covered for drugs that are on Medi-Cal's approved list of prescription drugs.
If you have both Medi-Cal and Medicare, the list of drugs that are covered depends on which plan you are enrolled in under Medicare Part D.
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You can apply for SSI-Linked Medi-Cal by applying for the Supplemental Security Income (SSI) program. If you are found eligible, you will automatically qualify for Medi-Cal. To apply for SSI, contact Social Security to schedule an appointment by phone or at a local office. Find your local Social Security Administration office by using the online Social Security Office Locator or calling (voice) 800-772-1213 (TTY) 800-325-0778. |
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The processing of your SSI claim should take between 3-6 months if all required documentation is provided. If your claim is denied by Social Security and appeals are filed, the SSI claim process could take longer.
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Yes. Your enrollment in private health coverage will not jeopardize your participation in SSI-Linked Medi-Cal. Obtaining private health coverage may allow you to access providers or services you may not have had available to you on Medi-Cal alone. If you have private health coverage and are eligible for Medi-Cal, you may qualify for the Medi-Cal/HIPP program, which can pay for your insurance premiums.
When using private health coverage and Medi-Cal simultaneously, the private health coverage is billed first. After the private health carrier pays or denies a claim, Medi-Cal is then billed and will pay for services that it covers.
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As long as you continue to meet the disability and financial requirements of the SSI program, you will continue to be eligible for SSI-Linked Medi-Cal. This program verifies assets, income and earnings annually.
If you get a job or your circumstances change, you may want to consider accessing Medi-Cal through another eligibility category (see FAQ 6). Also, Social Security's 1619(b) provisions may allow you to keep your Medi-Cal when you lose your SSI because of returning to work.
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Yes. If your spouse is not eligible for SSI, then Medi-Cal uses deeming rules to determine if you are eligible for the program. If both you and your spouse are eligible for SSI, then there is no deeming. Contact your local Medi-Cal office for more information about how deeming rules work and how they can affect your eligibility for this program.
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