PURPOSE

SSI-linked Medi-Cal is a Medi-Cal eligibility category (program) for California residents under age 65 who meet disability and financial eligibility requirements. Californians who qualify for Supplemental Security Income (SSI) are automatically enrolled in this eligibility category, though their Medi-Cal coverage may continue once their earnings rise above SSI eligibility levels. This is one of the multiple ways an individual may be eligible for Medi-Cal health coverage programs.

MEDICAL ELIGIBILITY

An individual under the age of 65 must meet Social Security’s medical rules for disability through the Supplemental Security Income (SSI) program.

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: Determining your SSI-Linked Medi-Cal Eligibility

When figuring out if you are eligible for SSI-Linked Medi-Cal, SSI's countable income calculation is used. Deductions are made from your gross income to find out how much of your income is counted ("total countable income").

To determine if you are eligible for SSI-Linked Medi-Cal, compare your total countable income to the SSI benefit applicable to you. You will be eligible if your total countable income is under the 2006 SSI monthly benefit rate of $836 for an individual ($1,472 for a couple).

COST

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

To continue to qualify for this category of Medi-Cal an individual must be eligible to receive an SSI payment. Individuals who cease to receive SSI payments due to earnings may be able to continue Medi-Cal coverage under another eligibility category, such as Social Security's 1619(b).

RESIDENCY REQUIREMENT

An individual must be a legal United States and California resident. The Supplemental Security Income (SSI) program provides an explanation of the rules on the Social Security Admninistration's website.

Another source of information for immigrants and Social Security can be found on the People's Guide.

BENEFIT

This eligibility category of Medi-Cal 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 Services (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) provides an explanation of many of the services covered by full-Scope Medi-Cal (Medicaid) on its 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. The other health coverage must be used before Medi-Cal coverage is available to supplement that coverage.

APPLICATION

To access this eligibility category of Medi-Cal, an individual needs to apply for Supplemental Security Income (SSI).

Processing the SSI claim should take between 1 to 6 months if all required documentation is provided. If a claim is denied by Social Security and appeals are filed, the SSI claim process may take longer.

Social Security should be contacted to schedule an appointment either by telephone or at a local office. At this time, the Supplemental Security Income application is not available online. The online application is only available for Social Security Disability Insurance benefits.

Information regarding local Social Security offices can be found using SSA's online office locator or by calling 800-772-1213 (voice) or 800-325-0778 (TTY).

RETROACTIVE PAYMENTS

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

1619(b) PROVISIONS FROM SOCIAL SECURITY

If an individual has earnings that reduce a monthly SSI cash benefit to zero, he or she may be eligible to continue Medi-Cal at no cost if he or she:

• Received Supplemental Security Income in the past twelve months
• Continues to meet medical disability requirements
• Continues to meet non-disability requirements
• Needs Medicaid health coverage to continue to work and
• Has income (wages) that is below the 1619(b) threshold amount of $32,499 annually (as of 2006 in California).

Note: for SSI beneficiaries who are blind, the 1619(b) threshold amount is $34,035 annually for 2006.

Each state's threshold amount is determined by Social Security to measure whether or not a person’s earnings are high enough to replace SSI and Medi-Cal (Medicaid) benefits. This threshold is based on:

• The average Medicaid expenses in that state and
• The amount of earnings which cause SSI cash payments to stop for that individual in that state.

An individual with earnings higher than the threshold amount can apply for an individual threshold amount through Social Security if their situation includes any of the following circumstances:

• Medical expenses above the average state amount
• A personal attendant whose fees are publicly funded
• Impairment-related work expenses
• Blind work expenses or
• A Plan for Achieving Self Support (PASS).

The Social Security Administration provides additional information about Social Security’s 1619(b) provision.

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, helps qualified individuals pay private health insurance premiums.

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

1. Aged and Disabled Federal Poverty Level Medi-Cal is medical coverage for which an individual qualifies at no cost if his or her Total Countable Income (minus certain other deductions) is not more than $1,047 for an individual or $1,472 for a couple during the year 2006.

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 who also 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.

5. 250% California Working Disabled (CWD) program allows disabled workers to buy into Medi-Cal health coverage by paying a monthly premium.