 | | | 250% California Working Disabled Medi-Cal: Frequently Asked Questions | | | | | | | | |
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1) What is the Medi-Cal 250% California Working Disabled Program (250% CWD)? |
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The 250% CWD program provides full scope Medi-Cal to disabled individuals who work and have income that is too high to qualify for other Medi-Cal categories. For this program, you can have up to 250% of the Federal Poverty Level in countable income and still receive Medi-Cal benefits. Enrollees pay a monthly, sliding-scale premium for this health coverage. The 250% CWD Medi-Cal program became effective April 1, 2000. |
2) What is the Federal Poverty Level? |
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During the mid-1960s Social Security began publishing articles with national poverty statistics. Thresholds were developed by taking the cost of a minimum adequate diet for families of different sizes and multiplying the cost by three to allow for other expenses. Poor families were those whose yearly income was below the threshold for a given family size.
The current Federal Poverty Level is determined by the Federal Department of Health and Human Services (HHS). These guidelines provide a method for many government programs to determine financial eligibility. Each year, HHS issues the Federal Poverty Guidelines in the Federal Register.
This Medi-Cal program only considers the Federal Poverty Levels for an individual and married couples when determining eligibility and premium costs. Through 3/31/2009, the FPL for individuals is $10,400 per year ($14,000 for a couple).
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3) How do I calculate the monthly amount of 250% of the Federal Poverty Level (FPL)? |
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First, take the annual poverty level for your family size ($10,400 for an individual, $14,000 for a family of two or more) and divide this number by 12 to give you the monthly FPL.
Next, multiply the FPL monthly income by 2.5 and round that number up.
This number will be 250% of the FPL per month. The monthly FPL for individuals is $2,167 and $2,917 for a couple, through 3/31/2009.
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4) Is all of my income taken into account when determining 250% of the federal poverty level for this Medi-Cal program? |
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No. This program uses Social Security's countable income calculation to determine your income. Additionally, the 250% CWD Program does not count unearned income from private or public disability benefits (such as SDI, SSI, SSDI, STD, LTD ) when determining your countable income. Important: Medi-Cal’s deeming rules apply when a worker has combined household income, for example income from a spouse. |
5) Is 250% California Working Disabled (250% CWD) Medi-Cal referred to in other ways? |
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Yes. Nationally, this program is referred to as the Medicaid Buy-In program. This eligibility category is currently unavailable in many states. States that do provide this program determine how it is administered. |
6) Are there other ways to qualify for Medi-Cal? |
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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 250% CWD 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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7) Who is eligible for 250% California Working Disabled (250% CWD) Medi-Cal? |
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You may be eligible for 250% California Working Disabled (250% CWD) Medi-Cal if you meet all the following criteria:
- You meet Medi-Cal’s definition of disability. Your earnings due to work are not considered when determining whether a disability exists or persists.
- Your total countable income can not exceed 250% of the Federal Poverty Level (see FAQ 3);
- You meet assets requirements for Medi-Cal. This Medi-Cal program exempts all Internal Revenue Service (IRS) approved retirement accounts, such as employer sponsored 401k, 403b accounts, or individual retirement accounts (IRAs) authorized in the IRS codes; and
- Your countable unearned income is less than the appropriate SSI/SSP benefit rate. Again, disability income doesn't count.
- You are working.
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8) How much does 250% California Working Disabled (250% CWD) Medi-Cal cost? |
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Through 3/31/2009, the 250% California Working Disabled Premium Table shows the range of monthly premiums from $20 to $250 for an eligible individual or from $30 to $375 for an eligible couple. Your monthly premiums are based on monthly Total Countable Income. Premiums may increase or decrease according to changes in your countable income. The Third Party Liability Branch of Medi-Cal bills you for the premium on the 23rd of each month. |
9) Does what I have in the bank or what I own, such as a home or car, affect my eligibility for 250% California Working Disabled (250% CWD) Medi-Cal? |
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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:
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checking and savings accounts;
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the value of stocks, bonds, and trust deeds;
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additional cars or recreational vehicles; and
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promissory notes and loans that are payable to you.
Note: This category of Medi-Cal also exempts (does not consider) resources related to employer sponsored retirement (401k, 403b) plans and individual retirement accounts (IRAs) authorized under the IRS codes.
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10) What type of health coverage does the 250% California Working Disabled (250% CWD) Medi-Cal provide and how long will coverage last? |
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The 250% California Working Disabled (250% CWD) program provides full scope Medi-Cal. If you are eligible for this program, you may also be able to access other Medi-Cal programs, such as: |
11) What prescription drug coverage comes with 250% California Working Disabled (250% CWD) Medi-Cal? |
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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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12) What are the medical eligibility requirements for 250% California Working Disabled (250% CWD) Medi-Cal? |
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You must meet the medical aspects of Social Security's definition of disability. Unlike the Social Security definition, however, this Medi-Cal program does not consider your work activity as a part of the medical definition of disability. |
13) Are there rules for immigrants to qualify for 250% California Working Disabled (250% CWD) Medi-Cal? |
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14) What does the 250% California Working Disabled (250% CWD) Medi-Cal consider work? |
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Work is not specifically defined by the 250% California Working Disabled Medi-Cal (250% CWD) program. A disabled worker on the 250% CWD Program must provide proof of current employment. Proof of employment includes pay stubs or written verification of employment from your employer.
If you are self-employed, you will have to provide records such as recent IRS tax returns to demonstrate employment. Also, for the independent contractor, verification may be provided with a 1099 IRS form as proof of employment.
Also, you are still considered to be working under the 250% CWD Medi-Cal if you are receiving vacation or sick leave pay from your employer.
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15) How do I apply for 250% California Working Disabled (250% CWD) Medi-Cal? |
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To apply for 250% California Working Disabled (250% CWD) Program, it is recommended that you request an appointment with your local county coordinator who is authorized to work in the 250% CWD Program. The Department of Health Care Services has a webpage listing local Medi-Cal offices. Medi-Cal provides applications in eleven languages. You can download an application online, but you must submit your application in person or by U.S. mail.
If you are currently enrolled in another eligibility category of Medi-Cal, talk to your Medi-Cal eligibility worker and ask to be transferred to this program.
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16) How soon after applying will I be eligible for benefits from 250% California Working Disabled (250% CWD) Medi-Cal? |
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On average, processing of an application takes between 30 to 90 days. The eligibility worker may enroll you in the program without conducting a medical determination of disability. For example, Social Security Disability Insurance (SSDI) beneficiaries have already met the disability rules for this program and do not need a medical determination.
After being approved for the program, you will be mailed a monthly premium invoice 90 days after application and thereafter on the 23rd of each month. If you are enrolled in this program, prior to receiving the premium notices, you will be responsible to pay premiums starting at the time of initial enrollment.
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17) What is the difference between Supplemental Security Income (SSI) 1619(b) provisions and 250% California Working Disabled (250% CWD) Medi-Cal? |
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Although both programs provide full scope Medi-Cal, there are several differences between SSI 1619 (b) provisions and 250% CWD Medi-Cal. SSI 1619(b) provisions allow you to keep Medi-Cal at no cost, but limits your income to the state's threshold amount and has special rules for retirement funds, which sometimes are exceptions and require approval from Social Security. 250% CWD Medi-Cal, on the other hand, requires that you pay a monthly premium based on your total countable income and does not have any limitations on retirement funds. In order to qualify for SSI, Social Security has determined that you are unable to work for at least twelve months. 250% CWD does not have this rule and thus allows you to work with a disability.
1619(b) Provisions and 250% CWD Benefits Compared
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Medi-Cal Program
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1619 (b) provisions
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250% CWD
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Cost
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None.
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Premium based on total countable income that cannot exceed 250% of the Federal Poverty Level.
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Retirement Funds
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Allowable based upon exception and approval.
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Allowable.
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Initial Eligibility Rules
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Unable to work for initial 12 months of receiving SSI due to a disability. Generally, earnings cannot exceed state's threshold amount.
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Able to work initial 12 months with a disability.
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As your circumstances change, it is important to review which Medi-Cal eligibility category may be most cost effective for you.
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18) Can I qualify for 250% California Working Disabled (250% CWD) Medi-Cal while I am eligible for private health coverage? |
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Yes. Your enrollment in private health coverage will not jeopardize your participation in 250% California Working Disabled 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 Medi-Cal/HIPP, 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 it covers.
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19) How do I stay enrolled/eligible in 250% California Working Disabled (250% CWD) Medi-Cal? How often do I need to reapply? |
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Your eligibility for the program is reviewed annually. This process involves verifying your current assets and income. Please remember that you are responsible to report any changes in assets or income as they occur.
It is very important to continue paying premiums when due. If your premium payments have not been received for two consecutive months, you will be sent a notice of action informing you of termination from the 250% California Working Disabled program. The Notice of Action will also inform you that you will be re-determined for eligibility under other Medi-Cal programs.
If you are discontinued from 250% CWD Medi-Cal for failure to pay the premium payments for two consecutive months, you will have a 6-month penalty period. If you wish to reenroll into the program during the 6-month penalty period, you must pay the current and past due premiums. However, if you wish to enroll after the 6-month penalty period, you will be considered a new applicant and must prepay the premium for the first month of your new eligibility.
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20) Can I be eligible for 250% California Working Disabled (250% CWD) Medi-Cal if I am married? |
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Yes. If you are married and both you and your spouse are eligible for the 250% CWD, then 250% of the Federal Poverty Level for two persons is used. If your spouse is not eligible for 250% CWD, then Medi-Cal uses deeming rules to determine if you are eligible for the program. Contact your local county Medi-Cal office for more information about how deeming rules work and how they can affect your eligibility for this program. |
21) What happens if I stop working? |
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If you stop working, you are no longer eligible for Medi-Cal’s 250% California Working Disabled Program (250% CWD). Coverage ends on the first day of the following month in which you have stopped working, unless you can demonstrate good cause.
A good cause includes such reasons as hospitalization, an inability to work that is directly related to the disability, a work-site closure, or a loss of current transportation with no other alternative means of transportation. If a good cause exists and you continue to meet all other eligibility requirements, the county continues your eligibility in the 250% California Working Disabled program for the next two months following the month in which you stopped working.
Note: When you are no longer eligible for this program, California state law SB 87 requires that Medi-Cal find out whether you are eligible for other Medi-Cal programs and services.
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