Danh mục Medi-Cal

Medi-Cal Categories

https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm

Income-based Medi-Cal

Medi-Cal is a major government-funded health program that helps people with low income.

The simplest way to qualify is if you:

• Don’t qualify for Medicare, and
• Are a a U.S. citizen or a qualifying immigrant

And you are in one of these situations:

• You are 19-64 years old and your family’s income is at or below 138% of the Federal Poverty Level (FPL) ($20,120 for an individual; $41,400 for a family of four).
• You are a child 18 or younger and your family’s income is at or below 266% of FPL ($79,800 per year for a family of four).
• You are pregnant, and your family’s income is above 138% of FPL, but at or below 213% of FPL ($42,004 if you are single and pregnant with your first child, $63,900 per year for a family of four; the unborn baby is counted as a member of the pregnant woman’s family). This is called Medi-Cal for Pregnant Women and it covers pregnancy-related services, including prenatal care, labor, delivery, postpartum care, and family planning services. It may also cover services for any other medical condition that is medically necessary for the woman.

Income-based Medi-Cal counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medi-Cal eligibility.

If you are in these situations, there are is no limit to how much money or other resources you have and it does not matter whether or not you have a disability.

Health Coverage Income Limits for Your Family

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Medi-Cal for People with Disabilities

People with disabilities have more ways they can qualify for Medi-Cal if they don’t meet the standard eligibility rules described above. For example, if you have a disability, you may qualify for Medi-Cal even if you have higher income or are on Medicare. The main additional ways to qualify are:

• Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL)
• SSI-linked Medi-Cal and SSI 1619(b)-linked Medi-Cal
• Medi-Cal’s Working Disabled Program, and
• Aged, Blind, & Disabled Medically Needy Medi-Cal (ABD–MN)

These ways to qualify are explained here.

Medi-Cal/MSP asset limit changes

Big changes for disability-based Medi-Cal categories with asset limits:

• On July 1, 2022, Medi-Cal asset limits increased to $130,000 for individuals, $195,000 for couples
• On January 1, 2024, these asset limits will be removed completely.

This applies to Medi-Cal through A&D FPL, the Working Disabled Program, and ABD–MN, as well as Medicare Savings Programs (MSPs). If you’ve been denied Medi-Cal or an MSP because you had too much in assets, try applying again.

Note: This doesn’t change SSI-linked Medi-Cal or Medi-Cal through SSI 1619(b), as they still have SSI’s $2,000 asset limit. And it doesn’t change income-based Medi-Cal, which doesn’t have an asset limit.

Get more info from Justice in Aging.

Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL).

If you are aged or disabled, and are not eligible for SSI, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. You must:

• Be either aged (65+), or disabled (meet Social Security’s definition of disability, even if your disability is blindness)
• Have less than $130,000 in assets ($195,000 for a couple). Like SSI, this program does not count all of your assets. Click here for a list of exemptions.
  
  
  • Note: If your disability began before you turned 26, you can open an ABLE account and save up money without having it counted by Medi-Cal. Learn more about ABLE accounts.
• Have less than $1,563 in countable monthly income for an individual ($2,106 for a couple).

If you are single and live on your own, follow these steps to figure out if your countable income makes you eligible for A&D FPL Medi-Cal. If you live with others, you should use DB101’s Benefits and Work Estimator.

1. Find your total countable income using Social Security’s rules.

Your Countable Income:

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Note: If you are blind, subtract any money you use for Blind Work Expenses (BWEs) from this amount.

2. Take the number of people in your household who are not applying for the A&D FPL program, and use it to figure out your Maintenance Needs Level. Maintenance Needs Levels are listed in the table below. Subtract this amount from your total countable income:

Family Maintenance Need Level (MNL)
Family Size	MNL
1	$600
2	$750
2 adults	$934
3	$934
4	$1,100
5	$1,259
6	$1,417
7	$1,550
8	$1,692
9	$1,825
10	$1,959

3. Subtract any health insurance premiums that you pay. These include Medicare, health, vision, and dental insurance premiums.
4. If you are living in a board and care facility, subtract $315.

The number you get is the amount of monthly income that is counted for the A & D FPL program. If it is less than $1,563 for individuals or $2,106 for a couple, then you qualify for free, full scope Medi-Cal based on A&D FPL rules.

If it is higher than $1,563 for individuals, you may qualify for Medi-Cal’s Working Disabled Program or ABD-MN Medi-Cal instead.

Aged, Blind, & Disabled Medically Needy Medi-Cal (ABD–MN)

If you cannot qualify for free Medi-Cal or Medi-Cal’s Working Disabled Program (described below), you may be able to get Medi-Cal through the Aged, Blind, & Disabled – Medically Needy (ABD–MN) program. However, you would to pay a share of cost. A share of cost is a certain amount of money you must spend on medical care each month before Medi-Cal begins to pay for services.

A share of cost can be expensive

Your ABD-MN Medi-Cal share of cost could be very high. In most cases, it would be cheaper for you to get Medi-Cal’s Working Disabled Program or even for you to get an individual plan with government subsidies on Covered California. Medi-Cal’s Working Disabled Program is described below and you can read more about individual plans in DB101’s Buying Health Coverage on Covered California article.

If you are single, you can figure out your share of cost by following the first step for calculating A&D FPL eligibility. After Step 1, take your countable income and subtract the MNL for your family size including yourself and also subtract any health, dental, or vision insurance premiums you pay each month. The resulting figure is your share of cost each month. If you get a number that is 0 or less, then you have no share of cost. You only have to pay a share of cost in months when you have medical expenses.

There are good factsheets translated into a several languages about how your share of cost works.

Example

You live alone and have $1,663 per month in countable income and have no other insurance. Your countable income is too high for free Medi-Cal and you don’t work, so you can’t get Medi-Cal’s Working Disabled Program. You qualify for ABD-MN Medi-Cal.

Your share of cost is $1,663 (your countable income) – $600 (the Maintenance Needs Level for an individual living alone) = $1,063. You will have to pay the first $1,063 in medical expenses during the month before Medi-Cal will start covering you.

SSI-Linked Medi-Cal

If you get Supplemental Security Income (SSI), a benefit for people with low income who are aged, blind, or disabled, you get Medi-Cal automatically. You don’t have to fill out any additional paperwork. Read DB101’s SSI article for more information about whether you qualify for SSI.

Staying on Medi-Cal through SSI 1619(b) if Your SSI Benefits End

If your SSI benefits go to zero because you go back to work, an SSI rule called 1619(b) lets you to keep your Medi-Cal coverage if you:

• Were eligible for SSI benefits for at least 1 month
• Need Medi-Cal coverage to keep working
• Still meet all the other SSI requirements, such as being disabled and having resources below $2,000, and
• Make less than $56,758 in gross income per year.
  • Note: If your earnings are over this limit and you have high medical expenses, you might still qualify for 1619(b). Ask your local Social Security office about the 1619(b) Individualized Earnings Threshold.

For additional information, read the DB101 SSI article, check out Social Security’s webpage on 1619(b), or talk to a benefits planner.

Note: If you don’t qualify for Medi-Cal through 1619(b) because your income is too high, you may qualify for Medi-Cal’s Working Disabled Program.

Example

Joe had been getting SSI for several years when his health improved and he decided to go back to work. After he started working, his income increased to $2,800 per month ($33,600 annually) causing his monthly SSI benefit to drop to zero.

Even though his income is now higher than the usual income limits for Medi-Cal, he is still eligible for Medi-Cal through 1619(b) because his annual income is less than $56,758.

After working for a year, Joe got a raise and went over the 1619(b) limit, so he switched to Medi-Cal’s Working Disabled Program so he could keeping getting his Medi-Cal coverage.

Medi-Cal’s Working Disabled Program

If you are working, disabled, and your income is too high to qualify for free Medi-Cal, Medi-Cal’s Working Disabled Program may allow you to get Medi-Cal. Note: Medi-Cal’s Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.

To qualify, you must

1. Meet the medical requirements of Social Security’s definition of disability. You don’t have to meet the income and work requirements.
2. Be working and earning income. The Medi-Cal regulations do not define what “working” means for this program, and you can qualify if you are working part time. You can use pay-stubs or other written verification from an employer to prove that you’re working.
   • Note: You can remain enrolled in the program if you become unemployed for up to 26 weeks.
3. Have assets worth less than $130,000 for an individual ($195,000 for a couple). The same asset exclusions apply for this program as for A&D FPL Medi-Cal except for a couple of major differences:
   • Retirement funds like a 401(k) or Individual Retirement Account (IRA) are not counted as assets for this program.
   • If you are enrolled in the program, you can save earnings in a separate bank account and this money will not count against the program’s resource limit. There is no limit to how much of your earnings you can save this way and still remain eligible for Medi-Cal.
     • Note: If you ever need to qualify for a different Medi-Cal program that has a resource limit, the earnings you saved in this account while on WDP will not be counted as resources.
     • Note: If your disability began before you turned 26, you can open an ABLE account and save up money without having it counted by Medi-Cal. Learn more about ABLE accounts.
4. Have countable income less than 250% of the Federal Poverty Level ($2,831 per month for individuals and $3,815 for couples).
   • Keep in mind that these are countable income limits, which is your gross income minus certain deductions. Your gross income can be much higher than your countable income. For example, an individual with no unearned income can make $68,970 a year in gross income and still be eligible for this program.
   • Disability income does not count for the WDP program. This means that SSDI, Worker’s Compensation, California State Disability Insurance, and any federal, state, or private disability benefits are not considered as income for this program.
     • Note: If you got SSDI before you reached retirement age and now your SSDI benefits have been converted to Social Security retirement benefits, they will not be counted as income either.
5. Have countable unearned income less than the appropriate SSI/SSP benefit rate. Again, disability income doesn’t count.

If you are single and live on your own, you can use the tool below to help figure out your countable income. Remember not to list any money you get from disability benefits as unearned income. Compare the results to the WDP income limit ($2,831 per month for individuals) to see if you’re eligible. If you live with others, you should use DB101’s Benefits and Work Estimator instead, since the calculation requires more information about their income.

Your Countable Income:

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For more information Medi-Cal’s Working Disabled Program, contact your local county social services agency.

Medi-Cal Eligibility Categories Summary
Income-Based
	Must have:	Low to moderate income
	Income Limits:	138% of FPL for adults 19-64 years old. 266% of FPL for children 18 and under.
	How Income is Counted:	All earned and unearned income is counted based on IRS rules for adjusted gross income. No income is disregarded.
	Countable Assets Limits:	No asset limit
	Cost of Benefit:	Free
	Benefit:	Full-scope Medi-Cal
Aged & Disabled Federal Poverty Level
	Must Meet SSI’s definition of:	Age or disability
	Income Limits:	Countable Income less than $1,563 for individual, $2,106 for couples
	How Income is Counted:	SSI’s countable income calculation – MNA for number of household members not applying – health, vision, and dental insurance premiums
	Countable Assets Limits:	Up to $130,000 for Individual, $195,000 for couples
	Cost of Benefit:	Free
	Benefit:	Full-scope Medi-Cal
SSI-Linked
	Must Meet SSI’s definition of:	Age, blindness, or disability
	Income Limits:	Countable income less than the SSI/SSP benefit amount for your living situation
	How Income is Counted:	SSI’s countable income calculation
	Countable Assets Limits:	Up to $2,000 for an individual, $3,000 for couples. Note: These are SSI’s limits. If your assets are too high for SSI, you may still qualify for other Medi-Cal categories.
	Cost of Benefit:	Free
	Benefit:	Full-scope Medi-Cal
Medi-Cal’s Working Disabled Program
	Must Meet SSI’s definition of:	Disability
	Income Limits:	Countable Income less than 250% of the Federal Poverty Level ($2,831 per month for individuals, $3,815 for couples)
	How Income is Counted:	SSI’s countable income calculation, but any disability income is not considered income
	Countable Assets Limits:	Up to $130,000 for Individual, $195,000 for couples; money in retirement accounts is not considered as an asset
	Cost of Benefit:	Free
	Benefit:	Full-scope Medi-Cal
Aged, Blind & Disabled – Medically Needy
	Must Meet SSI’s definition of:	Age, blindness, or disability
	Income Limits:	No income limit, but your countable income determines your share of cost
	How Income is Counted:	SSI’s countable income calculation – MNA for number of people in household, including the applicant – health, vision, and dental insurance premiums
	Countable Assets Limits:	Up to $130,000 for individuals, $195,000 for couples, with an additional $65,000 per additional family member
	Cost of Benefit:	Share of cost
	Benefit:	Full-scope Medi-Cal

It is important to remember that these are just some of the many ways to get Medi-Cal. To learn about other eligibility categories, you can visit a benefits planner or talk to a Medi-Cal eligibility worker at your local county social services agency.