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Medi-CalHelp :: Long Term Care

Medi Cal Help Resources

Medi Cal is a combined federal and California State program designed to help pay for medical care for public assistance recipients and other low-income persons. Medi-Cal is California's version of Glossary Link Medicaid, although Medi-Cal has significant differences from Medicaid. Both Medi-Cal and Medicaid are completely different than Glossary Link Medicare. Although Medi Cal recipients may receive Medicare, the Medi Cal program is not related to the Medicare program. Medi Cal is a need-based program and is funded jointly with state and federal Medicaid funds.

 

 

In Home Supportive Services

Includes the Personal Care Services Program (PCSP), IHSS Residual Program and IHSS Federal Waiver. Since August 1, 2004 when CMS approved California’s IHSS Federal Plus Waiver program, most IHSS recipients are paid under matching state and federal Glossary Link Medicaid dollars under the PCSP program, so Medi–Cal rules (including transfer rules) apply. The IHSS Residual Program – which has different and more restrictive rules – is now limited to a few individuals (at least according to DSS). However, since many IHSS recipients are also on SSI/SSP, transfers that are permissible under the Medi–Cal and IHSS programs could impact negatively SSI/SSP eligibility.

 

Long-term Care Medi Cal

Persons who apply for Medi Cal to pay for long term care would be considered Medically Needy. Individuals with income and Medically Needy QMBs would be obligated to pay a share of cost each month and can retain a Personal Needs Allowance of $35. Persons on SSI would be provided with a monthly income of $50.

 

Medically Needy/Medically Indigent with Share of Cost

This program provides full–scope Medi–Cal to the same individuals as indicated in number 5 above. Individuals in this group must pay or obligate to pay for a certain amount of medical expenses each month before Medi–Cal will pay for the remainder of their Medi–Cal covered expenses. The share of cost is equal to the amount of their income that is in excess of the maintenance need level ($600 for a single person) based upon the family size.

 

NF A/B Waiver & DDS Waiver

These two waivers provide in–home care services to individuals who would otherwise require nursing facility care. These programs also provide Medi Cal with much higher income and resource for spouses and disregards income and resources of parents since the individual participants are considered to be institutionalized. The income and resource limits for spousal situations in 2009 are: $2,739 per month (or more if the well–spouse receives more than the $2,739 in his/her name), plus $600 for the participant; $109,560 in CSRA nonexempt resources, plus $2,000 for the participant.

 

Healthy Families Program

Provides health care coverage through managed care only to children who are ineligible for Medi Cal without a share–of–cost. This program disregards resources but charges a monthly Glossary Link premium.

 

Pregnant Women & Children's Federal Poverty Level (FPL) Programs

These programs permit children to establish eligibility for free Medi–Cal without regard to resources at all.

  • Pregnant Women (pregnancy–related, labor and delivery only) and children under 1 (full–scope Medi Cal) with family incomes up to 200% FPL
  • Children 1 – 6 with family income up to 133% FPL
  • Children 6–19 with family income up to 100% FPL
 

Medically Needy/Medically Indigent without Share Of Cost

This program provides free Medi Cal based upon linkage based upon being aged, blind or disabled or being a deprived child up to 21years of age. Caretaker relatives of deprived children are also eligible. The first $65 plus ½ of the remaining earned income is disregarded in households including an ABD person. The first $33 plus 1/3 of the earned income is disregarded in households including a deprived child person.

 

250% Working Disabled Program

This program permits aged or disabled individuals to purchase Medi–Cal through payment of a monthly Glossary Link premium. Eligibility is limited to individuals with incomes under 250% of federal poverty level and disability income is exempt as well as a second motor vehicle if it has been modified to accommodate a handicapped individual.

 

Aged & Disabled Program

This program provides no share–of–cost (free) Medi–Cal and permits any individual with countable income at or below $1,133 (4/2009) or a couple with income at or below $1,525 (5/2009) to establish eligibility. This program follows the rules of the Medically Needy program.

 

14931(b)

This program provides free Medi Cal. The determination includes a $240 disregard of disability income with any remaining amount of the $240 disregarded from earnings. Then ½ of the earned income is disregarded. This program requires all family members living in the home to be included in the budget unit.

 

PICKLE

Provides free Medi Cal to individuals who became ineligible for SSI due to COLAs for Social Security. Individuals are eligible for PICKLE if they would’ve been eligible for SSI in the past even if they never actually received SSI. Under this program all Social Security COLAs are disregarded from income from the point in time when the individual would have become ineligible for SSI. This program follows the SSI rules including parent/spouse deeming.

 

To apply for the Aged and Disabled Federal Poverty Level Program, go to your County Medi–Cal Office to submit an application. You can download an application online, but a hard copy must be submitted in person or by mail. An eligibility worker at the Medi–Cal office will calculate your income and determine if you are eligible for the program.

It typically takes 30–90 days to process an application. It may be a quicker process for Social Security Disability Insurance (SSDI) beneficiaries because they have already met the disability requirements for the program. Others will have to undergo a medical determination of disability before being enrolled.

 

A&D FPL provides free, full services under Medi–Cal (health care services that are deemed " Glossary Link medically necessary"). Such services include physician visits, adult day health services, some dental care, ambulances, and some home health. Other medical expenses, such as x–ray and laboratory costs, orthopedic devices, eyeglasses, hearing aids, are also covered. Certain drugs are covered that are on Medi–Cal’s approved list. If you have both Medi–Cal and Glossary Link Medicare, Medicare Glossary Link Part D covers most drugs. (For more information on Medicare Part D drug program you can find a fact sheet on CANHR’s website, www.canhr.org).

 

Private Health Care Under A & D FPL

Enrolling in private health coverage would not put you at risk for becoming ineligible for A&D FPL. The cost of premiums may even help to reduce your countable monthly income, bringing you below the income limit allowed. With private health coverage, you would be able to access providers and services that may not have been available to you otherwise. Under these circumstances, the private health coverage is billed first. Medi–Cal pays for the services it covers after the private health Glossary Link carrier pays or denies a Glossary Link claim.

Example: MARTHA IS SINGLE. She receives a pension of $250 per month and $975 from Social Security before premiums are withheld for Glossary Link Medicare. Her total monthly income is $1225. She pays $125 per month for a Medicare Supplemental Health policy.

$1225 (monthly income)
– $20 (deduction from unearned income)
= $1205
- $125 (Medicare Glossary Link premium
= $1080 (Martha’s countable unearned income)

Martha is eligible for Medi–Cal at no share of cost because her countable monthly income is below the $1133 eligibility threshold.

 

Yes. The A&D FPL program is designed to allow the working disabled to keep a portion of their earned income out of the countable monthly income, thus allowing them to maintain eligibility in many cases. When calculating the countable monthly income, Medi–Cal subtracts $65 from the earned income and cuts the remainder in half before adding it to the unearned income, making it easier for the working disabled to stay below the eligibility income threshold.

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