Medi-Cal and Earned Income

Introduction

For disabled people, fear of losing health insurance if they work often prevents them from entering the job market. Medi-Cal is public health insurance for the low income and disabled. Medi-Cal can cover doctor’s visits, hospitalizations and prescription drugs. Working may affect Medi-Cal eligibility, depending on how you get your Medi-Cal and how much you earn.

Medi-Cal, SSI and 1619-B

Medi-Cal is automatic if you receive Supplemental Security Income (SSI). There is no monthly share of cost (much like a monthly deductible) with SSI-based Medi-Cal. There are also some protections in place if you work while receiving SSI-based Medi-Cal. If you earn income, your SSI will be reduced, but as long as you get even one dollar a month from SSI, you retain no share of cost Medi-Cal. If you earn enough money to lose all your SSI dollars, Social Security should switch your SSI-based Medi-Cal to federal 1619-B Medi-Cal. This program allows you to keep no share of cost Medi-Cal until your annual income from wages, in California, goes above $34,346. Individuals are only eligible for 1619-B if the sole cause for SSI payment cessation is increased earnings due to work. Further eligibility requirements are: must have disabling condition; need Medi-Cal in order to work; unable to afford benefits equivalent to those received if not working; meet all other requirements for SSI payments other than earnings.

If you have 1619-B Medi-Cal and your income from wages exceeds $34,346, you may be able to negotiate a higher threshold of income with the state and retain your health insurance. The state’s decision would be based on a complicated formula based on your annual medical costs.

Medi-Cal, SSDI and Share of Cost

If you receive Social Security Disability Insurance (SSDI), working could affect your health insurance. Medi-Cal raised its monthly share of cost (SOC) threshold in 2009 for the “Blind, Aged and Disabled” to $1097 for singles; $1474 for a couple. If, for instance, you get $720 from SSDI, you should no longer have a SOC. If you work, and your countable income goes over the $1097 level, you could still keep your Medi-Cal, but at a very high share of cost.

To figure Medi-Cal countable income, you must use SSI’s formula: gross monthly wages, minus $65, divide in half, add to your SSDI. In other words, if you got $720 from SSDI, and had part-time wages at $465, your countable income is $720 plus $200, or $920. You would have no share of cost. But, if your income from benefits and countable wages goes above $1026, then your share of cost becomes the difference between countable income (benefits, nearly half of wages) and $620. In that case, you may need to apply to Medi-Cal’s new Buy In program outlined below. If you have SSDI and Medi-Cal and currently have a share of cost, or plan to return to work, see a benefits counselor.

Medi-Cal (Buy-In) Working Disabled Program

New legislation in California allows disabled people who work to buy into Medi-Cal with a sliding scale of premiums. The legislation directly affects people who collect Social Security Disability Insurance (SSDI) and have Medi-Cal separate from their benefits. In order to qualify for this new buy in, you must meet Social Security’s standard of disability, even if you are not collecting SSI or SSDI benefits. You must also meet Medi-Cal’s “assets” limitations -- under $2,000 in investments, savings accounts, etc., for a single individual, $3,000 for a married couple. You can own one house and one car. Other assets, like household goods, are rarely taken into consideration.

Individuals may qualify for the Buy-In if their income from work is as high as $45,924 or more. Payments to and assets in retirement accounts (IRA’s, 401K’s, etc.) are deductible. The Medi-Cal Buy-In premiums range from $20 to $250 per month.

Avoiding Medi-Cal When You Work

The easiest way to avoid Medi-Cal if you return to work is to find a job with good health insurance benefits. Otherwise, you will have to find another way to work and side-step Medi-Cal and increases in share of cost. California’s AIDS Drug Assistance Program (ADAP) provides HIV medications regardless of insurance status. If you are covered by Medi-Cal, return to work, and incur an increased share of cost, ADAP will absorb the share of cost for you. ADAP is available to people with incomes under $50,000. It is free or charges on a sliding scale depending on income. If you have Medicare through SSDI, some California Health Maintenance Organizations (HMOs) may give you full hospital, doctor and prescription drug coverage regardless of your income.

Summary

Medi-Cal often appears to be an obstacle to returning to work, especially for people with HIV on SSDI. New legislation changes that situation substantially. People on SSI can return to work and retain their no share of cost Medi-Cal until their earnings reach $34,346. There are also other ways to keep Medi-Cal from interfering with returning to work. Consult a benefits counselor if you are confused by Medi-Cal’s return to work rules.