250% Medi-Cal Working Disabled Program: New Changes Afloat Presented by: Karla Bell Program Manager, California Health Incentives Improvement Project San Diego State University Interwork Institute

Overview 250% Medi-Cal Working Disabled Program Unique Features Eligibility Income and Premiums Benefits Enrollment Future Changes and Implementation of AB 1269 Resources DB 101 Demonstration Here is an overview of today’s webinar. I will go into detail about the 250% Medi-Cal Working Disabled Program. I’ll be covering a little about the unique features, and eligibility for the program. I will also explain income, premiums and how they are determined, benefits of this program, enrollment, future changes and a DB 101 demonstration.

California Health Incentives Improvement Project (CHIIP) Funded by a Medicaid Infrastructure Grant (MIG) from the federal Centers for Medicare and Medicaid Services (CMS) Overall goal: increase employment of people with disabilities Importance of maintaining Medi-Cal/Medicaid coverage when encouraging people with disabilities to become employed Medicaid Buy-In Programs The California Health Incentives Improvement Project-CHIIP, is funded by a Medicaid Infrastructure Grant from the federal Centers for Medicare and Medicaid Services. Our Goal is to increase the employment rate of people with disabilities by making sure necessary supports are in place, such as access to health care and the ability to use personal assistance services at work. Including California, Forty-Three states currently have a Medicaid Infrastructure Grant, or MIG for short. Many states have used MIG funding to establish or improve Medicaid Buy In programs. Medicaid Buy-Ins provide affordable access to Medicaid for working people with disabilities, by having participants “buy into” the Medicaid program, typically by paying premiums based on income. Today I will be giving you an overview of California’s Medicaid Buy-In, the 250% Medi-Cal Working Disabled Program. Please note that the information I will be giving you is unique to California’s buy-in. While many other states (42) also have Medicaid Buy-In programs, they are all very different. (States given the option to set resource and income limits and exclusions)

250% Medi-Cal Working Disabled Program The 250% Medi-Cal Working Disabled program is California’s Medicaid Buy-In program Work incentive program allowing people with disabilities the opportunity to work, earn up to $55,476/year, and pay a monthly premium to keep their Medi-Cal Medi-Cal ≠ Poverty California legislation implemented the 250% Working Disabled Program in April 2000 As of May 2011, 5,752 individuals are enrolled statewide The 250% Medi-Cal Working Disabled program is California’s Medicaid Buy-In program. California’s name for Medicaid is Medi-Cal. The Working Disabled Program helps to address the healthcare barrier so Californians with a disability do not have to choose between taking a job and keeping healthcare, or let the fear of loss of healthcare stop them from working. The Working Disabled Program is a work incentive that allows people with disabilities the opportunity to work and earn up to $55,476/year and pay a monthly premium to keep their Medi-Cal. This Program is for ANYONE with a disability who is WORKING. This program provides choice and opportunity to Californians with disabilities who would otherwise be ineligible for no share of cost, full scope Medi-Cal coverage due to earned income and work activity. Many people think of Medi-Cal as a poverty level program, but with the Working Disabled Program, Medi-Cal does not equal poverty. You can earn a lot, build assets and keep Medi-Cal. The program was implemented in April of 2000. As of May 2011, 5,752 individuals were enrolled statewide, it is still a small program so CHIIP is spreading the word about the benefits of the program by doing outreach and webinars.

250% Medi-Cal Working Disabled Program Unique Features: Individuals can earn up to $55,476 gross per year and still qualify for full scope, no share of cost Medi-Cal A working couple can earn up to $74,580 gross per year Higher gross wages possible when there are Impairment Related Work Expenses (IRWEs) Affordable monthly premiums: $20 - $250 (Single Person) $30 - $375 (Couples) Some unique features of this program include: Individuals can earn up to $55,476 gross per year or $74,580 for a couple and still qualify for Medi-Cal. Yes, you can earn up to $55,476 and still keep your Medi-Cal. Higher gross wages are possible when there are IRWEs-those are things you pay for out of pocket related to disability and needed for work. To receive full scope Medi-Cal you pay an affordable monthly premium that is between $20 and $250 for an individual and $30 and 375 for a couple.

250% Medi-Cal Working Disabled Program Unique Features: Any IRS approved retirement products, are allowed and not counted towards the typical $2000 (or $3000) asset/resource limits for Medi-Cal Exempt retirement accounts include: Individual Retirement Accounts (IRAs), SEP IRA, 401(K), 403(B), Profit Sharing, Individual (K), Solo DB, Safe Harbor 401(K), Social Security Integration (Profit Sharing Plan), Age Weighted (Profit Sharing Plan), ROTH IRA, 457, ROTH 403(B), KEOGH Plans, TSA Tax Sheltered Annuities, Stretch IRA, Thrift Savings Plan (TSP), Federal Employee Retirement System (FERS), Civil Service Retirement System (CSRS), New Comparability (Profit Sharing Plan) Another unique feature is that all IRS approved retirement products are allowed and not counted toward the $2000 or $3000 asset limit. For your information, here is a list of examples of exempt IRS approved retirement accounts. Some examples include IRAs, 401K, and 403B.

250% Medi-Cal Working Disabled Program Unique Features: Disability income not included in countable income when determining eligibility and premium amount Social Security Disability Insurance (SSDI), State Disability Insurance (SDI), Workers Compensation, Childhood Disability Benefits (CDB), federal, state and private disability insurance, Veterans’ disability benefits, etc. Another unique feature is that ALL disability income is exempt. So it is not included as countable income when determining eligibility and premium amount. I will be showing an example of the calculation that is used to determine countable income in a little bit. Examples of disability income include SSDI, SDI, Workers Compensation, CDB, private disability insurance, and Veterans benefits. While disability income is not counted to determine eligibility for this program, keep in mind that earned income may impact these cash benefits, therefore it is important to check into work incentive programs and work rules available through Social Security and other agencies. And I will be showing you an online resource for that later today.

250% Medi-Cal Working Disabled Program - Eligibility To qualify for the WD program, individuals must: Be a United States resident and living in California Meet Social Security’s definition of disability (medical definition only, does not count the ability to earn income) See ACWDL 02-34 for disability determinations for 250% program Let’s talk about eligibility for this program. You must be a United States resident and living in California. You must meet Social Security’s definition of disability, but the medical definition ONLY, it does not count the part that considers the ability to earn income. The medical definition of disability is a medically determinable physical or mental impairment that has lasted or is expected to last for a continuous period of not less than 12 months or expected to result in death. You do not have to currently receive a Social security disability benefit in order to qualify. This program is for anyone with a disability. All County Welfare Directors Letter 02-34 talks about how to do disability determinations for people not already on a disability programs or SSDI. All County Welfare Directors Letters are letters written and released by the state informing counties of policies and procedures.

250% Medi-Cal Working Disabled Program - Eligibility To qualify, individuals must: Be employed full-time or part-time, including self employment, with countable earnings below 250% of the Federal Poverty Level An applicant may be employed by another person, business, corporation An applicant may be self employed or be an independent contractor Work is undefined No set amount of hours required No minimum earnings criteria To qualify individuals must be working and this can be full or part time and it includes self-employment. Also their countable income must be below 250% of the Federal Poverty Level and I will have these amounts in a later slide. The applicant must be employed by another person, business or corporation or they may be self-employed or be an independent contractor. Now work is undefined, so there are no set amount of hours required and there is no minimum earnings criteria

250% Medi-Cal Working Disabled Program - Eligibility Individuals can find the work that fits with their level of disability Earnings can also be in-kind: To document have person who provides meals, room or board write up an informal agreement describing: The working arrangement and estimation for cost of meals, room or board Describe the work being performed Have both parties sign & date agreement Individuals can find the work that fits with their level of disability. So work activity can be as simple as pet sitting, driving, domestic support services, research, light clerical work, seasonal work or even collecting cans. Or it can be full time employment working as a social worker, attorney, teacher or barista at Starbucks!

Proof of Employment Pay Stubs Written verification of employment from an employer/business If self-employed: A contract may be used W-2’s can be used or: If an applicant is an independent contractor, the 1099 IRS form can be used Also, you are still considered to be working under the Medi-Cal Working Disabled Program if you are receiving vacation or sick leave pay from your employer.

250% Medi-Cal Working Disabled Program - Eligibility 3 Eligibility Tests: Assets Unearned Income Earned Income There are three eligibility tests used to determine if the person is eligible to enroll: The asset test, the unearned income test and the earned income test.

250% Medi-Cal Working Disabled Program - Eligibility Asset Test Assets must be less than: $2000 for an individual $3000 for a couple Assets, like the home you live in and one car, are not counted for this program All IRS approved retirement accounts are exempt To qualify your assets cannot exceed $2000 for an individual or $3000 for a couple. The home you live in and one car is exempt. Other exemptions include: items necessary for self employment such as inventory or bank account and things you use on the job such as tools or a second car. Assets can include checking and savings accounts, the value of stocks, bonds, & trust deeds, additional cars, recreational vehicles, promissory notes and loans that are payable to you. Remember all IRS approved retirement accounts are exempt.

250% Medi-Cal Working Disabled Program - Eligibility Unearned Income Test Unearned Income must be less than current SSI/SSP amount Disability income is excluded (SSDI, CDB, disability pension, SDI, etc.) $20 general income exclusion is applied to any unearned income Examples of unearned income: retirement, survivor’s Social Security, net income from property, Unemployment Insurance, CalWORKs Unearned Income must be less than the current Supplemental Security Income/State Supplement Payment amount. The SSI/SSP amount will vary based on the person’s living situation. For example, some of the current 2011 SSI/SSP Amounts are $845 for an Individual living in their own household and $1407 for a Couple living in their own household. All Disability income is excluded. A $20 general income exclusion is applied to any unearned income. Retirement income is countable unearned income. Although there is not an age limit for the Working Disabled Program, currently if a person is on SSDI and they convert to retirement at full retirement age, their retirement income will become countable unearned income. This has created a barrier for those who make that conversion and are unable to enroll in the WDP or continue because their unearned income is now too high. Later I will talk about how Assembly Bill 1269 will change this in the future.

250% Medi-Cal Working Disabled Program - Eligibility Earned Income Test Countable income must be below 250% of the Federal Poverty Level 2011 Countable income limits = 250% FPL For individuals: $2269/month For eligible couples: $3065/month 2011 Gross earned income limits For individuals: approx. $4623/month For eligible couples: approx $6215/month The third test is the Earned Income Test. For this test, your countable income must be below 250% of the Federal Poverty Level. The 2011 Countable Earned Income Limits are: $2269/month for an individual and $3065/month for a couple. A calculation is used to determine if your income is below 250%. Let’s also look at the 2011 Gross earned income limits: For an individual you can earn approximately $4623/month and qualify for this program. For eligible couples you can earn approximately $6215/month. For Couples to both qualify as eligible, they would both be disabled and working, and both of their incomes & resources will be considered. The couples income limits, asset amount and premium amount would be used. If one of the couple is ineligible, their income and resources will be considered and a deeming calculation will be applied. If the ineligible spouse’s income is over a certain amount, it will be countable-If deeming of spousal income applies to the individual their net countable income must be less than 250% of the federal poverty level for two persons. So How do they determine if a person's countable income is below 250%? Let’s take a look:

250% Medi-Cal Working Disabled Program - Income How Countable Income is determined: Net countable income = SSI Methodology (unearned income* - $20) + (earned income - $65 ÷ 2) *All disability income exempt Impairment Related Work Expenses (IRWE) can also be used as deductions Out of pocket expenses related to one’s disability and needed to work Examples: medications, medical equipment, attendant care services Countable income is calculated using the same calculation steps used to determine Supplemental Security Income payments. This calculation is used to determine your countable income for eligibility and premium amount for the WDP. The calculation steps are unearned income -$20 + earned income -$65 divide by 2. If you don’t have any Unearned Income the $20 income exclusion will be applied to your earned income. Remember that all disability income is exempt. IRWEs can also be used as deductions. These are out of pocket expenses that are related to one’s disability and needed to work. If a person has any IRWEs they will need to show proof that they paid for it such as a receipt. Some examples include: all costs related to a service dog (e.g.: food, training, grooming, vet bills, licenses), medical supplies, cost of medications, dialysis equipment, modifications to your home or vehicle (e.g. handbrake or electric lift), attendant care services, assistive technology (e.g.: special keyboards, typing aids, software, vision and sensory aids) that is needed to do your job and the cost of any training to use such equipment

Example - Mary Mary $1,500/month in gross earned income $900/month in SSDI (exempt) $100/month in Impairment-Related Work Expenses (IRWEs) Mary’s Countable Income: $1,500 (earned income) - 20 (general income exclusion) - 65 (earned income exclusion) -100 (IRWE) $1,315 ÷ 2 = $657.50 (countable income) Is Mary’s countable income less than 250% of the Federal Poverty Level? YES! FPL is $2269-Her income is low enough to qualify. So let’s take a look at an example of the calculation. Mary is starting a part time job as an administrative assistant. She currently receives $900/month in SSDI. The new job will pay her $1500/month. She is not eligible for any employer sponsored health insurance so she is very concerned about keeping her Medicare and would like to have Medi-Cal also. She also pays $100/mo in IRWEs. So here are the steps used to determine her countable income. If you remember, $2269 is 250% of the FPL. At $657, Mary’s countable income is definitely less than 250% of the FPL. So her countable income is low enough to qualify. Now let’s find out what her monthly premium will be.

250% Medi-Cal Working Disabled Program – Premium Chart Countable Earned Income From: Countable Earned Income To: Premium for Eligible Individual Premium for Eligible Couple $1 $600 $20 $30 $601 $700 $25 $40 $701 $900 $50 $75 $901 $1100 $100 $1101 $1300 $150 $1301 $1500 $125 $200 $1501 $1700 $225 $1701 $1900 $175 $275 $1901 $2100 $300 $2101 $2257 $250 $375 $2258 $3036 N/A If her countable income is $657.50 it is between $601 and $700 on the premium chart, so her monthly premium will be $25.00.

Example - Mary Before the Working Disabled Program, if Mary was offered the same job earning $1,500/month, she probably would not have taken it because her Share of Cost would have been $950 per month With the Working Disabled Program, Mary can take that job and get Medi-Cal for only $25/month A lot of people are stuck in Medi-Cal’s Medically Needy Share of Cost program. In this program they cannot use Medi-Cal until they meet their monthly share of cost, which means most people in Share of Cost never get to use their Medi-Cal. Before the Working Disabled program, if Mary was offered the same job earning $1,500 a month, she probably would not have taken the job because her share of cost would have been $950/month, which means she would have to spend $950 on her health care each month before Medi-Cal would even start. With the Working Disabled Program, Mary can take that job and she has immediate access to full scope Medi-Cal by paying a small $25/month premium. With the WDP she does not have a SOC, that leaves her with more money to spend on what she wants and she can even save for her future with a retirement account. Just a tip: since Mary also receives SSDI she will definitely want to get some benefits counseling to find out how this new job will also affect her SSDI and Medicare. A great website for her to start to learn about the SSDI work incentives is Disability Benefits 101, which I will be showing you very soon.

Example - Personal Assistance Services Nelson is a wheelchair user looking for options to continue his personal assistance services He is working at a local newspaper as an editor earning $4160/month and he has employer-sponsored insurance He used to have a trust from his parents, but he has used all the money in the trust to pay for the $1500/month cost of personal assistance services He would like to enroll in Medi-Cal and In-Home Supportive Services (IHSS) but he thinks the only way he can qualify is to quit his job

Example - Personal Assistance Services Nelson did a Google search and found Medi-Cal Working Disabled Program information on www.DB101.org He learned that he can use Medi-Cal for wraparound coverage with his Employer Sponsored Insurance and access IHSS for the personal assistance services he needs He applied for Medi-Cal at his County office, a disability determination was done and he was found eligible He was able to keep his job, pay a $200/month premium for Medi-Cal and he now has IHSS

250% Medi-Cal Working Disabled Program - Benefits The ability to work and maintain affordable health coverage through Medi-Cal No large shares of cost (Medi-Cal or IHSS) Liberal definition of employment Disability-related income/Worker’s Compensation is exempt in determining eligibility and premium However, earning income may impact cash benefits The WDP really is a very affordable choice for health coverage, private plans cost hundreds to thousands of dollars more and out of pocket costs for personal assistance services are very high. There are NO LARGE SHARES OF COST for Medi-Cal or IHSS-this is especially important since the IHSS Buy Out was eliminated recently and folks on IHSS SOC have a higher SOC now. This program has a very liberal definition of employment, so individuals can work at whatever level fits their disability. As I mentioned before, disability related income is exempt in determining eligibility and premium. But please note that earning income may impact other benefits a person receives, so I recommend going to Disability Benefits 101 to learn more about the rules, work incentives and resources available and also check out our archived Webinars on the SSI/SSDI Work incentives on TKNL.info.

250% Medi-Cal Working Disabled Program - Benefits Can build retirement accounts Maintain In-Home Supportive Services at home and in the workplace Medi-Cal’s Health Insurance Premium Payment program (Medi-Cal/HIPP) For more information on HIPP: www.disabilitybenefits101.org Build retirement accounts, maintain IHSS at home and in the workplace If you are enrolled in the Medi-Cal Working Disabled Program and have private health insurance, such as employer sponsored insurance, Medi-Cal may pay your private health insurance premiums through its Health Insurance Premium Payment (Medi-Cal/HIPP) program. To qualify, you must have a high-cost medical condition and have Medi-Cal determine that it is more cost-effective to pay your premiums than for you to use Medi-Cal. For more details on the HIPP program and how to apply, go to disability benefits 101.org.

250% Medi-Cal Working Disabled Program - Benefits If also on Medicare – are fully “dually-eligible”: Medi-Cal pays Medicare Part B premium Medi-Cal’s co-pay and premium payment programs for Qualified Medicare Beneficiaries (QMB) Access IHSS services (not covered by Medicare or private insurance) Automatically qualify for Medicare Part D Low Income Subsidy (LIS) There are so many benefits for a person who is dually enrolled in Medicare and the WDP. Medi-Cal will pay for the Medicare Part B premium which puts about $100 back in a person’s pocket each month. As of April 1, 2011, Medi-Cal is no longer paying the Medicare Part B premium for beneficiaries with Share of Cost (SOC) Medi-Cal, unless they meet their SOC in a given month or they are enrolled in a Medicare Savings Program. If this affects you or one of your clients, an option to consider is to enroll in the WDP and then the State will pay the Part B premium. Dual eligibles can also qualify for the QMB or Qualified Medicare Beneficiaries program. And a person can access IHSS to get personal assistance services that are not covered by Medicare or private insurance. If a person enrolls in the working Disabled Program they will also automatically qualify for the Medicare Part D Low Income Subsidy, which will cover the premium and deductibles of benchmark Part D prescription plans. The prescription co-pays will also be less at $1.10-$6.30. Please note that Medi-Cal does not cover the cost of Part D co-pays, but will cover the co-pays for prescriptions for private insurance.

Eliminating the Healthcare Barrier - Who should consider enrolling in the Working Disabled Program? Anyone with a disability who is working and wants to obtain or maintain Medi-Cal (and IHSS) Individuals enrolled in Medi-Cal and IHSS with a Share of Cost Individuals receiving Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) Most working Supplementary Security Income (SSI) beneficiaries get Medi-Cal through 1619, unless they want higher income or ability to build assets Get the message out: HEALTHCARE IS NOT A BARRIER The Working Disabled Program and other Medicaid Buy-In programs were created to eliminate the healthcare barrier for people with disabilities who want to take a job or find a better paying job. So who should consider enrolling in the Working Disabled Program? Those that should consider enrolling include-anyone with a disability who is working and wants to obtain or maintain Medi-Cal and In Home Supportive Services. Individuals who are enrolled in Medi-Cal and IHSS with a share of cost who become employed at a level that fits their disability can eliminate their share of cost once they enroll in the 250% Working Disabled Program. Did you know that over 80% of those that are enrolled in the Working Disabled Program are Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) beneficiaries? SSDI and CDB beneficiaries use the Working Disabled Program to maintain or obtain Medi-Cal at a low cost when they would otherwise “income out” of the program. We have mentioned many benefits of enrollment to those on SSDI and CDB including being able to work and keep Medi-Cal without a share of cost and decrease the costs associated with Medicare. Now, most working Supplementary Security Income (SSI) beneficiaries get Medi-Cal through 1619 A and B work incentives, unless they want higher income or ability to build assets. If this is the case they have the option of enrolling in the Working Disabled Program. As you can see the Working Disabled program is a great option for Californians with disabilities who want to work, increase earnings, build assets and keep healthcare coverage, so get the message out there that healthcare is not a barrier!

How to Enroll If you are already receiving Medi-Cal: Contact your Medi-Cal Eligibility Worker and ask them to enroll you. If you have a Share of Cost ask to be determined eligible. If you do not know who your Eligibility Worker is, contact your local Medi-Cal County office If you’re not currently receiving Medi-Cal: Apply for Medi-Cal at your local Medi-Cal county office. If you report earnings, you should be automatically enrolled. http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx Let’s talk about how to enroll in the Working Disabled Program. The Working Disabled Program is a County administered program, therefore to enroll a person needs to work with their local Medi-Cal County Office. If you are already receiving Medi-Cal, contact your Medi-Cal Eligibility worker and ask them to enroll you. If you have a Share of Cost ask to be determined eligible. If you do not know who your Eligibility Worker is, contact your local Medi-Cal County office. If you’re not currently receiving Medi-Cal you will need to apply for Medi-Cal at your local Medi-Cal county office. If you report earnings, you should be automatically enrolled. (Retroactive months: individual may be eligible for three months of retroactive Medi-Cal Benefits if otherwise eligible and if applicable premium is paid for each month for which retroactive coverage is requested.)

How to Enroll Mention that the program is “Aid Code 6G” County Coordinator may be contacted if Eligibility Worker or Supervisor are unfamiliar with the program http://www.chiip.org/wdp_county_coordinators.html Medi-Cal Application is available online, or from your County office http://www.dhcs.ca.gov/services/medi-cal/pages/medicalapplications.aspx Write on top of your application form: Applying for the 250% Working Disabled Program-Aid Code 6G Here are some other tips for enrollment: When you talk to a Medi-Cal Eligibility Worker about enrolling in the program, it will help to mention the program is “Aid Code 6G”. If the Medi-Cal Eligibility Worker if unfamiliar with the program, ask to speak to a supervisor. The Medi-Cal Working Disabled Program County Coordinator may be contacted if the Eligibility Worker or Supervisor are both unfamiliar with the program, you can direct them to the County Coordinator and you can find the County Coordinators listed on the chiip.org website that I have included here. County coordinators act as policy liaisons and address complaints from individuals or their representatives that are encountering difficulties such as a lack of knowledge of the Working Disabled Program at the local office level or an incorrect eligibility determination-so problems trying to get on the Working Disabled Program The Medi-Cal Application is available online, or from your County office, and the link to the online application appears here. I also recommend that the applicant write the following on top of your application form: Applying for the 250% Working Disabled Program-Aid Code 6G.

How to Enroll Completed application should be submitted with: Latest SSA award letter confirming medical disability determination is still active Copies of two most recent payroll checks or stubs (or letter from employer) Copies of two most recent bank statements Application processing takes between 30-90 days After being approved, you will be mailed a monthly premium notice If you do not pay your premium payments for 2 consecutive months, you will be sent a notice of action informing you of termination The completed application should be submitted with: Latest SSA award letter confirming medical disability determination is still active Copies of two most recent payroll checks or stubs (or letter from employer) or proof of self employment such as a contract, or tax returns Copies of two most recent bank statements Application processing takes between 30-90 days. After being approved for the program, you will be mailed a monthly premium invoice. If you do not pay your premium payments for 2 consecutive months, you will be sent a notice of action informing you of termination

250% Medi-Cal Working Disabled Program Future Changes: AB 1269 Assembly Bill 1269 was signed into law by Governor Schwarzenegger on 10/11/09 (Chapter 282, Statues of 2009) This Bill improves the Medi-Cal 250% Working Disabled Program Allows additional income and resource exemptions Extends unemployment period to 26 weeks Changes current premium calculation Now I would like to tell you about some changes and improvements to the Working Disabled Program that will be coming this summer. In October 2009, Governor Schwarzenegger signed Assembly Bill 1269 into law. The policy changes in this bill will improve the Medi-Cal Working Disabled Program by allowing additional income and resource exemptions, and extend the unemployment period to 26 weeks. It will also change the current premium calculation.

250% Medi-Cal Working Disabled Program Future Changes: AB 1269 Eliminates retirement age restriction by exempting retirement income that converts from Social Security Disability Insurance (SSDI) income All exempt IRS-approved retirement accounts allowed under the 250% Working Disabled Program will continue to be exempt under other Medi-Cal Programs Allows Earnings to be saved in separately identifiable account with no cap These earnings cannot be combined with other resources AB 1269 policy changes improve the Working Disabled Program in the following ways: It eliminates the retirement age restriction by exempting retirement income that converts from Social Security Disability Insurance (SSDI). So for individuals previously on SSDI who reach full retirement age, their Social Security retirement income will be exempt for ELIGIBILITY, but not premium. Another change is that all exempt IRS approved retirement accounts allowed under the Working Disabled Program will continue to be exempt under other Medi-Cal programs under which the beneficiary later becomes eligible for medical assistance where that eligibility is based on age, blindness, or disability. So if the person changes to another Medi-Cal program based on age, blindness or disability their retirement account will continue to be exempt. Also, the changes allow earnings to be saved in a separately identifiable account with no cap, so a person who is enrolled in the program will be able to save earnings over the $2000 or $3000 asset limit. These earnings cannot be combined with any other resources. Also, the a person will still have to meet the $2000/3000 asset limit to initially enroll in the program, but once enrolled they will be able to save earnings with no cap.

250% Medi-Cal Working Disabled Program Future Changes: AB 1269 Allows individuals to remain in the program for 26 weeks if they become unemployed Premium payments required during this time of unemployment Change in premium calculation. Premium based on 5 percent of countable income (including disability income) Another improvement to the Working Disabled Program is a grace period of 26 weeks if employment ends. If a person on the program becomes unemployed, they can elect to remain on Working Disabled Program for a period up to 26 weeks as long as premiums are still paid during this time of unemployment. There will also be a change in premium calculation for the Working Disabled Program. The premium will be based on 5 percent of a person’s individual or spousal countable income. Premiums will keep the same minimum and maximum range of $20-$250 for individuals and $30-$375 for couples. But this change means that a person's disability income will be considered countable income for premium determination, therefore enrollees will see a small increase in their premium amount.

AB 1269: Scheduled Implementation Less restrictive provisions under PPACA will be implemented once ARRA funding runs out. Less restrictive provisions are: Eliminating age restriction by exempting retirement income Exempt retained earned income held in a separate identifiable account Allow individuals to remain in program for 26 weeks if they are unemployed All retirement accounts allowed under the 250% WDP will continue to be exempt under any other Medi-Cal program that is subject to federal Social Security Act based on age, blindness or disability Not all of these provisions will go into affect this summer. Provisions that are considered “LESS RESTRICTIVE” under the Patient Protection and Affordable Care Act will be implemented once the federal American Recovery and Reinvestment Act (ARRA) funding is no longer available. Less restrictive provisions that will be implemented include: The elimination of age restriction by exempting retirement income for SSDI beneficiaries that convert to retirement The exemption of retained earned income held in a separate identifiable account Allowing individuals to remain in the program for 26 weeks if they are unemployed AND All exempt IRS approved retirement accounts allowed under the Working Disabled Program will continue to be exempt under other Medi-Cal programs where that eligibility is based on age, blindness, or disability if a person switches to another Medi-Cal Program.

AB 1269: Scheduled Implementation Restrictive provisions under PPACA will not be implemented until after 2014. The restrictive provisions are: Change in calculation of premium payments under AB 1269

Draft AB 1269 Timeline ARRA funding ends tentatively by June 30, 2011 Implementation All County Welfare Directors Letter (ACWDL) issued July 1, 2011 ACWDL will include tips for Eligibility Workers and other County Staff on how to explain changes Implementation begins by August 1, 2011 CHIIP will also work with Department of Health Care Services to develop and distribute informing notices to all Working Disabled beneficiaries regarding AB 1269 to go out by August 1, 2011 So let’s take a look at the timeline and find out when these new changes will be implemented. Even though AB 1269 was signed into law in 2009, the state was not able to implement the changes until the ARRA fund they were receiving can to an end. Department of Health Care Services will collaborate with counties, advocates and stakeholders on implementation of AB 1269 provisions such as working to define AB 1269 provisions, develop beneficiary notices, to discuss needed training and outreach and to identify an issues that may delay implementation of AB 1269 provisions. Disability Benefits 101 will also have up to date information on the implementation and new changes and CHIIP will continue to provide webinars on the topic before and after implementation.

Resources For more information: Disability Benefits 101 http://www.disabilitybenefits101.org See Medi-Cal Eligibility Procedures Manual, section 5R http://www.dhcs.ca.gov All County Welfare Directors Letters (ACWDLs) Go to Forms, Letters & Publications

Resources List of 250% WDP County Coordinators http://www.chiip.org/wdp_county_coordinators.html Find your local County Office http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx Medi-Cal Application http://www.dhcs.ca.gov/services/medi-cal/pages/medicalapplications.aspx

Resources Talent Knows No Limits http://www.talentknowsnolimits.info/ Work Incentives Planning and Assistance Projects Benefits counselors for SSI/SSDI beneficiaries https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate Area Work Incentives Coordinators (AWIC) http://www.ssa.gov/sf/awic.htm

Resources Local Independent Living Centers One-on-one benefits counselors http://www.cfilc.org Health Insurance Counseling and Advocacy Program (HICAP) Free Medicare Counseling 1-800-434-0222 http://www.cahealthadvocates.org/HICAP/

Resources Health Consumer Alliance Local health consumer centers for help getting health care http://healthconsumer.org/ Disability Rights California Advocacy and legal work http://www.disabilityrightsca.org/ 800-776-5746 (Toll free) 800-719-5798 (TTY)

Resources: 250% Medi-Cal Working Disabled Program - ACWDLs 00-16 – Introductory letter and procedures 00-51 – Frequently asked questions 01-26 – 250% WDP forms and notices 01-46 – 250% WDP update 01-65 – 250% WDP and IHSS 02-34 – Disability Determination for the WDP 05-07 – 250% WDP envelope request information 06-27 – 2006 CHIIP outreach and training activities 08-47 – 2008 Elimination of sunset date 09-29 – 250% WDP and Managed Care 09-33 – Eligibility and beneficiary discussions on 250% WDP

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Survey and CRC Credits Please give us feedback on today’s webinar by completing our survey: http://www.surveymonkey.com/s/ZLY9R75 Certified Rehabilitation Counselor (CRC) credits are available for this webinar: To receive CRC credits you will need to complete a survey and a short quiz: http://interwork.sdsu.edu/chiip/webinar/archive/crc_credits/110505/webinar.html We will also follow up with an email will include links to the CRC quiz, survey, and the archive of this webinar so you can listen to it again

Thank you for joining us today! For more information or questions: Karla Bell, CHIIP/SDSU Interwork Institute 619-594-5381 kbell@interwork.sdsu.edu Archived Webinars:http://www.talentknowsnolimits.info/w ebinar.html To order brochures or promotional materials, contact Nicholas Moore at 916-654-8194, Nicholas.Moore@edd.ca.gov Medi-Cal Working Disabled Program Brochure I Can Work Brochure