Karla Bell and Rachel Stewart
California Health Incentives Improvement
Getting Started
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Who can be eligible for In-Home Supportive
 Any California resident, living in his/her own home, who is
already eligible for Medi-Cal can be eligible for IHSS
 The four eligibility categories people with disabilities most
often use to get on Medi-Cal are:
 SSI-linked Medi-Cal
 Aged and Disabled Federal Poverty Level Medi-Cal
 Medi-Cal Working Disabled Program
 Aged, Blind, and Disabled Medically Needy Medi-Cal
 See DB101 Medi-Cal Program description for more
information on these programs: www.db101.org
IHSS Services
 In-Home Supportive Services (IHSS):
services to help individuals remain safely in
their home, including:
 Housecleaning
 Meal preparation
 Laundry
 Personal care services (bowel/bladder care,
bathing, grooming, dressing, etc.)
 Accompaniment to medical appointments
 Protective supervision
Myth: If I go back to work I’ll lose my
Medi-Cal and IHSS
 Medi-Cal While Working--Section
 Medi-Cal Working Disabled Program
Supplemental Security Income (SSI)
Work Incentives
 Section 1619(b):
 SSI work incentive that allows working SSI recipients
keep free Medi-Cal
 Free Medi-Cal coverage continues until earnings reach a
threshold amount:
 $35,023 (non-blind)
 $35,716 (blind)
 These are 2011 amounts for California
 People with high medical costs or publicly funded
attendants (i.e. IHSS) can earn even more
(“Individualized Threshold”)
 Benefits can start again if you stop working or your
earnings decrease (Reinstatement)
To qualify:
 Have been eligible for an SSI cash payment for at least 1
 Would be eligible for cash payment except for earnings;
 Still be disabled or blind;
 Still meet all other eligibility rules, including the resources
test (SSI resource limit: $2000 individual/$3000 couple);
 Need Medi-Cal in order to work;
 Have gross earned income that is insufficient to replace
SSI, Medi-Cal, and any publicly funded attendant care.
 Individualized Threshold: threshold can be adjusted on a case-by-
case basis
 Higher Individualized Threshold if:
 Blind Work Expenses (BWE)
 Impairment Related Work Expenses (IRWE)
 Plan to Achieve Self-Support (PASS Plan)
 Publicly Funded Personal Attendant (i.e. In-Home Supportive Services)
 Medical Expenses above State Average
 Social Security’s Programs Operation Manual reference:
 SI 02302.050 Individualized Threshold Calculation
 https://secure.ssa.gov/apps10/poms.nsf/lnx/0502302050
 Area Work Incentives Coordinators
 http://www.ssa.gov/sf/awic.htm
Medi-Cal Working Disabled Program
 The 250% Medi-Cal Working Disabled Program
allows individuals to earn up to $55,476/year and
keep their Medi-Cal!
 Eligible couples can earn up to $74,580/year
 Even higher wages are allowed with IRWEs
 Affordable monthly premiums to access Medi-Cal
and IHSS without a share-of-cost
 $20-$250 for individuals
 $30-$375 for couples
Medi-Cal Working Disabled Program
 Disability-based income is exempt when determining
eligibility for program and maximum earnings
 i.e. SSDI, Workers Comp, State Disability
Insurance, private disability insurance
 Allowed to have IRS-approved retirement accounts –
these do not count towards the typical $2000 (or
$3000 for couples) asset limit for Medi-Cal
 i.e. Individual Retirement Accounts (IRAs), 401(K),
403(B), Profit Sharing, Individual (K), Solo DB, Safe
Harbor 401(K), ROTH IRA, 457, ROTH 403(B), KEOGH
Plans, TSA Tax Sheltered Annuities, Stretch IRA, Thrift
Savings Plan (TSP)
Medi-Cal Working Disabled Program
 If also on Medicare – are fully “dually-
 Medi-Cal pays Medicare Part B premium
 Medi-Cal’s co-pay and premium payment
programs for Qualified Medicare Beneficiaries
 Access IHSS services (not covered by
Medicare or private insurance)
 Automatically qualify for Medicare Part D Low
Income Subsidy (LIS)
Medi-Cal Working Disabled Program
 To qualify:
 Meet Social Security’s definition of disability
(medical definition only, does not count the
ability to earn income)
 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 a business, or be
self employed or an independent contractor
 Work is undefined
 No set amount of hours required
 No minimum earnings criteria
Medi-Cal Working Disabled Program –
 Assembly Bill 1269 was signed into law by
Governor Schwarzenegger on 10/11/09
 This Bill improves the Medi-Cal 250% Working
Disabled Program
 Allows additional income and resource exemptions
 Extends work stoppage protection to 26 weeks
 Changes current premium calculation
 As of August 1, 2011 the less restrictive changes will
be implemented
 Department of Health Care Services will send a notice
to all current Working Disabled Program enrollees
 ACWDL will also be issued to the Counties
Medi-Cal Working Disabled Program Improvements
As of August 1, 2011 – the following “less
restrictive” changes will be implemented:
 Eliminates retirement age restriction by
exempting retirement income that converts from
Social Security Disability Insurance (SSDI)
 All exempt IRS-approved retirement accounts
allowed under the 250% Working Disabled
Program will continue to be exempt when
transferring to other Medi-Cal Programs
Less Restrictive Changes, cont.
 Allows Earnings to be saved in separately identifiable
account with no cap
 These earnings cannot be combined with other resources
 Account must be separate from your regular savings and
checking accounts
 Earned income that is in your separate identifiable account will
not be counted as a resource for the WDP Program
 Allows enrollees who are temporarily unemployed to
remain in the program for up to 26 weeks during their
work transition
 Enrollees are required to pay their monthly premium during time
of unemployment
Future Changes
In 2019 (after MOE provisions to ACA expire), the
more restrictive changes will be implemented
 Premium calculation will be changed to 5% of
countable income
 Minimum and maximum premium amounts will
remain the same:
 $20-$250 for individuals
 $30-$375 for couples
 Disability-based income and retirement income
will also be included in the 5% premium
Myth: I’ll lose my
Medi-Cal and IHSS
Myth: In-Home Supportive Services hours
can only be used while at home
In-“HOME” Supportive Services
 Old Thinking
 People with disabilities are not able to work
 Therefore, they are only allowed to use their
IHSS hours in the home (or for occasional trips
to the doctor)
 New Thinking
 Work opportunities are expanding for people
with disabilities
 IHSS hours can now be used at work as well
as home
IHSS at Work
IHSS in the Workplace – AB 925 (effective 2003):
Allows the transfer of previously authorized IHSS
hours to use in the workplace
Important: No new hours or new services
 Limited to services currently authorized for use in
the home
 Cannot receive additional hours for employment
 Services (or hours) transferred are to enable the
recipient to “obtain, maintain, or return to, work”
 Services must be “relevant and necessary in
supporting and maintaining employment”
IHSS at Work
 Services needed to “obtain, retain, or return to,
 Obtain: traveling to job interviews, pre-employment
testing, and personal care during these activities
(does not include college or vocational courses)
 Retain/return to work: includes personal care on the
 Must be “relevant and necessary”:
 Paramedical services
 Personal care
 Related Services, as defined in WIC 12300
Workplace Personal Assistance Services
Two types of Workplace Personal Assistance
1.Personal care-related assistance
 Assistance in the restroom, on lunch breaks
 Can use IHSS hours
2.Job-related assistance
 Interpreting, lifting or reaching work materials, travel
assistance between work sites
 Cannot use IHSS hours (employer may have a
responsibility under the ADA to provide reasonable
accommodations for job-related tasks)
Using IHSS in the Workplace
 Before you start using IHSS hours in the
workplace, you must contact your social worker
to discuss the transfer of hours (how many, for
what services, etc.)
 Refer IHSS Social Worker to Dept of Social Services
All County Letter (ACL) # 04-43
 Currently, we have no knowledge of how many
people are taking advantage of the IHSS at work
option (Dept. of Social Services does not track
this in their system)
Myth: In-Home
Supportive Services
hours can only be
used while I am at
Question and Answer
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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/RZX7VYZ
Certified Rehabilitation Counseling (CRC) Credits are
available for this webinar:
 To receive CRC credits please complete this short quiz
and survey:
 http://interwork.sdsu.edu/chiip/webinar/archive/crc_credit
 We will also follow up with an email with links to the CRC
quiz, survey and archive of the webinar so you can listen
to it again
Contact information
 Karla Bell:
 [email protected]
 Rachel Stewart:
 [email protected]

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