DPSS ePolicy

• To convert existing policy to the new webpage – No content changes
• To revise existing policy and form(s)
   

What changed?

1. The MC 0384, Ways to Pay Your Premium For The 250 Percent Working Disabled Program, has been revised.
   
   
2. The Electronic Funds Transfer Payment Options For 250 Percent Working Disabled Premium Payments flyer, identified as 250% EFT-LA, has been modified to capture the name of the new Governor.
   
   
3. Release of a new informational notice, 250 Percent Working Disabled Program Advantages and Program Considerations Advantages to 250 Percent Working Disabled Program.
   
   
4. Clarification regarding work requirements for the 250% Working Disabled Program (WDP).
   
   
5. Clarification on treatment of exempt income.
   
   
6. Clarification regarding the 26-week temporary unemployment period.
   
   
7. Clarification regarding retroactive benefits.
   
   
8. Reminder that the State’s Third-Party Liability & Recovery Division processes refunds for the 250% WDP. 
    

The 250% WDP establishes Medi-Cal eligibility for qualified working disabled individuals, whose net non-exempt earned income is below 250% of the Federal Poverty Level (FPL) and whose unearned income and resources meet Supplemental Security Income and State Supplementary Payment Program (SSI/SSP) requirements.

To be eligible for the 250% WDP, an individual must:

1. Meet the federal definition of disability for Social Security disability programs;
   
   
2. Be eligible to receive SSI/SSP benefits, if earnings were disregarded; 
   
   
3. Be employed;
   
   • There are no minimum hours to work or minimum income to earn.
     
     
4. Be a citizen or Legal Permanent Resident (LPR); 
   
   
5. Be within the Medi-Cal property limits;
   
   
6. Have net family income less than 250% of the FPL; and
   
   
7. Pay the monthly premium payment.

Note:  Although Substantial Gainful Activity (SGA) is still a consideration when evaluating for regular disability-based Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal, it is not a factor in determining whether disability exists for the 250% WDP. 

Income Exemptions

The disability income listed below is considered exempt under the 250% WDP:

1. Federal, State and private disability income.  Some examples of exempt disability income include, but are not limited to:
   • Social Security Disability;
   • State Disability Insurance;
   • Workers’ Compensation;
   • Disabled Widow(er) and Adult Child benefits; and
   • California State Teachers’ Retirement System (CalSTRS).
     
     
2. Social Security disability income that converts to Social Security Retirement.
   • Only Social Security disability income that converts to Social Security Retirement income continues to be exempt when the individual reaches retirement age.
   • Disability income from other sources (public or private) that converts to retirement income when the beneficiary reaches retirement age is no longer exempt and must be considered unearned income when evaluating for the 250% WDP.  
     
     
3. Retained earned income held in a separate identifiable bank account is exempt (See Definitions). 
   • Retained earned income is exempt as countable property and will continue to be exempt if it is held in a separate identifiable account, and it is not commingled with any existing checking or savings account. 
   • There is no maximum limitation on the amount that can be kept in the separate identifiable account. 
   • Proof of the exempt retained earned income and the separation from other personal checking, savings, or other resources is required.
   • Interest generated by these accounts cannot remain in the account.  The interest is considered unearned income and counted in the 250% WDP eligibility determination.
     
     

Property Exemptions

The following resources are exempt from the 250% WDP:

1. Authorized retirement resources under the Internal Revenue Code, such as:
   • Individual Retirement Accounts (IRAs);
   • Keogh Plans;
   • Deferred Compensation; and
   • Thrift Plans.

Continuation of Exempt Resources

Retirement accounts exempt under the 250% WDP (401K, Keogh Plan, etc.) continue to be exempt when the beneficiary transfers from the 250% WDP to an Aged, Blind, Disabled Medically Needy Program (ABD-MN).

Temporary Unemployment

Beneficiaries can continue to be aided under the 250% WDP during periods of temporary unemployment up to 26-weeks during each annual eligibility period.  Premium payments must continue to be paid during this period.

The timeline for determining the unemployment period begins with the date the 250% WDP beneficiary states his/her unemployment began.

Retroactive (Retro) Benefits

The 250% WDP allows three months of retro eligibility.  The applicable premium must be paid for each month for which retro coverage is approved.

To promote self-sufficiency and encourage the disabled to seek employment opportunities without fear of losing essential health care benefits, the Federal Balanced Budget Act of 1997 established a new category known as the Working Disabled.  This new category allows states to provide Medicaid (Medi-Cal) coverage to certain working disabled individuals.

California enacted this legislation effective April 1, 2000.  It requires a monthly premium for eligible persons based on a sliding scale.  Individuals eligible to the 250% WDP would receive zero Share-of-Cost (SOC) Medi-Cal but pay a monthly premium.  Premium payments range from a minimum of $20.00 per month to a maximum of $250.00 per month for single individuals and from $30.00 per month to $375.00 per month for eligible couples.  The California Department of Health Care Services (DHCS) is responsible for the collection of premiums.

To be eligible for the 250% WDP, the individual must:

1. Meet the federal definition of disability;
   
   • Determined by SSA or State Disability Determination Service Division-State Programs (DDSD-SP);
      
2. Be eligible to receive SSI/SSP benefits, if earnings were disregarded;
   
   
3. Be employed (verification required);
   
   
4. Be a citizen or LPR;
   
   • Qualified immigrants set forth by SSI include:
     
     • Aliens granted asylum under Section 208 of the Immigration and Nationality Act (INA).
       
     • Refugees admitted to the United States under Section 207 of the INA.
       
     • Aliens paroled into the United States under INA Section 212(d)(5) for at least one year.
       
     • An alien whose deportation is being withheld under Section 243(h) of the INA.
       
     • An alien granted conditional entry under Section 203(a)(7) of the INA.
       
     • An alien who is Cuban and Haitian Entrant as defined in Section 501 of the Refugee Education Assistance Act of 1980.
       
     • Battered aliens who meet the requirements of the qualified alien status.
       
       
5. Be within Medi-Cal property limits;
   
   
6. Have net family income less than 250% of the FPL;
   
   
7. Pay the monthly premium payment.

1. Proof of employment includes, but not limited to:
   
   • Paystubs, receipt or written verification from employer.
     
     
2. Proof of disability:
   
   • Disability only exists if the individual is found to be disabled under SSA or DDSD-SP.
     
     • Verification of disability from SSA or DDSD-SP.

N/A