DPSS ePolicy

To convert existing policy to new webpage – No content changes.

Revision of existing policy.

What changed?

Effective May 1, 2022:

1. Aged (65 years of age or older), disabled, and blind individuals who do not have Satisfactory Immigration Status (SIS) or are unable to establish SIS are now eligible for full scope Medi-Cal benefits under the Aged, Blind and Disabled Federal Poverty Level (FPL) Program (ABD FPL Program), if otherwise eligible.
   • New policy related to the Older Adult Expansion (OAE).
2. Effective July 1, 2022, property limits will increase to $130,000 per person and $65,000 for each additional person. 

The ABD FPL Program provides full scope, zero share-of-cost (SOC) Medi-Cal to aged, blind and disabled individuals.  The ABD FPL rules also apply to couples. 

To be eligible for the ABD FPL Program, an individual must:

1. Be aged (65 or older), blind or disabled (including children);
2. Not reside in a Long-Term Care (LTC) facility;
3. Have income at or below the income levels set for the A & D FPL Program;
4. Be a citizen or have SIS;
   • Individuals who do not have SIS or are unable to establish SIS are eligible for full scope Medi-Cal benefits under OAE.
5. Be within Medi-Cal property limits.

While individuals aged 50 or older who do not have SIS or are unable to establish SIS are now eligible to full scope Medi-Cal under the OAE, they are not eligible to the ABD FPL based on age as the age limit for that program has not changed (still 65 or older); however, they may qualify under the ABD FPL if they are disabled or blind.

Individuals found income ineligible to the ABD FPL Program must be evaluated for other Non-Modified Adjusted Gross Income (MAGI) Medi-Cal Programs.

A couple who does not qualify together for the ABD FPL Program due to excess income can choose to have only one spouse be evaluated for the program.  The other spouse can choose to be evaluated for other Non-MAGI Medi-Cal or choose not to be evaluated for Non-MAGI Medi-Cal.  This option should be explored prior to conducting a Medi-Cal evaluation based on the Spousal Impoverishment (SI) policy.  If the spouse who is being evaluated for the ABD FPL Program is still ineligible because their income is over the ABD FPL limit, staff must then follow SI policy.

Staff must explore this option at Intake and/or Renewal (RE), as applicable.

January Cost-of-Living Allowance (COLA) – ABD FPL Program

The Social Security COLA increase effective in January is disregarded each year until the effective FPL increases are issued in April. See SSA COLA/FPL Increases for additional information.

Effective December 1, 2020:

1. ABD FPL income is based on 138% of the FPL.
2. The standard income disregard of $230 for an individual and $310 for couples previously used to determine eligibility will no longer be allowed when evaluating for this program.
3. A new income disregard equal to the amount of the individual’s Medicare Part B Premium will be applied when determining eligibility for ABD FPL Program even when the State begins to pay the Medicare Part B Premium.
   • The income disregard continues to be applied as long as the individual/couple remains within the ABD FPL Program limits.

In January 2001, California implemented the A & D FPL Program.  To qualify under this program, the net non-exempt income of an aged or disabled individual had to be at or below 100% of the FPL.

In July 2009, the B FPL Program was established.  The eligibility criteria for this program are the same as the A & D FPL Program, except that linkage is based on blindness, not disability.

Senate Bill 104 increased the FPL for the ABD FPL Program from 100% of the FPL to 138% of the FPL.  In addition, the standard income disregards of $230 for an individual and $310 for a couple is no longer allowed when evaluating for this program.

Assembly Bill 1088 allowed a new incurred Medicare Part B Premium income disregard even when the Medicare Part B Premium is paid for by the State.

Assembly Bill 133 (Budget Act of 2021) amended the Welfare and Institutions Code (WIC) section 14007.8 to expand eligibility for full scope Medi-Cal to individuals who are 50 years of age or older, and who do not have SIS or are unable to establish SIS as required by WIC section 14011.2, if otherwise eligible.

Qualified Aged Individual

An individual who is 65 years of age or older and is within the FPL limit.

Qualified Disabled Individual

An individual who is determined disabled by Social Security Administration (SSA) criteria or from Disability Determination Services Division – State Programs (DDSD-SP) and is within the FPL limit.

Qualified Aged Couple

A married couple who are both 65 years of age or older and are within the FPL limit.

Qualified Disabled Couple

A married couple who are both determined disabled by Social Security Title II, Title XVI, or a medical determination of disability from DDSD-SP and are within the FPL limit.

Ineligible (IE) Family Member

Individual in the Medi-Cal Family Budget Unit (MFBU) who is not aged, blind or disabled and whose Medi-Cal eligibility is not being considered under the A & D FPL or B FPL Program.

An IE family member can be considered for other Medi-Cal programs.

Blind Individual

An individual who has a medical determination that states that he/she has:

1. Central visual acuity of 20/200 or less, or
2. Limited visual filed subtends and angle of 20 degrees or less.

Title II Benefits

Retirement, Survivors, and Disability Insurance (RSDI) benefits.

Title XVI Benefits

Supplemental Security Income (SSI) benefits.

Title XIX Benefits

Medicaid (Medi-Cal in California).

ABD Individual/Couple

1. Be aged (65 or older) or disabled; or
2. Be a Blind Individual/Blind Couple  determined disabled. 
   • Determined blind by Title II (Social Security) or disabled through a Tile XIX (DDSD-SP) determination.

Note:  The criteria for a determination of blindness under the Title II program meets the definition of disability.

1. Not reside in an LTC facility.

Citizenship/Satisfactory Immigration Status (SIS)

1. Citizen or have SIS.
2. An individual or couple, without SIS, can receive benefits under the A & D FPL Program.

Property Limits

1. Individual - $2,000
2. Couple - $3,000

Effective July 1, 2022, property limits will increase to $130,000 per person and $65,000 for each additional individual up to a maximum of 10 individuals.

Income

1. At or below 138% of the FPL after allowing the following deductions:
   • All applicable income deductions allowed by the Medically Needy (MN);
     • $20 any income;
     • $65 & ½ earned income deductions and Impairment Related Work Expenses (IRWEs), if applicable;
     • Health Insurance Premiums, if paid for by the beneficiary (e.g., Medicare Premium, other health coverage).

Note:  IRWEs can be used as income deductions for employed individuals.

Disability determined by SSA/SSI/Railroad

1. MEDS (QX, QT Screen)
2. Award letter verifying permanent disability.

Disability determined by DDSD-SP

1. MC 221 LA - Disability
2. Determination and Transmittal form from DDSD-SP.

Blind Disabled determined by Title II Social Security

1. MEDS (QX, QT Screen)
2. Award letter verifying Title II benefits.

N/A