medi-cal program guide

2021/05/21

You dont have to fill out any additional paperwork. If you are enrolled in the program, you can save earnings in a separate bank account and this money will not count against the programs resource limit. What if Im denied for Medi-Cal, what other health coverage options do I have? After he started working, his income increased to $2,800 per month ($33,600 annually) causing his monthly SSI benefit to drop to zero. To get Medi-Cal as a disabled person, you must have severe physical and/or mental problem(s) which will: Stop you from working during those 12 months, OR. We can help! medicare prosthetics orthotics Note: The guide is intended to provide a better understanding of this complex program; however, it is important to note that this is not an eligibility manual. Medi-Cal's Working Disabled Program is described, Compare with private plans on Covered California, Income-based Medi-Cal, children (266% FPG), Subsidized private plans, reduced fees (250% FPG), Subsidized private plans (no income limit), Your Impairment Related Work Expenses (IRWEs), Gross Income Less than SGA ($1,350 for individual, $2,260 if blind). Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. Can I get help from Medi-Cal with Medicare costs? If your SSI benefits go to zero because you go back to work, an SSI rule called 1619(b) lets you to keep your Medi-Cal coverage if you: For additional information, read the DB101 SSI article, check out Social Securitys webpage on 1619(b), or talk to a benefits planner. Medi_22_079_LS_052422. Blue Shield of California Promise Health Plan currently serves Medi-Cal members in Los Angeles and San Diego Counties. These cookies will be stored in your browser only with your consent. You can think of Medi-Cal as a single program that you can qualify for in a number of ways. Compare the results to the WDP income limit ($2,831 per month for individuals) to see if you're eligible. You can apply for the Medicare Savings Programs online (. Within each category, individual programs are described, aid codes are listed, and the number of beneficiaries is shown to give a sense of the programs relative size and scope. Were eligible for SSI benefits for at least 1 month, Still meet all the other SSI requirements, such as being disabled and having, Meet the medical requirements of Social Securitys. Then go back to your Vault to learn more. Medicare is public health coverage for people with disabilities and seniors. You must: If you are single and live on your own, follow these steps to figure out if your countable income makes you eligible for A&D FPL Medi-Cal. The same asset exclusions apply for this program as for A&D FPL Medi-Cal except for a couple of major differences: Retirement funds like a 401(k) or Individual Retirement Account (IRA) are not counted as assets for this program. For information go to www.coveredca.com or call 888-975-1142. For more information Medi-Cal's Working Disabled Program, contact your local county social services agency. Are you a Blue Shield Promise member or provider? You are a child 18 or younger and your familys income is at or below 266% of FPL ($73,815 per year for a family of four). The Former Foster Youth program provides Medi-Cal coverage up to age 26 for youth who were in Foster Care on their 18th birthday. This book provides important information crucial to understanding the Medi-Cal program. When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined. If you've been denied Medi-Cal or an MSP because you had too much in assets, try applying again. programs md bs direct complete guide wishlist In San Bernardino County you will be required to select a managed care provider such as Molina or the Inland Empire Health Plan as your primary care provider., You may have a share of cost, similar to a Co-Payment, for medical/dental treatment based on your income and family size. If it is less than $1,563 for individuals or $2,106 for a couple, then you qualify for free, full scope Medi-Cal based on A&D FPL rules. After working for a year, Joe got a raise and went over the 1619(b) limit, so he switched to Medi-Cal's Working Disabled Program and paid a small monthly premium so he could keeping getting his Medi-Cal coverage. Medi-Cal provides comprehensive health coverage for children and families. There is no limit to how much of your earnings you can save this way and still remain eligible for Medi-Cal. Depending on income and family size, you and your family may be eligible to free or low-cost Medi-Cal. Medi-Cal provides important health benefits to adults and children. You qualify for ABD-MN Medi-Cal. Blue Shield of California Promise Health Plan

No income is disregarded. Medi-Cal is California's Medicaid healthcare program that offers free or low-cost health coverage.

The resulting figure is your share of cost each month. If you are in these situations, there are is no limit to how much money or other resources you have and it does not matter whether or not you have a disability. This category only includes cookies that ensures basic functionalities and security features of the website. And it doesn't change income-based Medi-Cal, which doesn't have an asset limit. The Medi-Cal regulations do not define what working means for this program, and you can qualify if you are working part time.

A share of cost is a certain amount of money you must spend on medical care each month before Medi-Cal begins to pay for services. Depending on your situation, individual health plans on Covered California might make more sense than Medi-Cal's Working Disabled Program or ABDMN Medi-Cal (described above). We cannot refer you to individual providers. If your resources are too high for Medi-Cal's Working Disabled Program and your income is too high for other forms of Medi-Cal, you may be able to get government help paying for an individual plan on Covered California instead. The medical problem must be the main reason why you do not work. Medi-Cal is the name for the Federal Medicaid Program in California. People with disabilities have more ways they can qualify for Medi-Cal if they don't meet the standard eligibility rules described above. Customer picks a Covered CA plan, if ineligible to Medi-Cal. You can use pay-stubs or other written verification from an employer to prove that youre working. If you were in Foster Care on your 18th birthday, you are eligible to Full-Scope Medi-Cal benefits up to age 26. income. All earned and unearned income is counted based on IRS rules for adjusted gross income. Have assets less than $130,000 for an individual and $195,000 for a couple. Note: If you are blind, subtract any money you use for Blind Work Expenses (BWEs) from this amount. cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, pas de origen, ascedencial, religin, sexo, estado civil, genero, identidad de genero, orientacin sexual, edad ni discapacidad. Use the Medi-Cal for the Working Disabled Estimator to get an idea of whether you'd qualify for this program and what your premium would be. Read DB101s SSI article for more information about whether you qualify for SSI. Would you like to take a short survey telling us about your experience with DB101? If you live with others, you should use DB101's Benefits and Work Estimator. Take the number of people in your household who are. The complete guide is available as a PDF under Document Downloads. Medi-Cal with Blue Shield Promise Health Plan is free for residents who meet eligibility requirements. Click below for an informational PDF. Are you sure you want to lock your account? Note: If you dont qualify for Medi-Cal through 1619(b) because your income is too high, you may qualify for Medi-Cal's Working Disabled Program. Closed Captioning (subtitles)in multiple languages, can be enabled by using the CC icon. If ineligible to a County based Medi-Cal program, the customers application will be referred to Covered CA to determine eligibility to other non-County based health coverage. However, you would to pay a share of cost. You may apply for Medi-Cal online via BenefitsCal, in person at your local offices, via mail, over the phone, or by fax. Be working and earning income. If you lock your account, you won't be able to log in again. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Be working and earning income (this can be part-time work). Interested in joining? Blue Shield of California Promise Health Plan is a Medicare Advantage HMO plan with a Federal Government contract in California. If you are aged or disabled, and are not eligible for SSI, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. Log in, Aged & Disabled Federal Poverty Level (A&D FPL) Program, Medi-Cal Programs Qualification at a Glance chart, California State Disability Insurance (CSDI), learn about how AB 1269 made the California Working Disabled program event better, local Social Security Administration office, contact your Department of Public Social Services (DPSS) county office, 250% California Working Disabled (CWD) Program, Life-insurance policy with a face value of $1,500 per person, Prepaid burial plan (unlimited if irrevocable or up to $1,500 if revocable) and burial plot, Be aged (65+) or disabled (meet Social Securitys, Have less than $130,000 in assets for an individual and $195,000 for a couple. It can range from $20 to $250 for an individual, or $30 to $375 for couples. Joe had been getting SSI for several years when his health improved and he decided to go back to work. Learn more about what types of income affect income-based Medi-Cal eligibility. Medi-Cal is a major government-funded health program that helps people with low income. , Clinical policies, procedures and guidelines, Policies, guidelines, standards and forms, Department of Health Care Services website, Blue Shield Promise Medi-Cal Evidence of Coverage (EOC), About Blue Shield of California Promise Health Plan, https://www.healthcareoptions.dhcs.ca.gov/, Primary care doctor, wellness and specialist visits, Family planning, maternity and newborn care, Individual, Family, and group Mental Health services for mild/moderate conditions, Behavioral Health treatment for youth under 21, Substance misuse screening and counseling, Care management for higher levels of mental health care, Medical supplies and durable medical equipment, People who live in our service area (Los Angeles and San Diego Counties), People who meet income guidelines and/or other program requirements. Staff approves or denies the County based Medi-Cal program within prescribed timeframes. The Guide to Medi-Cal Programs, Third Edition (PDF), *** We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, pas de origen, ascedencial, religin, sexo, estado civil, genero, identidad de genero, orientacin sexual, edad ni discapacidad. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. If you get Supplemental Security Income (SSI), a benefit for people with low income who are aged, blind, or disabled, you get Medi-Cal automatically. For example, if you have a disability, you may qualify for Medi-Cal even if you have higher income or are on Medicare. We Provide Free Translation and Interpreter Services, including ASL. Income-based Medi-Cal counts most types of earned and unearned income you have. , If you did not receive your card, lost your card, your card was stolen, or the card you received in the mail has the wrong information on it, you may call and ask for a Benefit Identification Card (BIC) by contacting the Customer Service Center at 1-877-410-8829., Medical, Dental, and Vision services and some prescriptions., If you are pregnant and cannot afford to pay for health care and some dental care, Medi-Cal can help pay for medical expenses for you and your unborn. In addition to everyday health care, there are special health problems that require specialized services. It is important to remember that these are just some of the many ways to get Medi-Cal. Have countable income less than 250% of the Federal Poverty Level ($2,831 per month for individuals and $3,815 for couples). The provider network may change at any time. Copyright 2022World Institute on Disability, Technology 2002-2022Eightfold Way Consultants. We also use third-party cookies that help us analyze and understand how you use this website. Medi-Cal has always covered low-income children, pregnant women and families. DPSS provides health care assistance to Seniors as well as children and adults with disabilities. The Adults without Children Medi-Cal program provides no cost Medi-Cal benefits to adults between the ages of 19 to 64 without children. Page last updated: 05/27/2022 You are pregnant, and your familys income is above 138% of FPL, but at or below 213% of FPL ($39,000 if you are single and pregnant with your first child, $59,108 per year for a family of four; the unborn baby is counted as a member of the pregnant woman's family). Like SSI, this program does not count all of your assets. California Physicians Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association. Covered California is the health insurance market place which serves as a one-stop shop where individuals and families obtain information about health care options. The Medicare Savings Programs are: Specified Low Income Medicare Beneficiary (SLMB). Necessary cookies are absolutely essential for the website to function properly. A share of cost is usually more expensive than paying a premium, Your ABD-MN Medi-Cal share of cost could be very high. Even though his income is now higher than the usual income limits for Medi-Cal, he is still eligible for Medi-Cal through 1619(b) because his annual income is less than $54,082. For information on Blue Shield Promise Cal MediConnect Plan and other Cal MediConnect options for your health care, call the Department of Health Care Services at 1-800-430-4263 (TTY: 1-800-735-2922), or visit https://www.healthcareoptions.dhcs.ca.gov/. For Assistance, Call 1-866-613-3777. The orientation chapter discusses Medi-Cal eligibility, immigration and disability issues, financial requirements, application process and redetermination procedures, and coverage and benefits. The easiest and quickest way to apply for CalWORKs, CalFresh and/or Medi-Cal is online at www.benefitscal.com. The main additional ways to qualify are: These ways to qualify are explained here. We know our members come from all over the world, and all walks of life. 266% of FPL for children 18 and under. Many times you can get Medi-Cal at no cost to you, even if you have income. There are good factsheets translated into a several languages about how your share of cost works. Note: If you got SSDI before you reached retirement age and now your SSDI benefits have been converted to Social Security retirement benefits, they will not be counted as income either. Note: This doesn't change SSI-linked Medi-Cal or Medi-Cal through SSI 1619(b), as they still have SSI's $2,000 asset limit. Remember not to list any money you get from disability benefits as unearned income. Find out more about Medi-Cal income guidelines, Learn more about Medi-Cal program requirements. If you are pregnant, Medi-Cal may provide you with free or low-cost health care coverage during your pregnancy. Spend some time looking at your results. In most cases, it would be cheaper for you to pay a monthly premium for Medi-Cal's Working Disabled Program or even for you to get an individual plan with government subsidies on Covered California. Big changes for disability-based Medi-Cal categories with asset limits: This applies to Medi-Cal through A&D FPL, the Working Disabled Program, and ABDMN, as well as Medicare Savings Programs (MSPs). You only have to pay a share of cost in months when you have medical expenses. Call us toll-free at (866) 820-6009[TTY: 711], Monday through Friday, 8 a.m. to6 p.m. How to enroll video How to enroll video (espaol), To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video. Have countable income less than 250% of the federal poverty level (in 2022, this equates to $2,853/mo. If youre living outside of these counties, check out the Department of Health Care Services website for coverage in your area. Fill out the application as completely as possible to avoid delay in processing your application. These include Medicare, health, vision, and dental insurance premiums. Learn more about essential health benefits. If you need health benefits, you can apply for Medi-Cal anytime throughout the year online or through Covered California. These cookies do not store any personal information. for couples; these figures include the $20 disregard). Have less than $1,584 in countable monthly income for an individual ($2,126 for a couple). Call us toll-free at (866) 820-6009 (TTY 711), Monday through Friday, 8 a.m. 6 p.m. You can also read Blue Shield Promise Health Plans step-by-step Medi-Cal enrollment guide. You will receive notice when necessary. 138% of FPL for adults 19-64 years old. Enrollment in Blue Shield of California Promise Health Plan depends on contract renewal. If you reside in a nursing home (also known as long-term care facility) or need nursing home care, Medi-Cal could pay for all or part of the care and services you receive. Comment Regarding: Medi-Cal: Medi-Cal Categories, Health Coverage Income Limits for Your Family. We will contact your supervisor to confirm that you are authorized to have this role. If you are entitled to or receiving Medicare, you may be eligible to payment of your Medicare Part A and/or Part B premiums, deductibles, and co-insurance fees by applying for the Medicare Savings Programs, even if you are not receiving Medi-Cal. Here are a few examples: See DB101s article about Buying Coverage on Covered California to learn more. Like SSI, this program does not count all of your assets. To qualify, you must. The number you get is the amount of monthly income that is counted for the A & D FPL program. For private plans with subsidies, your monthly premium amount depends on your Different programs sometimes use slightly different numbers for the. Note: The California Health Care Foundation focuses on policy research, and we are unable to assist with individual Medi-Cal cases. If you cannot qualify for free Medi-Cal or Medi-Cal's Working Disabled Program (described below), you may be able to get Medi-Cal through the Aged, Blind, & Disabled - Medically Needy (ABDMN) program. It is mandatory to procure user consent prior to running these cookies on your website. Select your preferred language using the GEAR icon. Modernizing Payment to Community Health Centers, The Guide to Medi-Cal Programs, Third Edition (, Transitional or continuing Medi-Cal coverage. The Affordable Care Act makes sure that all Medi-Cal health plans offer the essential health benefits. Staff verifies the application submitted is complete and schedules the customer for an interview to obtain appropriate non-financial/financial information and verifications to determine program eligibility. We can help! When your provider uses your Benefits Identification Card (BIC) to verify your Medi-Cal eligibility, your provider will know if Medi-Cal will pay for a medical/dental treatment or if you need to make a Co-Payment for any treatment. This includes adults, children, families with children, seniors, and persons with disabilities.

If you have limited income and resources, the Medi-Cal Program provides comprehensive health coverage to you and your family for free or low-cost. If you are single, you can figure out your share of cost by following the first step for calculating A&D FPL eligibility. The Medi-Cal program descriptions are organized into nine broad categories. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Have less than $1,563 in countable monthly income for an individual ($2,106 for a couple). Eligibility requirements include property and income limits which may change annually. On Jan. 1, 2014, California expanded Medi-Cal eligibility to include low-income adults. Note: If you ever need to qualify for a different Medi-Cal program that has a resource limit, the earnings you saved in this account while on WDP will not be counted as resources. Submit an application for CalWORKs, CalFresh, Medi-Cal, County Medical Services Program (CMSP), or Disaster CalFresh via BenefitsCal by clicking Apply Now from the homepage. If you are working, disabled, and your income is too high to qualify for free Medi-Cal, Medi-Cal's Working Disabled Program may allow you to get Medi-Cal by paying a small monthly premium. IHSS helps pay for personal assistance services so that people with disabilities can live in the community. If it is higher than $1,563 for individuals, you may qualify for Medi-Cal's Working Disabled Program or ABD-MN Medi-Cal instead. Worried about losing Medi-Cal? These figures include the $20 disregard. So, we give all providers training and support to make sure our members get the best service. Be either aged (65+), or disabled (meet Social Securitys. Some immigrants don't qualify for Medi-Cal's Working Disabled Program, but do qualify for government help paying for a private insurance plan. ***. Have assets worth less than $130,000 for an individual ($195,000 for a couple). Countable income less than the SSI/SSP benefit amount for your living situation, Up to $130,000 for individual, $195,000 for couples, Countable Income less than 250% of the Federal Poverty Level ($2,831 per month for individuals, $3,815 for couples), SSI's countable income calculation, but any disability income is not considered income, Up to $130,000 for Individual, $195,000 for couples; money in retirement accounts is not considered as an asset, No income limit, but your countable income determines your share of cost, SSI's countable income calculation - MNA for number of people in household, including the applicant health, vision, and dental insurance premiums, Up to $130,000 for individuals, $195,000 for couples, with an additional $65,000 per additional family member. The nine categories are: The main text is supported by a glossary, an index, and an Aid Code Quick Reference sheet. But opting out of some of these cookies may affect your browsing experience. With a DB101 account, you can easily save and find your favorite DB101 pages, mini-tools, and estimator sessions. 2002-2022. You live alone and have $1,663 per month in countable income and have no other insurance. Dental benefits are available to Medi-Cal members who qualify through Denti-Cal program provided by the Department of Health Care Services(DHCS). We are contracted with L.A. Care Health Plan and the Department of Health Care Services. Your share of cost is $1,663 (your countable income) - $600 (the Maintenance Needs Level for an individual living alone) = $1,063. Countable income less than the, for couples; money in retirement accounts is not considered as an asset, Learn more about what types of income affect income-based Medi-Cal eligibility, Some types of income do not count against these limits, including SSI benefits, Aged & Disabled Federal Poverty Level Medi-Cal, Aged, Blind, & Disabled Medically Needy Medi-Cal, Buying Health Coverage on Covered California article, Medi-Cal for the Working Disabled Estimator, SSI/SSP benefit amount for your living situation, Work Incentives Planning and Assistance (WIPA) counselor, county In-Home Supportive Services (IHSS) office, Health Insurance Counseling & Advocacy Program (HICAP), Department of Rehabilitation (DOR) office, America's Job Center of California (AJCC), You are 19-64 years old and your familys income is at or below 138% of the. All rights reserved. If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. for individuals or $3,835/mo. Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association. Your countable income is too high for free Medi-Cal and you don't work, so you can't get Medi-Cal's Working Disabled Program. It may also cover services for any other medical condition that is medically necessary for the woman. You will have to pay the first $1,063 in medical expenses during the month before Medi-Cal will start covering you. To learn about other eligibility categories, you can visit a benefits planner or talk to a Medi-Cal eligibility worker at your local county social services agency. For detailed information about benefits, review the Blue Shield Promise Medi-Cal Evidence of Coverage (EOC), also known as the Member Handbook. The premium you pay for WDP coverage depends on your countable income and family situation. To learn more about dental coverage please visit Denti-Cals website or call them at (800) 322-6384 (TTY: 711). If you are living in a board and care facility, subtract $315. I lost my Medi-Cal card, where can I get another card? Blue Shield of California Promise Health Plan has neither reviewed nor endorsed this information. Were your Medi-Cal benefits suspended due to incarceration? You can apply for Medi-Cal regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. There may be situations where an individual plan on Covered California has a lower premium than your Medi-Cal's Working Disabled Program if you qualify to get government help with your premium.