Western Poverty Law - MAGI Medi-Cal Programs

Medi-Cal Aged &/or  Disabled Federal Poverty Level
(A&D FPL) Program

Aged, Blind & Disabled Medi-Cal Program

The Aged and/or  Disabled Federal Poverty Level Program (Income Chart) (A&D FPL) serves individuals aged 65 and older, and persons with disabilities. The program makes

FLASH!!!

Check out this Fact Sheet from Justice in Aging on Medi Cal changes for 2022

Full-Scope Medi–Cal Health Benefits

(i.e., health coverage for medically necessary services such as physician visits, hospital care, ambulances, prescription drugs, and in-home care) available with no Share of Cost (SOC). To qualify for this program, individuals

Must meet all of the following three criteria:

  1. Be aged (65+) or disabled (meet Social Security’s definition of disability, even if your disability is blindness).
    1. Listing of Impairments
  2. See next module for income & assets

Resources & Links

 

 

 

 

SSI #Resources & Income Limits

The Aged & Disabled  Medi-Cal program uses SSI countable income rules  as well as a few extra rules you should know. For more information, visit or webpage on the  SSI program, the Medi-Cal section of the Disability Benefits 101 websiteCA Health Care Advocates Archive

Countable resources are the things you own that count toward the resource limit. Many things you own do not count.

FLASH!!!

July 1, 2022, California  will raise the asset limit in the Medi-Cal programs serving older adults and people with disabilities to $130,000 for an individual and $65,000 for each additional family member.

no sooner than January 1, 2024, the state will eliminate the asset test completely. CA Health Care Advocates

  1. Have less than $2,000 in Countable assets for an individual ($3,000 for a couple).
    1. Medi-Cal property limitations.
    2.  asset questionnaire
    3. CANHR simpler list
    4. CANHR Fact Sheet
    5. Understanding Medi-Cal’s Asset Test for Seniors and People With Disabilities
    6. Western Poverty Law 
    7. Nolo - SSI Income & Asset Limits
    8. Income SSA.Gov
      1. SSA Site
    9. Will my settlement affect my government benefits?  VIDEO
    10. Our webpage on SSI Resources & Income
  2. Have less than $1,271 - 123% of FPL  in countable monthly income for an individual ($1,719 for a couple). ca health advocates.org ADFPL    *  AB 715 Fact Sheet * Western Poverty Law  * 
    1. Share of Cost if income is too high, but you qualify on asset test?

Our website is #MUCH more than just
Pro Bono helping you with Medi-Cal

We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 138% of FPL, Federal Poverty Level

We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions.  When you have other questions or need coverage, take a look at   our other websites:

#My Medi-Cal 
How to get the Health Care You Need
24 pages

Smart Phones - try turning sideways to view pdf better
My medi cal explanation of medi cal

 

******************************************

Western Poverty Law - Insurance for Low Income

Advocate Guide to Medi Cal 

advocate guide to Medi Cal

Nolo Social Security, Medicare, Medi Cal & Government Pensions

nolo social security government pensions

 

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.  MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

FAQ’s

Question

My tax person informed me that claiming my 81 year old father-in-law as a dependent on my taxes would not affect his eligibility for A&D – Aged & Disabled FPL Full Scope – Federal Poverty Level Medical-cal. Is this true?

Similar situation in regards to claiming my mother. She receives SSI/SSDI and receives medical Medi-Cal . Would claiming her as a dependent affect her eligibility for medi-cal

Answer

See Chapter 3 – Western Poverty Law Center on Health Insurance for Low Income.   See also Social Security’s website on SSI

Does your Mom get SSI or SSDI, it makes a difference. SSI is dealt with here.   See also Social Security’s website on SSI  for income & resource information.

SSI

Eligibility
blue arrowBenefits
blue arrowResources
blue arrowIncome
blue arrowLiving Arrangements

SSDI gives one Medicare after two years.

We don’t get paid to help people with Medi-Cal, SSI or SSDI. When you read the manual, be sure to read it 3x and when you think you understand it, read it again. We’ve only skimmed the material

Question

I am 70 years of age and have been on medi cal due to low income. I recently applied for my ex husbands social security and my income increased to $1,379.10. Can I still qualify for medi cal?

***Sorry, it looks like you are now over the income limit.  See excerpt below.   Losing Medi-Cal would give you a Special Enrollment Period into a Medicare Advantage Plan where there are generally no premiums and very little co-pays that we can help you with.  You might also qualify for low income subsidies for your prescriptions.

****

Question

What if one qualified for Medi-Cal because of a disability, but wants to opt out and get subsidies in Covered CA or just pay full price during Open Enrollment?

Excerpt of email…

[Covered CA] was advised that since member has disability even if he doesn’t want to be on Medi-cal, he will still be referred to them. … Medi-cal caters for people with disability.  The member should ask Medi-cal for possibility of releasing him, unfortunately, it’s not under our control .

Maybe shouldn’t argue with Medi-Cal to say not disabled – could hurt Medicare and Social Security Disability Claim

Medi Cal Contact Information

#Email  Addresses & Phone #'s: 

Ombudsman

  • Ombudsman Webpage
    • Phone: 1-888-452-8609
    • Email:   [email protected] 
      • The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.

Complex Questions Assistance

Medi-Cal for All Children program 

SB 75 Eligibility and [email protected]

Medi Cal - #County Office Lookup

See our Main Webpage on Medi Cal contact information

Links – Resources

Related Pages

[child-pages]

[sibling-pages]

25 comments on “Aged and Disabled Federal Poverty Level Program

  1. Question

    My grandma earns 1096 through social security and then she ears $586 through her pension for a total of 1682.47

    They have calculated her net non exempt income at 1400.55 beginning 12/2017

    Minus her $600 maintenance need means she has a share of cost of $801 beginning 12/2017.

    The wierd thing is my grandma was approved for medi-cal and IHSS last year with the same income.

    I’m thinking somehow the non exempt income might have been calculated differently.

    Can you please help me figure out how they determine non exempt income?

    I looked at the link above https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm but it didn’t help me.

    My grandma cannot pay for any share of cost. Her rent alone is over $800 per month not counting any bills etc.

  2. The A&D FPL program is connected to income.

    Do you perhaps know of another program that may help my wife Linda, who is incapactated due to a brain tumor and that does not have us ratcheting up insurance premiums every year to cover the share of cost?

  3. We suppose to call to renew mom’s financial aid 1 week before March 29.

    With all this corona virus thing… we totally forgot.

    What do we do

  4. I have been approved for full Medi-Cal services under the Aged & Disabled Federal Poverty Level Program ,

    Can I safely discontinue a policy for a supplemental insurance that covered the 20% that medicare didn’t cover.

  5. I’m 78, never worked, not disabled. I have a reverse mortgage with my sister whom I live with and we file taxes together. Our income is too low for Covered CA. What can I do to get Insurance. Buying into Medicare is way too expensive, especially since I’d have to pay late enrollment penalties. What can I do?

  6. My 83 year father was forced to stop working due to his ailing health.

    As his daughter, I am extremely over whelmed right now trying to get my dad financial assistance, and, care. Nothing is coming to fruition and all of the agencies (non-profit) won’t return my calls or help, it’s very discouraging.

    My dad receives a modest sum of $1,48 from Social Security and has expenses of rent $964 & utilities $400. He has nothing left over for food/medication/other items or help and desperately needs it.

    He has over $3k in medical bills that are mounting. He goes to 4-6 appointments per month (including for his eye).

    He had cataract surgery on both eyes last year and the surgeon messed up the right eye, leaving him blind in the right eye. He had has gallbladder removed right before the Christmas holiday. It’s been one thing after another.

    We are out of money and yet, he cannot qualify for any assistance. I do not understand.

    I cannot find anyone who is willing to help us. He sits at home all day alone.

    Medicare is providing some nurse assistance 1 day per week but that too will end at the end of the month.

    I applied for Medi-Cal on November 1, 2017 but the application is pending a “shared” cost approval.

    It goes on and on. I do not know where to turn to for help.
    He is a Vet but trying to get those benefits could take months; and, too trying to find help has been too difficult.

  7. What counts as MAGI Income & how are household members counted? annuity trust of 24,000 per year, In home support service of 32,000 – supporting my parents my youngest son 14,years old.
    Do we still qualify for Medical.?

    See our new page where we’ve answered this question for you.

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