Medi-Cal Aged &/or Disabled Federal Poverty Level
(A&D FPL) Program
The Aged and/or Disabled Federal Poverty Level Program (A&D FPL) serves individuals aged 65 and older, and persons with disabilities. The program makes
(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:
- Be aged (65+) or disabled (meet Social Security’s definition of disability, even if your disability is blindness).
- Have less than $2,000 in Countable assets for an individual ($3,000 for a couple).
- 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 *
This 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 website. CA Health Care Advocates Archive
This is practically my first day analyzing this and I don’t get paid for Medi-Cal work. Please review the above links. It doesn’t seem that the income qualification does one any better, than just MAGI Income Qualification.
This 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 133% of FPL, Federal Poverty Level, see the income chart.
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:
SSI-Related Programs & Coverage Groups
Income & Assets Chart
My Medi-Cal
How to get the Health Care You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- 10 Essential Health Benefits
- Our Webpage onMedi Cal Benefits
- Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Our Webpage on
COVID 19
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
BenefitsResourcesIncomeLiving 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
Links – Resources
CA Health Advocates – Medi-Cal for People who have Medicare
Orange County Social Services Agency
Chart – MAGI and NON-MAGI Qualification for Medi-Cal
See also our site on Medi-Medi – both Medi-Cal and Medicare
Social Security & Social Security Disability
Insure Me Kevin.com – Friendly Competitor
Medi-Cal Eligibilty Procedures Manual Article 22 Disability 179 pages
Program for All Inclusive Care For The Elderly
PACE creatively coordinates the care of each participant enrolled in the program based on his or her individual needs with the goal of enabling older individuals to remain living in their community.
Welfare & Instituions Code General Provisions [14000 – 14042]
Related Pages
- IHSS In Home Supportive Services
- Part B Medicare Premium paid by Medi Cal
- Share of Cost – What is it?
- Social Security Disability – SSDI
- SSI – Supplemental Security Benefits – Automatic Medi Cal
- Aged and Disabled Federal Poverty Level Program
- MAGI Income – FAQ’s – Conical
- Pregnant Women – Medi-Cal Eligibility – MCAP to 322% FPL
Will the Aged & Disabled program pay for Medicare Part B Outpatient & Doctor Visits premium of $148?
Check our webpage on Part B forgiveness for that.
I have been paying Medicare Part A Hospital Part B Dr. Visit because I need to buy it. I don’t have 40 credits. https://medicare.healthreformquotes.com/seminar/rules-get-part-hospital-medicare-no-charge/
Now I paid $691.80 each month.
Question: Medi-Cal said that Once I joined to medicare, I could not return to Medi-cal.
Please let’s me know that is true or not.
What plan-criteria did you qualify for Medi-Cal?
Aged & Disabled?
MAGI – Under 65? https://individuals.healthreformquotes.com/subsidies/intro/calculation/age-65-tax-credits/ https://individuals.healthreformquotes.com/subsidies/magi/
See our webpage on Covered CA subsidies for those over 65 who don’t qualify for premium free part A Medicare https://medicare.healthreformquotes.com/seminar/rules-get-part-hospital-medicare-no-charge/
GOTCHA
While you are generally considered eligible for government-sponsored MEC (and are ineligible for the PTC) if you are able to enroll in that coverage, you are considered eligible for government-sponsored coverage under the following programs only if you are enrolled in the program.
4. Coverage under Medicare Part A for which the individual must pay a premium. https://www.irs.gov/pub/irs-pdf/p974.pdf
So, it looks like if you let your Medicare Coverage go, you might then apply for Medi Cal, if you otherwise qualify.
Try going through Western Poverty’s booklet on Insurance for Low Income Californian’s https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=4
Please note, I’m not an attorney nor an authorized Medi Cal representative. Try emailing someone on our contact page to double check. https://medi-cal.healthreformquotes.com/contact-info/
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.
I really only do MAGI Medi-Cal
And even on that I don’t get paid
After the 20th I could look into this a little more
You might want to call or email Medi-Cal
Or call people at California health advocacy – DB 101 who are the ones we both cited – Here’s who DB 101 suggests you contact
Call or visit your local county social services agency.
Call Disability Rights California at 1-800-776-5746.
Call the Health Consumer Alliance at 1-888-804-3536.
I have a huge tax loss carry forward tax loss. Is that an offset against my countable income?
Publication 554 Tax Guide for Seniors
Publication 907 Tax Highlights for Persons With Disabilities
Publication 524 Credit for the Elderly or the Disabled
Western Poverty Law
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?
Since you have a tax loss… and negative MAGI Income, you shouldn’t have a share of cost.
You might look into Medicare Advantage since you have Medicare A Hospital & B Doctor Visits
While your entitled to a “Medi Medi” plan, you wouldn’t have to take it. You can qualify for a regular Medicare Advantage Plan. Just has higher co pays.
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
See our webpage on Insurance Coverage for Corona Virus, the link is above in our webpage.
The CA Department of Insurance is asking Insurance Companies to give a 60 day grace period.
The April 15th tax deadline has been set back 3 months.
Tenant evictions are on hold
So, my 2c is just file today!
I’m not authorized to give advice or help people with Medi Cal. Follow the links and updates to our web pages. Wait on hold for hours to ask someone and get the wrong answer.
Did you want Term Life or Health Insurance Quotes? See links above.
I found a citation
It’s in the covered California press release about coronavirus open enrollment
Open up the link scroll down and you’ll see it says there’s a 90 day hold on redetermination
https://www.coveredca.com/newsroom/news-releases/2020/03/20/california-responds-to-covid-19-emergency-by-providing-path-to-coverage-for-millions-of-californians/
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.
I presume your talking about a Medi Gap plan?
What if you want to go to a doctor that doesn’t accept Medi Cal?
What Medi Cal HMO plan will you be in?
Here’s our page on dual coverage.
It might be possible that Medi Cal would pay your Medi Gap premium? Go to our Medi Gap Medi Cal page and let us know which of 7 categories you qualified under.
What if you don’t pass redetermination next year, will you be able to get your Medi Gap plan back? Here’s Medi Gap’s guaranteed issue rules Yes, it looks like losing Medi Cal is one of them. There are DEADLINES!
See also Medicare Savings Programs.
will the A D FPL program pay for my part b Dr. visits of Medicare?
It looks that way. Check our webpage on MSP Medicare Savings Programs.
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?
You’re right, proceeds from a reverse mortgage don’t count as MAGI Income. https://www.irs.gov/faqs/other/for-senior-taxpayers/for-senior-taxpayers
Please fill out this asset questionnaire and return to us privately at [email protected]
CANHR simpler list
Please review Understanding Medi-Cal’s Asset Test for Seniors and People With Disabilities
Medi Cal General Property Limitations
Please send us a list privately of what the MAGI income is.
Problem:
Most adults with incomes up to 138% of the Federal Poverty Level (FPL) are eligible for free Medi-Cal because of the Affordable Care Act (ACA). But seniors can only qualify for free Medi-Cal if their incomes are below 123% FPL – the income level for the Medi-Cal Aged & Disabled Program. This means that adults who are eligible for free Medi-Cal at 64 can lose free Medi-Cal when they turn 65. The only way for seniors with income above 123% FPL to access Medi-Cal benefits is to pay hundreds of dollars in a monthly Medi-Cal “share of cost,” which many are unable to do. The ACA, while good for most low-income Californians, left out nearly 30,000 low-income seniors. https://www.justiceinaging.org/wp-content/uploads/2019/03/AB-715-Arambula-Factsheet.pdf
Medi Cal State Wide Enrollment – Los Angeles
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.
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.