Medi-cal (California) Eligibility criteria for under 64 yrs old

[minkeygirl]

I have always thought that Medi-cal (Medicaid) eligibility was asset based. No one ever (none of the county social workers or social workers who assessed me) told me otherwise until I found this by a fluke. As soon as I saw it I got out my tax return from last year, saw I was well within their guidelines. I jumped on my computer and applied. (I'm waiting to hear). This is huge.

Ages 19 to 64. Medi-Cal covers California adults who:

• Were former foster youth enrolled in Medi-Cal at age 18, until they turn 26
• Have incomes at or below $16,105 for an individual and $21,708 for married couples (138% of the federal poverty level)

"Income" is defined as adjusted gross income plus any tax-exempt income; to compute it, add lines 8b and 37 on a 1040 tax form. A person whose income is within those limits will get Medi-Cal coverage free until 2016, when they are slated to begin paying 10% of the cost.

- See more at: http://www.calqualitycare.org/learn/nursing-homes/pay/medical#sthash.eiGxDEbE.dpuf

 

[IreneF]

I have always thought that Medi-cal (Medicaid) eligibility was asset based. No one ever (none of the county social workers or social workers who assessed me) told me otherwise until I found this by a fluke. As soon as I saw it I got out my tax return from last year, saw I was well within their guidelines. I jumped on my computer and applied. (I'm waiting to hear). This is huge.

Ages 19 to 64. Medi-Cal covers California adults who:

• Were former foster youth enrolled in Medi-Cal at age 18, until they turn 26
• Have incomes at or below $16,105 for an individual and $21,708 for married couples (138% of the federal poverty level)

"Income" is defined as adjusted gross income plus any tax-exempt income; to compute it, add lines 8b and 37 on a 1040 tax form. A person whose income is within those limits will get Medi-Cal coverage free until 2016, when they are slated to begin paying 10% of the cost.

- See more at: http://www.calqualitycare.org/learn/nursing-homes/pay/medical#sthash.eiGxDEbE.dpuf

What county do you live in?

 

[minkeygirl]

Why would that matter? .

 

[IreneF]

Why would that matter? .

Because both the counties and the state administer Medi-cal, and there may be more programs available in your county that the social workers haven't told you about.

 

[minkeygirl]

When you complete your application online they call you and talk to you about all the programs available through that office.

As for the county? I know more than their social workers do about available programs. Which is why I posted this because none of the county drones I've spoken to over 20 years ever told me about this.

In fact I recently told a social worker about a transportation program they never even heard of. Counting on them for information is a joke.

 

[Mary]

@minkeygirl - FWIW, that link you provided does contain an asset limit, if you scroll down the page:

Asset limit. Individuals may own assets not worth more than $2,000; married couples may own $3,000 worth. But not all assets are included in the count. Exempt assets include:
A primary home
One vehicle Household items
Personal belongings including clothing, heirlooms, and wedding and engagement rings
Burial plots and any money in a designated burial plan fund
Life insurance policies and the balance of pension funds, IRAs, and certain annuities - S

My neighbor is 89, very low income, but has a lot in savings so she doesn't qualify for food stamps, which she would otherwise. I know it's a different program than Medi-Cal but am guessing its eligibility requirements are similar.

But it's definitely worth looking into --

 

[minkeygirl]

@Mary

This is the criteria if under 64 for Medi-cal. As far as I know this is the only one that is NOT asset based. Food stamps, administered through the same place is different than this. I'm only talking about Medi-cal for those under 64.

Ages 19 to 64. Medi-Cal covers California adults who:

• Were former foster youth enrolled in Medi-Cal at age 18, until they turn 26
• Have incomes at or below $16,105 for an individual and $21,708 for married couples (138% of the federal poverty level)

"Income" is defined as adjusted gross income plus any tax-exempt income; to compute it, add lines 8b and 37 on a 1040 tax form. A person whose income is within those limits will get Medi-Cal coverage free until 2016, when they are slated to begin paying 10% of the cost.


I believe the one you are referring to is 65 and over. I'm not seeing where you are getting that from since there is no heading.

Age 65 and older, blind, or disabled. Under former rules still in effect, Californians who are at least 65, blind, or disabled can qualify for Medi-Cal coverage if they have either:

• A low income and few assets and savings
• Personal resources reduced due to health care expenses

Income limit.This Medi-Cal income limit is calculated as a percentage related to federal poverty guidelines, which change every year. The current limit is about $1,188 monthly for an individual and $1,603 for a couple.

Asset limit. Individuals may own assets not worth more than $2,000; married couples may own $3,000 worth. But not all assets are included in the count. Exempt assets include:

• A primary home

 

[minkeygirl]

@Mary Also I posted previously, they look at people getting rid of assets to try to qualify for medi-cal and other programs. You can't do it within 5 years of wanting to sign up or there is a penalty of time. It was too confusing for me to figure it out.

From what I know your neighbor does not qualify for the programs because of age and assets.

Here's another link. Income based. You have to be within the income limits but assets are not used to calculate eligibility.

https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm

 

[minkeygirl]

How they calculate income if you meet one of the two criteria

Modified Adjusted Gross Income (MAGI)
Total annual income of everybody living in a household, including most earned and unearned income. MAGI is used to help determine eligibility for income-based Medi-Cal and for subsidies that help households pay for individual health coverage on Covered California.
MAGI includes:

• Wages, salaries, tips, and other earned income
• Taxable interest, dividends, business income, and capital gains
• Social Security Disability Insurance (SSDI) benefits and Social Security retirement benefits of people who file taxes
• Unemployment compensation; and
• Most other types of taxable income.

MAGI does not include:

• Supplemental Security Income (SSI), CalWORKs, CalFresh, and veterans' disability benefits
• Workers' compensation
• Earned income that is placed in a 401(k) plan or Individual Retirement Account (IRA) (Income placed in Roth versions of these accounts is included in MAGI.)
• Pre-tax deductions from a paycheck, including contributions to health savings accounts (HSAs) and flexible spending accounts (FSAs)
• Child support received; and
• Most other types of non-taxable income.

Get more information about what is included in Modified Adjusted Gross Income.

 

[Mary]

@Mary Also I posted previously, they look at people getting rid of assets to try to qualify for medi-cal and other programs. You can't do it within 5 years of wanting to sign up or there is a penalty of time. It was too confusing for me to figure it out.

From what I know your neighbor does not qualify for the programs because of age and assets.

Here's another link. Income based. You have to be within the income limits but assets are not used to calculate eligibility.

https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm

@minkeygirl - I'm really glad to see this for you! I found the first link in your initial post a little confusing because it does mention assets and it was unclear to me whether it was referring only to people aged 65 or older, or everyone.

But the link you cited here specifically says assets are not counted in calculating eligibility for the age group up to 64 - woo hoo! I hope it works out for you -

 

[*GG*]

In fact I recently told a social worker about a transportation program they never even heard of. Counting on them for information is a joke.

Hey, be nice, we pay good money for those gov't folks

GG

 

[minkeygirl]

We pay them but They don't do their jobs, don't tell people about benefits available but I'm supposed be nice to them? I'd rather call them out and not keep perpetuating the stupidly of they system?

It's the Peter principle. Promote people to their highest level of inefficiency . It's why our govt is so screwed up. Once you get your govt job it pretty much takes an act of congress to get you out.

 

[Forbin]

It's worth noting that, upon death, Medi-cal will attempt to recover costs paid for your care which were incurred after age 55 (or in a nursing home at any age). However, one's assets need to be so low to qualify for Medi-cal in the first place that the only practical way for them to recover their costs is by making an estate claim against the proceeds from the sale of your house (which is one of the few assets that is exempt in determining your qualifications for Medi-cal) after your death.
http://www.dhcs.ca.gov/services/Documents/Estate_Recovery_112015.pdf

There are some exceptions under which they will not seek recovery, including one for heirs who acted as caregivers and, in doing so, delayed the Medi-Cal recipient's entry into a nursing home for two years.
http://www.canhr.org/factsheets/medi-cal_fs/PDFs/FS_MedCal_recovery_FAQ.pdf

They will not go after your home as an asset during your lifetime. They also will never put a lien on your home. They will make an estate claim instead.

 

[minkeygirl]

This is what I found out. If you are under 64 you are eligible for Medi-cal based on income. If however you are disabled, that cancels out any other options and your eligibility is based on assets.

So if you are an able bodied person, under 64 who can earn money and that money earned and any interest it generates is within their guidelines ($around $16,000/yr but don't quote me) then you can get Medi-cal. If however you are disabled, receive SSDI, are on a fixed income, and live at or below the poverty level, then your eligibility is based on assets and you cannot have more than $2000.00 for one person and $3000.00 for a couple.

I was told that I could "spend down the money" and show proof that I spent it to meet the $2000 asset criteria. So basically, if you have a non-medical emergency you are screwed. I've been saving for 2 years for dental work that will cost at least 3K. To meet their criteria: gone. I had emergency repairs to my home last year to the tune of $1500. If I had an emergency after that: screwed.

How can this be right?

 

[SickOfSickness]

How can this be right?

It's just one of the rules, because the program is meant for poorer people, and they had to pick some cut-off.

However, they know it's keeping people from some important savings like you said, so something was done last year, but it only helps younger people. If you're just over the cut-off (emphasis mine), you're out of luck. But they might expand it to help older people later.

A new law just passed by Congress and signed by President Obama will allow people with disabilities who became disabled before they turned 26 to set aside up to $14,000 a year in tax-free savings accounts without affecting their eligibility for government benefits. As things stand now, a person diagnosed with a disability generally can’t have assets worth more than $2,000 without forfeiting eligibility for government programs like Medicaid and Supplemental Security Income (SSI).

Under the Achieving a Better Life Experience (ABLE) Act, the tax-free savings accounts can be used to pay for qualifying expenses such as the costs of treating the disability or for education, housing and health care, among other things. The existence of the accounts will not compromise the individual’s ability to qualify for benefits like SSI or Medicaid as long as the account balance does not exceed $100,000.

 

[minkeygirl]

It makes zero sense to me that people who are disabled and on a fixed income have to meet a stricter criteria than able bodied people who have the capacity to earn money and are not restricted by illness

Seems to be they have it ass backwards or there should be no differention at all.

Obama law has zero affect on me or people who get sick older in life. Restrictions on the use of the money won't pay to fix a gas leak or property taxes.

I should be able to save money for emergencies and not be penalized.

 

[KitCat]

I thought all medicaid programs were asset based as well.

I am wondering how this worked out for you. Were you able to get on medical?