Aged & Disabled Federal Poverty Level Program Worksheet and Explanation for An Adult with an Ineligible Spouse and/or children 5450CPE 14 steps are listed below. These correspond to the steps listed on the blank worksheet that is included here. The Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal program follows SSI income rules. But, you must use the medically needy rules to find out if you qualify. The term ineligible spouse usually means that your husband or wife is not 65 years old or older. Or it means that your husband or wife does not have a disability according to Social Security rules. You and your wife or husband both might have a disability and be 65 or older and still not quality as a couple. When that happens, you or your husband or wife might be able to qualify as an individual. The person who most needs to be covered by the Medi-Cal with no-share-of cost-program can choose to be the one who applies. The one who does not apply would then be the ineligible spouse. You can only qualify for the A&D FPL program if what you earn is within allowable limits. Children and pregnant women in the Federal Poverty level programs must also have earnings within allowable limits. In the medically needy programs, you can get rid of extra income if you pay for medical expenses yourself. You cannot do this in the A&D FPL program. Instead, you figure out your countable income by subtracting what you pay for health plan premiums. This includes premiums for dental, health or vision policies. You can do the same for any other member of your family as well. Your children and the ineligible spouse qualify for the Medically Needy Medi- Cal program if they are not eligible for no-share-of-cost Medi-cal under another program. You must use the income counting rules of the Aged-Blind-Disabled Medically Needy program. Those rules calculate your income with this formula: subtract $65 from your income. Then subtract 50% of the amount left over. See steps 6 and 9 below in the worksheet to see how this works. Instructions for Filling out the Worksheet: Step 1: Add your earnings to your husband or wife s earning. Enter the amount into the worksheet. Do not take out any deductions for the cost of health insurance premiums or tax withholding. For instance, either you or your husband or wife Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 1
might get Social Security benefits and the cost of Medicare premiums has been subtracted from the total amount. But the Medi-Cal program counts the amount of Social Security benefits before Medicare premiums get subtracted. (Medicare will pay your premium directly if: you qualify for the A&D FPL program; you qualify for any other Medi-Cal program with no share of cost; OR you qualify for Medi-Cal with a share of cost which you pay.) Unearned income includes interest, pensions, annuities, state disability insurance and unemployment benefits. You must add your income to your spouse s income, even if the number is zero. Step 2: Deduct the $20 any-income deduction. Step 3: Enter the balance (any amount left over), if there is any. The balance equals the total countable income you have that is unearned. Step 4: Enter the number from Step 1. If your ineligible spouse gives you IHSS services, do not count that as income. If you are self-employed, your gross earned income means your adjusted gross income. That is, subtract the deductions allowed by the IRS from your gross income receipts. 1 Earned income includes any income on which Social Security taxes are paid or are payable. Earned income also includes honoraria, and book royalties. Gross income does not include income that has been put into a cafeteria plan through your work for childcare or medical expenses. That income does not have Social Security taxes taken out of it. 2 Step 5: Deduct the balance (any amount left over) of the $20 any-income-deduction. Look at Step 2 and see if any part of the $20 deduction was unused. 1 To estimate your current monthly income: Find out your last year s income tax return. Compare last year s adjusted gross income and last year s gross receipts. Let s say that last year your adjusted gross income was 50% of your adjusted gross receipts (i.e., $20,000 based on receipts of $40,000). Social Security will assume that your monthly adjusted gross income for this year would be 50% of your total receipts. 2 20 CFR 416.1110(a); Social Security Program Operations Manual System (POMS) SI 00820.100-C.1. Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 2
Step 6: Deduct the $65 earned income work incentive deduction. 5450CPE Step 7: Deduct any Impairment Related Work Expenses or IRWEs from your (the applicant s) earnings. IRWEs are expenses you pay yourself because you work and because you have a disability. For example, this includes paying for attendant care to help you before, after and during work. It also includes paying for transportation when you cannot use public transportation consistently because you are disabled. IRWEs also include medical expenses that you pay for to be able to work, even if you do not work. You can take this deduction if: you are under 65 years old; or if you are age 65 or older, and you qualified for Medi-Cal or other benefits because of a disability before you were 65. Step 8: Subtract the unused portion of the $20-any-income deduction, if there is any (from Step 5). Subtract the $65 earned income deduction (Step 6). Subtract any IRWE deductions from the gross earned income (Step 7). This is your subtotal. Enter it into the worksheet. Step 9: Deduct 50% of the subtotal entered at Step 8. This is an additional work incentive deduction. Step 10: Subtract the amount in Step 8 from the amount in Step 9. Enter the balance (the amount left over). This is your total countable earned income. The amounts in Steps 9 and 10 should be the same. Step 11: Add together your total countable unearned income and your total countable earned income. Step 12: Deduct any health insurance premium payments that you paid for yourself. This includes Medi-Gap, dental or vision insurance. Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 3
Department of Health Services (DHS) All-County Letter (ACL) 01-18; MC 176 Aged/Disabled FPL group spreadsheet (10-17-00) Step 13: If there are children or other adults in the family (not including your ineligible spouse), deduct a maintenance need allowance (MNL). Use the figures in the Maintenance Need Allowance chart below. Children are included if they are under 18, or if they are full-time students who are 18,19 or 20 years-old. For example, a family of two parents and three children would be a family of five. Don t count the spouse who is applying for A&D FPL benefits. Now you have a family of four. The MNL deduction for a family of four is $1100. Step 14: The amount left over is the countable income of the spouse applying for Medical under the A&D FPL program. This is the amount used to decide if you qualify for the A&D FPL program. Authority: Welfare & Institutions Code 14005.40; DHS ACLs Nos. 00-57, 00-68, 01-18, 02-38. Maintenance Need Allowances Maintenance Need Level (MNL) (unchanged since July 1, 1989): 1 - $600, 2 - $750, 2 adults - $934, 3 - $934, 4 - $1100, 5 - $1259, 6 - $1,417, 7 - $1,550, 8 - $1,692 Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 4
Blank A&D FPL Worksheet for an Adult with an Ineligible Spouse Step 1 Enter in the Total unearned income from both Husband & Wife before subtracting Medicare or other deductions Step 2 Subtract the $20 any-income-deduction - 20.00 Step 3 The sum is the total countable unearned income for the couple Step 4 Enter in gross earned income from both Husband and Wife before any deductions (from Step 1) Step 5 Subtract the balance of the $20 any-income deduction from step (2) above, if any Step 6 Subtract $65 earned income deduction - 65.00 Step 7 Subtract any Impairment Related Work Expenses (IRWEs) for eligible spouse Step 8 Calculate the Subtotal Step 9 Subtract 50% of the subtotal in step (5). This is an additional work incentive deduction. Step 10 Total Countable Earned Income for couple Step 11 Add together the total countable unearned income (step 3) and total countable earned income (step 10) for total countable income. Step 12 Subtract any health insurance premium payments except Medicare premiums 3 Step 13 Subtract the applicable MNL based on family size minus the spouse seeking A&D FPL Step 14 This is the income counted for determining whether your spouse qualifies for A&D FPL Medi-Cal Is the amount in Step 14 equal to or less than $1133 for 2009? That amount is 100% of the FPL ($903 in 2008) for an individual plus $230. If yes, then you qualify for Medi-Cal with no share of cost. 3 The Medi-Cal program will pay for your Medicare Part B premium directly if you qualify. You will then get your full Social Security check without any deduction for Medicare. Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 5
Maintenance Need Allowances: 1 - $600, 2 - $750, 2 adults - $934, 3 - $934, 4 - $1100, 5 - $1259, 6 - $1,417, 7 - $1,550, 8 - $1,692 Disability Rights California Worksheet 3 Eligible & Ineligible Spouse Page 6