Health Coverage for Elderly, Blind, or Disabled Adults

The Medi-Cal Program

Single persons and couples 65 years of age or older are potentially eligible for Medi-Cal, although they may have a share of cost. A share of cost is similar to a monthly deductible. It is the amount of medical expenses a Medi-Cal beneficiary must pay or be obligated to pay before Medi-Cal will cover any medical expenses.

If persons applying as elderly or disabled would have a share of cost, they are automatically evaluated for the Aged and Disabled Federal Poverty Level (A&D FPL) Program. Under the A&D FPL Program, the income limits for free Medi-Cal are higher than those for other Medi-Cal programs.

Single individuals and couples aged 21-64 with no children may qualify for Medi-Cal benefits if the State of California determines that the criteria for blindness or disability are met. That determination is made through a disability evaluation.

Note:Persons receiving SSI automatically receive Medi-Cal benefits.

The eligibility information listed below will give you an idea of whether you may be eligible to receive Medi-Cal coverage under the A&D FPL Program. However, eligibility for Medi-Cal can only be fully evaluated by an Eligibility Worker (EW) at one of the Social Services Agency Intake Offices. If and when you decide to apply, your EW will explain in further detail what requirements specifically apply to your situation.

Basic Eligibility Requirements

Persons applying for the Aged and Disabled Federal Poverty Level (A&D FPL) Program must meet the following requirements:

•

Be 65 years of age or older or be determined disabled.

•

Cannot be residing in a Long-Term Care (LTC) facility.

•

Be within the Medi-Cal property limits.

•

Income of single persons/couples must be at or below the 100% A&D FPL. (See chart below.)

*Note:*	1)	Disabled persons are not subject to age limitation.
	2)	Recipients of Title II disability benefits do not need an additional disability referral or determination.

A&D FPL Program – Income Limits Chart
Effective April 1, 2009 - September 30, 2010

Number of Persons	100 % Federal Poverty Level (FPL) + Disregard
One person	$ 1,133
A couple	1,579

Applying for Medi-Cal (Elderly, Blind, or Disabled)

Persons who would like to apply for Medi-Cal health insurance may:

•

Apply in person by visiting one of the Social Services Agency Intake Offices and filling out an application, or

•

Call an Intake Office and ask for a mail-in Medi-Cal application.

You may also call one of the intake offices and ask to speak with the Information Supervisor. The Information Supervisor will answer any questions you may have about Medi-Cal programs.

Documents You Will Need to Bring When You Apply

Your Eligibility Worker (EW) will tell you exactly what documents you will need to provide as proof of identity, income, property, residence, and so on. The following list contains examples of some of the most common items you may need to provide so that your EW can see if you are eligible for Medi-Cal benefits.

	Proof of Identity
	•	California Driver’s License or ID from the Department of Motor Vehicles (DMV)
	•	Passport
	Proof of Age
	•	Birth certificate
	•	California DMV ID or driver’s license
	Proof of Social Security Number
	•	Social Security Card
	•	Proof of application for Social Security Card
	Proof of Immigration Status
	•	Permanent Resident Card/Green Card/ Alien Registration Card
	Proof of Property
	•	Bank statements (checking and/or savings accounts)
	•	Car registrations
	•	Papers that show the value of property
	Proof of Income
	•	Pay stub or employer’s documents
	•	Other papers that provide proof of monthly income (e.g., Social Security Award Letter, Unemployment check stub, and/or Disability check stub)
	California Residency
	•	Housing bill/receipt
	•	Utility bill

Other Programs for Elderly or Disabled Persons

The following are other programs you may ask your EW about:

•

The “250% Working Disabled Program (WDP): This program allows the working disabled to purchase Medi-Cal coverage by paying monthly premiums on a sliding scale based on the person’s countable income.

•

Medicare Savings Programs: Under these programs, the State pays certain Medicare premiums, deductibles, and co-insurance of individuals who meet the requirements. The 3 programs are:

•	Qualified Medicare Beneficiary
•	Specified Low-Income Medicare Beneficiary (SLMB)
•	Qualifying Individual (Q-I) Program

•

State Waiver Programs:

•	Department of Developmental Services - Home and Community Based Services (DDS-HCBS) Waiver. This program serves developmentally disabled persons who remain in their homes and communities rather than being placed in an institutional setting.
•	Model Nursing Facility (Model-NF) Waiver: This program serves certain individuals who live at home instead of residing in an institution.

•

In-Home Supportive Services (IHSS): This program pays individuals for routine tasks they perform for others who, because of functional limitations, would not be able to remain in their own home without this assistance. Routine tasks under this program include but are not limited to house cleaning, meal preparation, personal hygiene, and transportation.

•

Tuberculosis (TB) Program: This program provides limited coverage for outpatient TB-related services at no share of cost to TB-infected persons. To be fully qualified for this program, applicants must either be ineligible for Medi-Cal or currently receiving full-scope Medi-Cal with a share of cost.

•

Special Treatment Programs that cover such services as dialysis and tube feeding.

You may call a local Social Services Agency Intake Office and ask to speak with the Information Supervisor. The Information Supervisor will answer any questions you may have about these or other Medi-Cal programs.