Medi-Cal for Seniors and and Medi-Cal Disabled Programs
The programs available under this category are divided into two categories. There are the general senior and disabled programs and there are programs designed to cover the medical expenses not covered by Medicare.
Aged/Disabled Federal Poverty Level Program. This program provides no cost coverage to seniors and people with disabilities that would be required to share in costs under the Medi-Cal Medically Needy Program. Children with disabilities can also be eligible for this program if they meet the income requirements and Social Security Administration standards for a disability. Individuals who do not have satisfactory immigration status, but would otherwise qualify, may be covered for emergency services only.
Long-Term Care Program (LTC). This program aims to help the elderly, people with disabilities, and people with chronic disabilities. This program covers the costs of medical and nursing facilities or in-home care. In-home care may include personal care, case management, and community-based services. Most long-term care benefits are covered under other programs. This program, however, has different criteria to benefit married couples. When one partner is institutionalized but the other is not, the property requirements are altered to ensure the spouse still living independently can continue to do so financially.
250% Working Disabled Program. This program is specifically for disabled individuals that are still able to work. In order to be eligible for this program, you must have a total income of less than 250% of the FPL. You have to meet the Social Security Administration’s definition of disabled, and you must have less than $2,000 in personal property. The personal property limit does not count retirement plans or other accounts approved by the IRS.
This program allows you to deduct all disability-based income from total income to qualify under the income requirement. This means if you are deceiving cash benefits through SSI that will not be included when determining total income.
In-Home Supportive Services (IHSS) Program. There are three separate programs that fall under this category. Each program is designed to allow the elderly and people with disabilities to stay in their own homes. Although IHSS services are considered part of the Medi-Cal program, being eligible to receive these services does not mean you are automatically eligible for Medi-Cal health coverage.
Personal Care Services Program – this program includes ancillary services as well as protective supervision. In order to qualify for this program, you need to meet eligibility requirements for full scope, federally funded Medi-Cal
IHSS Independence Plus Waiver – Services under this program include personal care, protective supervision, domestic service, and transportation. To qualify for this program, you must be eligible for full scope, federally funded Medi-Cal. In addition to that, individuals have to go through a needs assessment by an IHSS social worker to determine need.
IHSS Residual Program – This is a state/county-funded program that provides domestic services for individuals who are aged, blind, or disabled and do not qualify for the other two IHSS programs.
Medi-Cal and Medicare: Medicare Savings Programs
These programs are available to low-income individuals already receiving Medicare benefits. The programs are intended to help cover medical expenses not covered by Medicare. These programs can be applied for through the county Medi-Cal offices.
Qualified Medicare Beneficiary (QMB) Program. This program is essential a free Medicare supplemental health policy. The program covers out of pocket expenses such as deductibles and a percentage of doctor visits. It can cover premiums for Medicare Part A and Part B. While it does not cover Part D, recipients can get a subsidy to help pay Part D premiums. In order to be eligible, you have to make less than 100% the FPL.
Specified Low-Income Medicare Beneficiary (SLMB) Program. This program covers the premiums for Medicare Part B only. To be eligible, you must make less than 120% of the FPL. You may also qualify for full Medi-Cal coverage.
Qualifying Individual 1 (QI-1) Program. This program covers the Medicare Part B premiums for people that make between 120% and 135% the FPL. Individuals on this program are ineligible for full Medi-Cal coverage.
Qualified Disabled Working Individual (QDWI) Program. This program is intended to cover the premiums for Medicare Part A. To be eligible for this program, you must make less than 200% the FPL and have less than $4000 in countable resources.
Medically Needy (MN) programs
This program is for people that do not qualify for cash assistance programs like SSI or CalWORKs and meet the SSE requirements for age, blindness, or disability. The program can also cover those that would have qualified under the previous criteria for AFDC. You have to fit into one of the following categories:
- 65 or older
- Parents or children who meet the requirements for deprivation
- Caretaker relatives
There are two versions of this program; one that includes shared costs and one that does not include shared cost. Which program you are eligible is dependent on income.
The Medi-Cal Medically Indigent (MI) Program
The MI Program follows the same income requirements as the MN Program, but provides coverage for specific groups of people that may not fall into the demographic requirements of the MN Program. This program provides coverage for the following groups.
- Abandoned babies
- Children receiving foster care assistance
- Children who are eligible for Aid for Adoption of Children
- Pregnant women and individuals under the age of 21 that do not meet the requirements for the Medically Needy Program
- People between the ages of 21 and 65 that live in nursing facilities but are not disabled
- People without satisfactory immigration status that require nursing home care
Medi-Cal Transitional Coverage Programs
Transitional Coverage Programs are for people that are in a state of transition. This may include people transitioning off of CalWORKs or off of SSI. It may also include people that are leaving the foster care program, experience a change in alimony or child support payments that impacts their eligibility, or people that may experience ineligibility for other programs due to a divorce or death of their spouse. Transitional coverage can also be used to cover individuals while they are being determined for eligibility for certain programs such as the pregnancy-related programs.
Other Medi-Cal Programs
There are a handful of Medi-Cal programs available that do not fall under any of the other categories. These are limited scope programs because they cover the medical expenses related to a specific medical need or condition.
Breast and Cervical Cancer Treatment Program (BCCTP). This program covers the medical expenses related to the treatment of breast and cervical cancer. To be eligible for this program, you must be a California residents diagnosed with breast or cervical cancer and make no more than 200% the FPL. Applicants that meet the following requirements may be eligible for no share Medi-Cal coverage.
- Under 65 years of age
- A citizen or individual with satisfactory immigration status
- No creditable health insurance
- Been diagnosed with breast or cervical cancer
- Be in need of treatment
Applicants may be covered through presumptive eligibility while their eligibility status is being determined.
Family Planning, Access, Care, and Treatment (PACT). This program covers a range of family planning services for both men and women with incomes at or below 200% of the FPL. This program provides partial or full coverage for contraception, emergency contraception, pregnancy counseling, Preconception consoling, pregnancy testing, sterilization, STD testing, STD treatment, cancer screening, HIV screening, and hepatitis B immunization.
Dialysis Program. This program covers medical expenses related to kidney dialysis. It is designed for people that are not eligible for SSI or disability-based Med-Cal. Individuals with higher incomes can qualify and pay on a sliding scale based on their income and property.
Tuberculosis (TB) Program. This program is to cover medical expenses for tuberculosis-related services. Having TB does not automatically qualify somewhere for SSI or disability-based Medi-Cal. There are set income and property limits for eligibility.
Total Parenteral Nutrition (TPN) Program. This program covers TPN intravenous feedings. People that require TPN, but still work may not be eligible for disability-based Medi-Cal. This program provides services on a sliding scale based on their income and property.