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

full-scope Medi–Cal

(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:

  1. Be aged (65+) or disabled (meet Social Security’s definition of disability, even if your disability is blindness).
    1. Listing of Impairments
  2. Have less than $2,000 in Countable assets for an individual ($3,000 for a couple).
    1. Medi-Cal property limitations.
    2.  asset questionnaire
    3. CANHR simpler list
    4. CANHR Fact Sheet
    5. Understanding Medi-Cal’s Asset Test for Seniors and People With Disabilities
  3. 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

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 websiteCA 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.

Would an immediate annuity help your situation?

Medi-Cal Trumps Covered CA Subsidy Programs

Qualification for Elderly and Disabled

This video was done in 2009 – I’m not sure how it applies to MAGI Medi-Cal Qualification – check with www.youtube.com for the other video’s in this series

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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
blue arrowBenefits
blue arrowResources
blue arrowIncome
blue arrowLiving 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

12 comments on “Aged and Disabled Federal Poverty Level Program

  1. 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

  2. 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.

  3. 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?

  4. 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.

  5. 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.

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