How does MediCal determine your “Net Non-Exempt Income”?

I had to complete the ‘Redetermination Form’ (Form: M/C 210) for my grandmother (whom also receives IHSS  In Home Supportive Services).
I submitted ALL relevant information to continue to keep her on the specific medi-cal program; the A & D FLP – Aged & Disabled Federal Poverty Level program.

However they had to have messed something up, because I recieved a letter (on 5/31) from MediCal which states as follows;

“Beginning 07/01/2017 you will no longer receive MediCal Benefits under the ‘A&D FPL’ program, because your income “exceeds” the amount allowed for living expenses” (which is absolutely ridiculous & makes me very irritated) …

“You now have a ‘Share of Cost’ totaling : $663.90”.

Which I’m not quite sure HOW they’re determining these numbers. I submitted all relevant info that was request by Medi-Cal for the redetermination form;

•Utility bills($179mo.)
• Rent : $779
•Secondary Health ins ($297.90mo)
•Medicare Premium ($57.10, medi-cal pays part B + some of part D equaling $120 per mo.)
• bank statements, ect…
(* also., Her only income is SSI *)

GROSS INCOME = $1633.00

***The Aged & Disabled Program only allows $1,235 in countable monthly income (income left after allowable deductions Disability Rights) for an individual  CA Health Care Advocates * Our webpage

Countable Income Calculation (Medi-Cal)

The formula used to determine income and to consider eligibility for SSI-Linked, Medically Needy, and Aged and Disabled Medi-Cal programs.

Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 “General Income Exclusion” from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.

Step 2: If you have earned income (for example, wages), subtract a $65 “Earned Income Exclusion” from it (along with the remainder of the $20 “General Income Exclusion” that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide by two.

Step 3: Add your countable unearned income to your countable earned income to find your total countable income.

Different Medi-Cal programs may include more deductions or exclude certain types of income. See the program descriptions for details.  DB 101 

NET NON EXEMPT INCOME = $1321.50
• MAINTAINENCE NEEDS = $ 600.00
• “Extra Income” / Share of Cost = $ 663.90

 

SO, here’s what I’m asking you:

1.) how did they determine my grandmothers “NET NON-EXEMPT INCOME” $1,321.05 ?

I thought (according to db101.org)

***Please use the full URL.  Is this it?  https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm   

Please send me your actual paper work.  It looks like the page above explains how to do the calculation and it’s in your favor.

that “net non exempt income” should be calculated (at roughly) 1/2 of your income,

***I don’t see that anywhere

& that her countable income would be based upon $768 (or so) then SUBTRACT DEDUCTIONS & MAINTENANCE NEEDS of the standard issue for a “single person”. Which then she would have ZERO a share of cost, just as before!

 

#2.) where the hell are they coming up with the number of $663.90 for her “excess income / Share of cost”?? I am thinking it’s maybe “extra income” because Medi-Cal pays her Part B + Part D ins. Premium – B+D monthly totaling $124.80 (which leaves her only paying $57.10 for part D which is deducted from her SSI for Part D)

 

Medi-Cal with a Share of Cost (SOC)

If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program (see above), but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC). An SOC functions like a deductible. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month.

Note: A SOC is not a monthly premium. It is more like a deductible. It is the amount of medical expenses you are responsible to pay for before you can get full Medi-Cal coverage for the remainder of the month. If you have no medical expenses, you pay nothing.

Your SOC is determined according to your monthly income, using the following formula:

Medi-Cal subtracts $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying.

For example, if you have an individual monthly income of $1,300,

Medi-Cal subtracts $600

for a SOC of $700.

This means you must pay at least $700 in covered medical expenses and/or health care premiums in a given month before Medi-Cal covers any of your health care costs for that month. For people with a high SOC, Medi-Cal is mostly a form of catastrophic coverage, meaning Medi-Cal will most likely only help them for emergencies or high-cost medical conditions.

Note: If you have Medi-Cal with a SOC, Medi-Cal will not pay your Medicare Part B monthly premium. This means your Part B premium will be deducted from your Social Security check each month. One exception applies if you are in a Medicare Savings Program (MSP) that pays for your Part B premium (QMB, SLMB or QI). If you are in one of these MSPs, you will not be affected.

If you meet your SOC with medical costs in any given month, Medi-Cal will retroactively pay your Part B premiums for the month(s) in which the SOC is met. Medi-Cal will send the payment to the Social Security Administration (SSA), which will refund you the amount of the premium. Any Part B premium refund received from the SSA will be counted as a resource, not income, in the month you receive it. cahealthadvocates.org/ShareOfCost  

 

Can you help me determine where the hell They went wrong and screwed up!? I am hoping that this isn’t confusing & I wrote this in a way that is understandable & doesn’t make you go cross-eyed lol

2 comments on “Net Non Exempt Income

  1. My grandma earns 1096 through social security and then she ears $586 through her pension for a total of 1682.47

    They have calculated her net non exempt income at 1400.55 beginning 12/2017

    Minus her $600 maintenance need means she has a share of cost of $801 beginning 12/2017.

    The wierd thing is my grandma was approved for medi-cal and IHSS last year with the same income.

    I’m thinking somehow the non exempt income might have been calculated differently.

    Can you please help me figure out how they determine non exempt income?

    I looked at the link above https://ca.db101.org/ca/programs/health_coverage/medi_cal/program2a.htm but it didn’t help me.

    My grandma cannot pay for any share of cost. Her rent alone is over $800 per month not counting any bills etc.

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