Monday, June 29, 2009

A Lesson in Benefits Problem Solving

The following is the body of a letter that I received several days ago. It illustrates well the misunderstandings and confusion that result from disabilty programs' rules and regulations. The greatest difficulty lies in the acronyms used to identify benefits. They are all quite similar and it is very easy to misuse them.


Thank you so much for responding. Your information was very helpful. My COBRA expired after 18 months and care-hipp paid the last year of it. But they simply sent me a letter and told me that my Cobra had ended and there was no more portability and that I was not eligilble for any extentions.

It's a moot point now since I only have two more months and I get Medicare. I will adjust my income to get medi-cal. Do you happen to know how much I am able to make to be eligible? My SSI checks are $1300/mo. which only covers my rent.

This individual is not receiving SSI. He/she is receiving SSDI. In California, the most a sighted SSI recipient living alone can recieve is $850.00 per month. Receiving $1300 per month from Social Security indicates that this individual is receiving SSDI (Social Security Disability Insurance)

Right now I have some help from (county) Housing but that's going away completely in October. I will call you closer to September 1st when my Medicare kicks in, but for right now, if I apply for Medi-cal in September to go along with my Medicare, how much can I suppliment my income?

No Share of Cost Medi-Cal is available to those whose countable income is less than $1,133 per month. There are ways to reduce countable income, the most frequently used is the purchase of a supplemental dental or vision insurance plan with monthly premiums high enough to reduce monthly income to below the $1,133 level.

(I was originally told by my benifits counselor that I could not qualify for medi-cal with more than $2000.00 worth of assests and that I must spend any assets I have, so I spent down $62.000, ( all the way down to seven,) trying to qualify but I'm afraid to spend any more of my little emergency cushion.). That's all I have put away for the rest of my life.

It is true. Medi-Cal assets limits exempt:

  1. One home as primary residence
  2. One car
  3. No more than $2000 in all accumulated assets -- Checking, Savings, IRAs, 401Ks, Pensions, etc.
I thought I heard you say during your talk that the work suppliment program through SSDI is not based on assets but on income and that if I made less than a certain amount a year to suppliment my SSDI, that I could qualify for Medi-medi. Is that correct?

No, not correct. You're discussing two separate issues.

  1. SSDI has no assets limits. You may have an unlimited savings account(s), numerous homes and cars, etc., you may still qualify for SSDI. If you are found to be medically disabled, then your payments will begin.
  2. If you are receiving the benefit and want to enter or re-enter the workplace, you may do so. If your earnings are under $700 per month in 2009, your SSDI benefit will not be affected at all. If you earn over $700 gross, you will have triggered a Trial Work Month (TWM).

    Nine Trial Work months constitute a Trial Work Period (TWP). When the Trial Work Period ends at the end of the 9th month the Extended Period of Eligiblity (EPE) begins. That lasts for 36 months.

    During those months, any earnings above "Substantial Gainful Activity" (SGA) --$980 per month -- will disqualify you for the benefit for that month. If earnings fall below $980 during any of those 36 months, you will be entitled to the benefit.

    None of the above affects your Medicare. That you may keep with no change to the Part B preimum for nearly 9 years.
  3. Medi-Cal operates separetly from Medicare. There is a Medi-Cal program called the Working Disabled Program that will provide No Share of Cost Medi-Cal to anyone who is disabled and earning income -- as long as their assets are no more than 1 home, 1 car and less than $2,000 in checking, savings, IRAs and other savings programs.

    This progam requires that the applicant earn income by providing a product or a service to anyone -- an individual, a business, etc. -- who is willing to pay him/her for that service on a regular basis. This could mean a job in the conventional sense of "a job." It could mean something less conventional... walking a dog, pet sitting, even, in some cases, regularl recycling cans and bottles; anything to earn a consistent income.

    This program charges a premium instead of a Share of Cost. Earnings between $1.00 and $600.00 generate a premium of only $20.00. The amounts increases as earnings increase.

    Go to and for more information.

    How much would that amount be?) Again, thanks in advance for all your help. I have spent down most of my life's savings because a benefits counselor told me I had to. I hope a didn't make a mistake.

    I don't know about making a mistake but I do know that you will have to have less than $2000 to qualify for Medi-Cal. There are no asset limits for Medicare.

    I hope this helps. Please comment here on the blog or e-mail me at if you have any questions.

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