Transcript PowerPoint
WORK AND PERSONAL ASSISTANCE
SERVICES: MAINTAINING AND USING
IHSS IN THE WORKPLACE
Presenters:
Karla Bell and Rachel Stewart
California Health Incentives Improvement
Project
Getting Started
To use the Captioning window:
Click the Window pulldown menu and select Show
Closed Captioning
A Captioning window will appear at the bottom of your
screen
You may resize and move this window to meet your
viewing needs
Asking Questions:
The presenter will take your questions at the end of the
presentation using the Chat window
We will provide links to the CRC quiz and survey at
the end of the Webinar
Who can be eligible for In-Home Supportive
Services?
Any California resident, living in his/her own home, who is
already eligible for Medi-Cal can be eligible for IHSS
The four eligibility categories people with disabilities most
often use to get on Medi-Cal are:
SSI-linked Medi-Cal
Aged and Disabled Federal Poverty Level Medi-Cal
Medi-Cal Working Disabled Program
Aged, Blind, and Disabled Medically Needy Medi-Cal
See DB101 Medi-Cal Program description for more
information on these programs: www.db101.org
IHSS Services
In-Home Supportive Services (IHSS):
services to help individuals remain safely in
their home, including:
Housecleaning
Meal preparation
Laundry
Personal care services (bowel/bladder care,
bathing, grooming, dressing, etc.)
Accompaniment to medical appointments
Protective supervision
Myth: If I go back to work I’ll lose my
Medi-Cal and IHSS
Medi-Cal While Working--Section
1619b
Medi-Cal Working Disabled Program
Supplemental Security Income (SSI)
Work Incentives
Section 1619(b):
SSI work incentive that allows working SSI recipients
keep free Medi-Cal
Free Medi-Cal coverage continues until earnings reach a
threshold amount:
$35,023 (non-blind)
$35,716 (blind)
These are 2011 amounts for California
People with high medical costs or publicly funded
attendants (i.e. IHSS) can earn even more
(“Individualized Threshold”)
Benefits can start again if you stop working or your
earnings decrease (Reinstatement)
1619(b)
To qualify:
Have been eligible for an SSI cash payment for at least 1
month;
Would be eligible for cash payment except for earnings;
Still be disabled or blind;
Still meet all other eligibility rules, including the resources
test (SSI resource limit: $2000 individual/$3000 couple);
Need Medi-Cal in order to work;
Have gross earned income that is insufficient to replace
SSI, Medi-Cal, and any publicly funded attendant care.
1619(b)
Individualized Threshold: threshold can be adjusted on a case-by-
case basis
Higher Individualized Threshold if:
Blind Work Expenses (BWE)
Impairment Related Work Expenses (IRWE)
Plan to Achieve Self-Support (PASS Plan)
Publicly Funded Personal Attendant (i.e. In-Home Supportive Services)
Medical Expenses above State Average
Social Security’s Programs Operation Manual reference:
SI 02302.050 Individualized Threshold Calculation
https://secure.ssa.gov/apps10/poms.nsf/lnx/0502302050
Area Work Incentives Coordinators
http://www.ssa.gov/sf/awic.htm
Medi-Cal Working Disabled Program
The 250% Medi-Cal Working Disabled Program
allows individuals to earn up to $55,476/year and
keep their Medi-Cal!
Eligible couples can earn up to $74,580/year
Even higher wages are allowed with IRWEs
Affordable monthly premiums to access Medi-Cal
and IHSS without a share-of-cost
$20-$250 for individuals
$30-$375 for couples
Medi-Cal Working Disabled Program
Disability-based income is exempt when determining
eligibility for program and maximum earnings
i.e. SSDI, Workers Comp, State Disability
Insurance, private disability insurance
Allowed to have IRS-approved retirement accounts –
these do not count towards the typical $2000 (or
$3000 for couples) asset limit for Medi-Cal
i.e. Individual Retirement Accounts (IRAs), 401(K),
403(B), Profit Sharing, Individual (K), Solo DB, Safe
Harbor 401(K), ROTH IRA, 457, ROTH 403(B), KEOGH
Plans, TSA Tax Sheltered Annuities, Stretch IRA, Thrift
Savings Plan (TSP)
Medi-Cal Working Disabled Program
If also on Medicare – are fully “dually-
eligible”:
Medi-Cal pays Medicare Part B premium
Medi-Cal’s co-pay and premium payment
programs for Qualified Medicare Beneficiaries
(QMB)
Access IHSS services (not covered by
Medicare or private insurance)
Automatically qualify for Medicare Part D Low
Income Subsidy (LIS)
Medi-Cal Working Disabled Program
To qualify:
Meet Social Security’s definition of disability
(medical definition only, does not count the
ability to earn income)
Be employed full-time or part-time, including
self employment, with countable earnings
below 250% of the Federal Poverty Level
An applicant may be employed by a business, or be
self employed or an independent contractor
Work is undefined
No set amount of hours required
No minimum earnings criteria
Medi-Cal Working Disabled Program –
Improvements
Assembly Bill 1269 was signed into law by
Governor Schwarzenegger on 10/11/09
This Bill improves the Medi-Cal 250% Working
Disabled Program
Allows additional income and resource exemptions
Extends work stoppage protection to 26 weeks
Changes current premium calculation
As of August 1, 2011 the less restrictive changes will
be implemented
Department of Health Care Services will send a notice
to all current Working Disabled Program enrollees
ACWDL will also be issued to the Counties
Medi-Cal Working Disabled Program Improvements
As of August 1, 2011 – the following “less
restrictive” changes will be implemented:
Eliminates retirement age restriction by
exempting retirement income that converts from
Social Security Disability Insurance (SSDI)
income
All exempt IRS-approved retirement accounts
allowed under the 250% Working Disabled
Program will continue to be exempt when
transferring to other Medi-Cal Programs
Less Restrictive Changes, cont.
Allows Earnings to be saved in separately identifiable
account with no cap
These earnings cannot be combined with other resources
Account must be separate from your regular savings and
checking accounts
Earned income that is in your separate identifiable account will
not be counted as a resource for the WDP Program
Allows enrollees who are temporarily unemployed to
remain in the program for up to 26 weeks during their
work transition
Enrollees are required to pay their monthly premium during time
of unemployment
Future Changes
In 2019 (after MOE provisions to ACA expire), the
more restrictive changes will be implemented
Premium calculation will be changed to 5% of
countable income
Minimum and maximum premium amounts will
remain the same:
$20-$250 for individuals
$30-$375 for couples
Disability-based income and retirement income
will also be included in the 5% premium
calculation.
Myth: I’ll lose my
Medi-Cal and IHSS
Myth: In-Home Supportive Services hours
can only be used while at home
In-“HOME” Supportive Services
Old Thinking
People with disabilities are not able to work
Therefore, they are only allowed to use their
IHSS hours in the home (or for occasional trips
to the doctor)
New Thinking
Work opportunities are expanding for people
with disabilities
IHSS hours can now be used at work as well
as home
IHSS at Work
IHSS in the Workplace – AB 925 (effective 2003):
Allows the transfer of previously authorized IHSS
hours to use in the workplace
Important: No new hours or new services
Limited to services currently authorized for use in
the home
Cannot receive additional hours for employment
purposes
Services (or hours) transferred are to enable the
recipient to “obtain, maintain, or return to, work”
Services must be “relevant and necessary in
supporting and maintaining employment”
IHSS at Work
Services needed to “obtain, retain, or return to,
work”:
Obtain: traveling to job interviews, pre-employment
testing, and personal care during these activities
(does not include college or vocational courses)
Retain/return to work: includes personal care on the
job
Must be “relevant and necessary”:
Paramedical services
Personal care
Related Services, as defined in WIC 12300
Workplace Personal Assistance Services
Two types of Workplace Personal Assistance
Services:
1.Personal care-related assistance
Assistance in the restroom, on lunch breaks
Can use IHSS hours
2.Job-related assistance
Interpreting, lifting or reaching work materials, travel
assistance between work sites
Cannot use IHSS hours (employer may have a
responsibility under the ADA to provide reasonable
accommodations for job-related tasks)
Using IHSS in the Workplace
Before you start using IHSS hours in the
workplace, you must contact your social worker
to discuss the transfer of hours (how many, for
what services, etc.)
Refer IHSS Social Worker to Dept of Social Services
All County Letter (ACL) # 04-43
Currently, we have no knowledge of how many
people are taking advantage of the IHSS at work
option (Dept. of Social Services does not track
this in their system)
Myth: In-Home
Supportive Services
hours can only be
used while I am at
home
Question and Answer
The webinar Chat window is now open for your
questions
Type your question into the text entry area below
the Chat window
Click enter or return on your keyboard to submit
your question
Survey and CRC Credits
Please give us feedback on today’s webinar by completing
our survey:
http://www.surveymonkey.com/s/RZX7VYZ
Certified Rehabilitation Counseling (CRC) Credits are
available for this webinar:
To receive CRC credits please complete this short quiz
and survey:
http://interwork.sdsu.edu/chiip/webinar/archive/crc_credit
s/111007/webinar.html
We will also follow up with an email with links to the CRC
quiz, survey and archive of the webinar so you can listen
to it again
Contact information
Karla Bell:
[email protected]
Rachel Stewart:
[email protected]
www.talentknowsnolimits.info