The federal SGA amount will increase to $980 effective January 1, 2009. Counties will retroactively redetermine Medi-Cal eligibility based on disability if a case has been denied erroneously due to a delay in implementing the new SGA amount. SGA rules do not apply to blind individuals, Medi-Cal beneficiaries who return to work after disability has been approved, or to applicants of the Medi-Cal 250% Working Disabled Program. [Download]

Effective January 1, 2009, the community spouse resource allowance is $109,560 and the new maximum spousal income allocation/minimum monthly maintenance need allowance is $2,739 per month under the MCCA. [Download]

This letter corrects the date that affected beneficiaries will see the Part B premium deducted from their Social Security checks. Checks will be affected December, 2008, not November as stated in ACWDL 08-48. Counties are also reminded that they can suggest the 250% Working Disabled Program to beneficiaries as a program in which beneficiaries are not responsible for the Part B premium. DHCS sent a letter in October, 2008 alerting beneficiaries that they would have to begin paying the Part B premium; unfortunately they sent this letter to beneficiaries who are MSP eligible too. In November they will send a letter to the same group of people with more information about the Part B premium, MSPs, SOC, and the 250%WDP. Enclosed in this ACWDL is a copy of the letter SS will be sending to beneficiaries regarding the Part B premium. [Download]

This ACWDL puts part of budget trailer bill AB 1183 into effect by eliminating the state buy-in of Medicare Part B premiums for beneficiaries with a share of cost over $500 until or unless the SOC is met on a monthly basis. Some details:
-The change is effective 10/1/08 and will affect SS checks received in November (But not really, See ACWDL 08-48E)
-People eligible for a Medicare Savings Program will still have their Part B payments paid by the govt. Counties must determine MSP eligibility immediately for all Medi-Medis with or without a SOC. (See ACWDL 08-21)
-Beneficiaries who have to pay the Part B premium can disenroll from Medicare Part B with no negative affect on Medi-Cal eligibility, 22 CCR 50763(a)(1) only requires beneficiaries to apply for other health care coverage when no cost is involved.
-When beneficiaries begin to pay their own premiums Counties must recalculate the SOC deducting the Part B premium. They will receive a NOA letting them know why the SOC is being reduced and that they can disenroll form Medicare Part B and what some of the consequences of that will be.
-If a beneficiary pays the Part B premium and that deduction brings the SOC below $500 or makes them eligible for A&DFPL DHCS will pay the premium for that month retroactively, if the SOC then goes back up because the Part B premium is no longer being deducted the County needs to send a NOA.
-Reimbursement from SSA will be treated as property in the month of receipt
-Counties are not to predict buy-ins [Download]

Elton John’s plea to not let the sun go down on the working disabled was answered by AB1183. The sunset date of January 1, 2009 was eliminated by AB 1183 (Chapter 758, Statutes of 2008). The 250% Working Disabled Program will now operate indefinitely as a permanent Medi-Cal program. The 250% WDP allows employed individuals with disabilities to earn up to 250 % of the FPL and receive full scope Medi-Cal benefits. [Download]

This ACWDL lays out some changes in self-certification and independent evaluation minimum sample requirements. Included are the mandatory performance levels that must be achieved including 90% of regular applications processed in 45 days and disability applications processed in 90 days. [Download]