Aged & Disabled Federal Poverty Level Program
Worksheet and Explanation for
Single Adult Not Living in Board & Care

The Step numbers below correspond to the steps listed on the blank worksheet. The Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal program follows SSI income rules.

Under the A&D FPL program, as under the Federal Poverty Level programs for children and pregnant women, you qualify only if your income is within allowable limits. You cannot “spend down” excess income on medical expenses to qualify as you can under the medically needy programs. However, you can deduct any health plan premiums, such as a dental, health or vision policy, in determining your countable income.

If there are children in the home, go to worksheet 3 for an adult with an ineligible spouse and/or children.

Step 1:

Enter your unearned income before any deductions for health insurance premiums or tax withholding. For instance, if you receive Social Security benefits from which Medicare premiums are deducted, the Medi-Cal program counts the amount of Social Security benefits before any Medicare premium deduction. Unearned income includes interest, pensions, annuities, state disability insurance and unemployment benefits.

Step 2:

Deduct the $20 any-income deduction.

Step 3:

Enter the balance, if any. The balance is the total countable unearned income.

Step 4:

Do you have any earned income? If so, enter your gross earned income before any deductions. If you are self-employed, your gross earned income means your adjusted gross income – that is, your gross income receipts less IRS allowable deductions.¹ Earned income includes any income on which Social Security taxes are paid or are payable, honoraria, and book royalties. Gross income does not include earned income put into a cafeteria plan through work for child care or medical expenses, because that income is not subject to Social Security taxes. ²

Step 5:

Deduct the balance (any amount left over) of the $20 any income deduction. Look at Step 2 and see if any part of the $20 deduction was unused.

Step 6:

Deduct the $65 earned income work incentive deduction.

Step 7:

Deduct any Impairment Related Work Expenses or IRWEs. IRWEs are out-of-pocket expenses you have both because you work and you have a disability. Examples include attendant care for help before, after and during work; transportation when you cannot use or reliably use public transportation because of your disability. IRWEs also include out-of-pocket medical expenses if needed to work even if you would have the same expenses if you were not working. You are eligible to take this deduction if you are under age 65. If you are age 65 or older, you can take this deduction if you qualified for Medi-Cal or other benefits on the basis of disability before you were 65.

Step 8:

Enter the subtotal after deducting the unused portion of the $20 any income deduction if any (Step 5), the $65 earned income deduction (Step 6), and any IRWE deductions from the gross earned income (Step 7).

Step 9:

Deduct 50% of the subtotal entered at Step 7. This is an additional work incentive deduction.

Step 10:

Enter the balance after deducting the amount in Step 9 from the amount in Step 8. This is your total countable earned income. The amounts in Steps 9 and 10 should be the same.

Step 11:

Add together your total countable unearned income and your total countable earned income.

Step 12:

Deduct any health insurance premium payments that you pay for. Department of Health Services (DHS) All-County Letter (ACL) 01-18; MC 176 Aged/Disabled FPL group spreadsheet (10-17-00)

Step 13:

The remainder is the individual’s countable income.

Authority: Welf. & Inst. Code § 14005.40; DHS ACLs Nos. 00-57, 00-68, 01-18, 02-38.

Blank A&D FPL Worksheet for an Individual

Is the amount in Step 13 equal to or less than $1133 in 2009? That amount is 100% of the FPL ($903 in 2009) plus $230. If yes, then you qualify for Medi-Cal with no share of cost.