The ABD FPL program is a no-share of cost, full-scope Medi-Cal program for people who are over the age of 65, or who have a disability.  It has a higher income limit than other Non-Magi Medi-Cal programs.

This publication and attached worksheets can be used to determine eligibility under the ABD FPL program as an individual, couple, or an individual in a family. 

The worksheets are in the following order:

• Individual,
• Couple,
• Individual with spouse and/or children.

The income limits for the ABD FPL program are: Individual $1,801; Couple $2,433.1 Income is anything received in a month that can be used to provide for food and shelter.  Income becomes an asset as of the 1st of the following month.  Medi-Cal does not count assets when determining Medi-Cal eligibility.2 Examples of assets are things that you own like your home, car, money in a bank, or retirement account.

Note: Most people who qualify for ABD FPL Medi-Cal may also be eligible for food stamps. If you are on food stamps – now called CalFresh – you get a plastic card to use like an ATM or debit card to purchase food. There are special rules and extra deductions to help seniors (60 and older) and people with disabilities get CalFresh.

You can contact your county welfare department or your County Medi-Cal or IHSS eligibility worker to ask for more information. You may also want to contact your local legal aid for help. Disability Rights California does not have expertise in CalFresh eligibility.

What happens if your countable income is too high to qualify for no-share of cost Medi-Cal under the ABD FPL program?

Your “net countable income” is the income that is left over after allowable exclusions and deductions have been applied, such as unearned and earned income deductions.

If your net countable income is higher than the income limit to qualify for the ABD FPL program, then you may:

• Qualify for the ABD FPL program as a single individual, by purchasing additional supplemental health insurance,
• Qualify for the ABD FPL program as a couple, by purchasing additional supplemental health insurance, or
• Apply for the 250% Working Disabled Program.

Also, the county must review your eligibility for all Medi-Cal programs that you may qualify for. This may include the:

• Pickle program,
• Disabled Adult Child (DAC) program, or
• Aged, Blind, and Disabled (ABD) Medically Needy (MN) program.

There are also other tools that the county can use to help you establish eligibility for Medi-Cal. Some of these are:

• Long Term Care (LTC) Medi-Cal with a Community Spouse – Spousal Impoverishment Provisions,
• Long Term Care (LTC) Medi-Cal with Parents or a Spouse – Home and Community Based Services (HCBS) Waivers, or
• Cafeteria Plan – Exempt income for working people with cafeteria plans.

The rest of this publication will describe the bulleted points above a through i in more detail.

(a) Qualifying for the ABD FPL program, as a single individual

To qualify for the ABD FPL program, you can buy supplemental health insurance and pay a monthly premium, such as: dental insurance, vision insurance, and Medigap insurance. The premium amount you pay out of pocket each month is deducted from your countable income before assessing whether you are eligible for the ABD FPL program.

Calculation – Single Individual

Here is an example of how to determine how much you will need to pay in monthly health insurance premiums to bring your countable income down low enough to qualify for the ABD FPL program.

In this example, Mai lives by herself in a household of one. Mai’s only income is $2,100 from Social Security Retirement.

Step 1

$2,100 (Mai’s gross unearned income) – $20 (unearned income deduction) – $185
(average 2025 Medicare Part B premium) = $1,895 (countable income).

Step 2

$1,895 (countable income) - $1,801 (2025 ADB FPL single individual income limit) = $94 (net countable income/amount money Mai is over the income limit).

In this example, Mai must spend at least $94 to bring her net countable income low enough to qualify for the ABD FPL program.

TIP: For help in finding insurance to help you qualify for the ABD FPL program, contact a healthcare insurance agent or your local “Health Insurance Counseling & Advocacy Programs” (HICAP) at: https://cahealthadvocates.org/hicap/. You must tell HICAP how much you need to spend on insurance each month to qualify for the ABD FPL program. HICAP will not figure that out for you.

(b) Qualifying for the ABD FPL program, as a couple

To qualify for the ABD FPL program as a couple, you or your spouse can buy supplemental health insurance and pay a monthly premium. The amount you or your spouse pays out of pocket each month is deducted from your combined countable income before assessing whether you are both eligible for the ABD FPL program.

Calculation - Couple

Here is an example of how to determine how much you and your spouse will need to pay in monthly health insurance premiums to bring your countable incomes down low enough to qualify for the ABD FPL program.

Alice and Alberto are a married couple. They receive $3,000 from Social Security before any Medicare deductions are paid. They are not eligible for the ABD FPL program because their combined net countable income is above the ABD FPL couple income limit of $2,433. Their income is $177 too high. If they pay at least $177 a month in health insurance premiums, such as dental, vision, etc., their countable income would be brought down to the ABD FPL income limit for a couple of $2,433.

Step 1

$3,000 (couple’s gross total income) - $20 (unearned income deduction) - $370
(couple’s Medicare premiums) = $2,610.

Step 2

$2,610 (countable income) - $2,433 (2025 ABD FPL couple income limit) = $177 (net countable income/amount money couple is over the income limit).

In this example, the couple must spend at least $177 to bring their net countable income low enough for both people to qualify for the ABD FPL program.

(c) 250% Working Disabled Program

If you would like to test your ability to work, then you may want to consider the 250% Working Disabled Program.  Eligible individuals receive no-cost Medi-Cal.

Under the 250% Working Disabled Program, disability-based income is not counted as income.  Examples of disability-based income include things like Social Security Disability Income (SSDI), private disability pensions, etc.  The definition of work is broad so your work can be things like recycling cans or tutoring and there is no minimum number of hours you must work or earnings you must have.

Basic Eligibility

• You must be working (The county will ask that you provide proof such as paystubs, a letter from an employer or receipts from recycling),
• You must meet the Supplemental Security Income (SSI) definition of disability,
• Have net family income below 250% of the Federal Poverty Level (FPL),
• You must be eligible to receive SSI after excluding your earnings and disability-based income.  Non-disability-based income such as retirement or pension benefits will be counted in determining if you are eligible to receive SSI,
• Meet all other non-financial eligibility criteria.3

TIP: For more information on the 250% Working Disabled Program, you can visit the California Department of Health Care Services website or contact your county welfare office.

(d) Pickle Program

Did you (or your eligible spouse) ever qualify for SSI and Social Security at the same time?4 Social Security benefits include any dependent benefits received by children. If so, you (and/or your eligible spouse) may be eligible for no cost Medi-Cal under the Pickle program. 

For more information about the Pickle program eligibility you can review the National Health Law Program’s flyer entitled, A Quick and Easy Method for Screening for Medicaid Eligibility under the Pickle Amendment: 2025 Update.

(e) Disabled Adult Child program

The Disabled Adult Child (DAC) Medi-Cal program is for DAC Social Security recipients who lose their Supplemental Security Income (SSI) benefits because of a cost-of-living increase in Social Security benefits or because they became eligible for Social Security benefits. Eligible individuals receive no-cost Medi-Cal.

If you think you may be eligible for DAC Medi-Cal benefits you can ask the county welfare office to process an application for DAC Medi-Cal benefits. For more information about DAC Medi-Cal, please review the Disability Rights California publication entitled, Disabled Adult Child Medi-Cal Program Benefits.

(f) Aged-Blind-Disabled (ABD) Medically Needy (MN) program

The Aged-Blind-Disabled (ABD) Medically Needy (MN) program is a Share of Cost (SOC) Medi-Cal program. The share of cost is the countable income minus the applicable maintenance need level (MNL) based on family size – i.e., $600 for one person, $750 for an adult and child, $934 for a couple or three-person family, etc.5

Calculation – Couple under ABD MN

In this example, Alice and Alberto are a married couple. Their combined gross income before Medicare deductions is $3,200. After the $20 unearned income deduction and $370 Medicare premiums are deducted from their gross income their net countable income equals $2,810. They are not eligible for the ABD FPL program because their net countable income is above the 2025 ABD FPL couple income limit of $2,433. However, they may be eligible for ABD MN program with a Medi-Cal share of cost of $1,876.

Here is how to determine how much a couple’s Medi-Cal SOC will be for the ABD MN program.

Step 1

$3,200 (gross income) - $20 (unearned income deduction) - $185 (Alice’s Medicare Part B premium) - $185 (Alberto’s Medicare Part B premium) = $2,810 (couple’s countable income).

Step 2

$2,810 (couple’s countable income in step 1) - $934 (Maintenance Need Level for a couple) = $1,876 (couple’s Medi-Cal share of cost).

TIP: For the ABD MN program you can also deduct out-of-pocket healthcare costs not covered by your insurance to meet your Medi-Cal SOC each month.6 If you are found eligible for ABD MN Medi-Cal with a SOC, you may want to consider asking for Medi-Cal under the other Medi-Cal programs discussed earlier.

(g) Long Term Care Services through Medi-Cal with a Community Spouse – Spousal Impoverishment

Long-Term Care (LTC) Medi-Cal pays for nursing facility and Home and Community Based Services.  If you need Long-Term Care (LTC) Medi-Cal but you have too much income to qualify for no-cost Medi-Cal and your spouse does not require Long-Term Care (LTC) Medi-Cal, then you may use “spousal impoverishment protections” to allocate your income to your spouse to establish Medi-Cal eligibility without a share of cost.  You can use “spousal impoverishment protections” to help you qualify for Medi-Cal if you are in a skilled nursing facility, on the waitlist for, or getting Home and Community Based Services.  Medi-Cal does not count assets when determining Medi-Cal eligibility.

Medi-Cal "spousal impoverishment protections" allow a Medi-Cal beneficiary who needs LTC Medi-Cal to give a limited amount of their monthly income to the spouse that does not need LTC Medi-Cal. This monthly income limit is called the “Minimum Monthly Maintenance Needs Allowance” (MMMNA).  You can transfer some or all your income to your spouse until your spouse’s income combined with what you give to your spouse reaches the monthly MMMNA income limit.  You can also deduct the amount paid for Medicare of other health insurance premiums when determining if your spouse’s income is below the MMMNA income limit.

The limit on how much income can be allocated to spouses goes up every year based on cost-of-living increases. In 2025, the community spouse’s Maximum Monthly Maintenance Needs Allowance (monthly income limit) is $3,948.7

After you have transferred some or all of your income to your spouse, up to the allowable monthly income limit listed above, what is leftover in income will be used to determine your eligibility for Medi-Cal.

TIP: If the Medi-Cal programs are based on age or disability, then IHSS income cannot be deemed to the spouse for purposes of determining the disabled spouse’s Medi-Cal eligibility.8

Calculation – Couple using spousal impoverishment protections

In this example, Alice and Alberto are a married couple.  Alberto is temporarily in a rehabilitation facility.  He needs Long-Term Care Medi-Cal so he can go home with In-Home Supportive Services and Home and Community Based Services.  Alice has employer-based health insurance and pays $100 per month for health insurance.  Alice does not need Medi-Cal.  Alberto is going to hire his wife to be his IHSS caregiver.  Alberto receives a pension of $3,200 per month.  Alice receives a pension of $700 per month.  They have no other income.

Calculation for Income

Here is how to determine how much income Alberto can give to Alice.  The remaining income Alberto has will be used to establish his eligibility for Medi-Cal.  Alice’s IHSS provider earnings will not count, as stated above.

Step 1

Note: 2025 Maximum Monthly Maintenance Needs Allowance (maximum monthly income limit) is $3,948.  Alice’s income is a $700 pension. However, Alice’s $100 health insurance premium reduces her monthly income to $600 per month.

$3,948 (maximum monthly income limit for Alice) - $600 (Alice’s income) = $3,348 (the amount of money Alberto can give to Alice).  Alberto can allocate a maximum of $3,348 to Alice.

Step 2

Alice keeps her $700 pension and Alberto gives Alice all of his income ($3,200) each month.  Alice now has $3,900 each month to live from.

Step 3

Alberto has $0 income because he allocated all of his income ($3,200) to Alice.  Alberto can get no-cost Medi-Cal under the ABD FPL program because his countable income is under the ABD FPL $1,801 monthly income limit for a household of 1.  Alice can then choose not to take Medi-Cal or establish Medi-Cal eligibility under another Medi-Cal program.

(h) Access to Medi-Cal through Home and Community-Based Services Waivers

If an individual is ineligible for LTC Medi-Cal services because their spouse or parent’s income and/or resources are too high, then the person who needs LTC Medi-Cal may be able to qualify for Medi-Cal through one of Medi-Cal’s Home and Community-Based Services waivers. Income protections like institutional deeming and spousal impoverishment apply to Waiver recipients and can help individuals qualify for Medi-Cal. Here is where you can find a list of California’s Medi-Cal waivers.

(i) Cafeteria Plan – Exempt Income

If you have earned income, see if your employer has a cafeteria plan to pay for unreimbursed medical expenses. Money put in a cafeteria plan does not count as income under Social Security and Medi-Cal rules because those funds are exempt from Social Security (FICA) withholding taxes.

ABD FPL Worksheets

Single Adult - Not Living in Board & Care

Eligible Couples - Not living in Board & Care

Adult with an Ineligible Spouse and/or Children

Additional Medi-Cal Resources

You can visit our Medi-Cal Self Advocacy Resources webpage for more information about Medi-Cal. For help with determining your Medi-Cal eligibility you can contact https://healthconsumer.org/.

For Legal Assistance Call

• Call DRC’s intake line at: 1-800-776-5746.
• Call DRC’s Office of Clients’ Rights Advocacy (OCRA) at:
  • Northern California 1-800-390-7032 (TTY 877-669-6023)
  • Southern California 1-866-833-6712 (TTY 877-669-6023)

You may also complete a Get Help Form.

• 1. Department of Health Care Services (DHCS), All County Welfare Directors Letter (ACWDL) 25-01. The ABD FPL income limit is based on the greater of SSI payment rate or 138% of the Federal Poverty Level. For individuals who receive Social Security (Title II), their annual cost of living (COLA) shall be disregarded (i.e. from January through March), until the new FPL limits go into effect in April.  At that time the ABD FPL ceilings will be increased, and the individual’s current income will be used to determine eligibility.  Additionally, the Medicare Part B premium disregard is applied for individuals in this program who are eligible for Medicare Part B.  More information can be found in DHCS, ACWDL 20-18. You can also find ABD FPL program incomes limits for households of more than 2 people on the Health Consumer Alliance website
• 2. DHCS, ACWDL 22-25
• 3. DHCS, Medi-Cal Eligibility Division Information Letter No I 25-10
• 4. That includes SSI received for the 5th month of the waiting period before SSDI benefits start or the month before you first qualified for Disabled Adult Child benefits or when you first qualified for Social Security Retirement benefits.  This is because you receive Social Security Title II benefits for one month, in the following month.  Thus, if you received SSI benefits in March and were also eligible Title II benefits in March which you would not receive until April, you were eligible for and received both SSI and Social Security Title II benefits in the same month.
• 5. DHCS, ACWDL 24-10
• 6. Under the ABD MN program you deduct what you pay or are obligated to pay for necessary medical expenses to meet your Medi-Cal SOC.  Preferably starting with things not covered by Medi-Cal such as incontinence supplies, therapy, dental or vision care or insurance premiums.  For more information, you can review DRC’s Health Care publication, How Can I Use My Share of Cost to Get More Services I Need?
• 7. DHCS, ACWDL 24-14
• 8. 20 C.F.R. §416.1161(a)(16).