Social Security Increases and Medi-Cal Expansion

[MUSIC]

CARLY PACHECO, HOST: From KVMR and in partnership with FREED, this is Disability Rap. 

DENISE MILLER: There should have been much higher increases throughout the years. I think folks feel that and know that deeply, especially here living in California when the cost of living is so high.

PACHECO: Today, a look at the 8.7 percent increase in all Social Security payments starting this month, and the expansion of who is eligible for Medi-Cal here in California. 

MILLER: Keep reaching out to like their local Congress person, advocacy organizations that really continue to push for these increases. Because although this biggest increase is valuable for folks, it's still not enough and we need, you know, folks need to make their voices heard.

PACHECO: That's all coming up right here on Disability Rap. Stay tuned.

[MUSIC]

CARL SIGMOND, HOST: Welcome to Disability Rap. I’m Carl Sigmond with Carly Pacheco.   

PACHECO: In October, the Social Security Administration announced that it would institute an 8.7 percent increase in all Social Security cash benefits and Supplemental Security Income.  This cost-of-living adjustment, or COLA, which takes effect this month, is meant to counter the soaring cost of everyday expenses due to inflation. For people on fixed income, as many people who receive Social Security or SSI are, this increase will help them continue to put food on their table and pay their bills. This is Social Security’s largest COLA increase since 1981 and it will impact over 72 million Americans.

SIGMOND: This got us thinking about other government benefit programs here in California that are either increasing benefits and services for people with disabilities and older adults, or expanding their eligibility criteria to enable more people to qualify for the programs. 

PACHECO: One example is Medi-Cal, California’s Medicaid program. In July 2022, the state increased the asset limit for Medi-Cal from $2,000 to $130,000 for individuals, and from $3,000 to $195,000 for a couple. And in 2024, these Medi-Cal asset limits will be eliminated entirely. We also saw the state expand Medi-Cal eligibility to some undocumented immigrants here in California last year. 

To talk more about these changes and the impacts they will have on people with disabilities and older adults, we’re joined by a roundtable of guests. Ted Mumford is a staff attorney with Legal Services of Northern California, an organization that provides free legal services to qualifying low-income individuals with the goal of empowering them to identify and defeat the causes and effects of poverty. And we’re also joined by Denise Miller and Samuel Jain from Disability Rights California, the protection and advocacy organization for people with disabilities in the state.

SIGMOND: We welcome you all to Disability Rap. Denise, I want to begin with you. Can you just lay out for us these increases to Social Security? What are they? Who do they impact? And when will people see the increases? 

DENISE MILLER: Folks will generally see an average increase of more than $140.00 a month in their benefit check, though that varies depending on the type of program an individual is in. So, as far as when folks might see the increase in their checks, if you're on SSI you should see your increased payment start December 30th, 2022. For folks on the other programs like retirement or SSDI, those increases should happen in early January. And to find out the exact amount you are eligible for, you should get a notice from the Social Security Administration by snail mail, and if you have an account set up through social security online, you should be able to log into your account see what your benefit amount, your new benefit amount, will be for the new year. 

You know, I think the hope is that it just puts more money into people's pockets so that they can pay for basic living expenses like food, clothing, and shelter. But as we know there should have been more, much higher increases throughout the years. I think folks feel that and know that deeply, especially here living in California when the cost of living is so high. Yeah and I guess I would also say, you know encourage people to keep reaching out to like their local Congress person, advocacy organizations that really continue to push for these increases. Because although this biggest increase is valuable for folks, it's still not enough, and we need, you know, folks need to make their voices heard. That this is appreciated but you know, we still need more money to just meet basic living expenses here in California.

PACHECO: So let's switch gears over to Medi-Cal asset limit changes and talk about that a little bit. And maybe we want to start by just explaining what is the Medi-Cal - what are asset limits related to Medi-Cal? What does that really mean in real life for people?

SIGMOND: And I would like to bring you in here, Ted, for this question. 

TED MUMFORD: The asset limit is a relic of the past, this is a very strict limit that was tied to SSI and other Social Security benefits and hadn't been updated since I believe like the 70s or 80s. And so for those who are on Medicare and Medi-Cal, they were subject to an asset limit of $2,000.00 for individuals and $3,000.00 for couples. That means that you could not have in your bank account a savings of more than $2.000.00 for individuals or $3,000.00 for a couple. But thankfully last year that that increased to $130,000.00 for individuals $185,000.00 for couples, which is huge. And this, California's plan is to completely eliminate that asset cap by 2024.

So there are some exceptions to what qualifies as an asset. For instance, your primary residence does not count as an asset, which for most people, it is their primary form of savings. And so that already wasn't counted towards the two or three thousand. But there were many people out there who had a modest savings, or a 401k or something from a former employer. And that meant their income was very low and so they would qualify for a Medi-Cal plan without a share of cost, but they were kept from enrolling in Medi-Cal due to the fact that they had maybe $10,000.00 in savings, or $50,000.00 in a 401k or something to that effect. And so this is allowing people who receive Medicare, Medi-Cal or I'm sorry Medicare, to continue to save, to maintain a savings um that is modest, or by 2024 an unlimited amount, and still be eligible for Medi-Cal as a secondary plan to their Medicare insurance. And this is huge, I mean this is, I don't know the exact numbers, but it's affecting many thousands of Californians. 

And at the end of 2023 if you have assets worth more than $130,000 or $195,000 in December of 2023 people can start applying for Medi-Cal starting in 2024. So if you are in that category of people who would be eligible for Medi-Cal except for $130,000 or $195,000 asset limit, you can start thinking about applying at the end of this year. 

PACHECO: The eligibility for Medi-Cal doesn't just relate to I think what we traditionally think of as sort of a health insurance, simple health insurance benefit. But there's a lot of other benefits, you know, one notably for people with disabilities is IHSS which is In Home Supportive Services, which provides a benefit for people who need caregiving in their home to allow them to maintain living in the community. And at FREED I can say that we have seen a lot of people over the years who have gotten stuck in that in between place. So they're not, they don't earn anywhere near enough to hire their own support to come into the home and take care of their needs, but they have a little bit of savings that, their, is their safety net, right? I mean we all want a little bit of a safety net because who knows when the car is going to break down, or you're going to need to repair something in your home. And so people were kind of put in this place where they had to “spend down” their resources. I don't know if anybody could talk to like, what did that really mean for people.

MUMFORD: Yeah, I've counseled many many clients on that very issue. For many people who are sort of stuck in that in between, mostly middle class individuals who are not wealthy enough to hire their own personal caregivers or pay out of pocket for a Skilled Nursing Facility, they were stuck either using the last of their resources, you know they maybe had $25,000 in the bank and they had to use/spend that $25,000 all the way down to $2,000 before they became eligible for Medi-Cal. And that was understandably incredibly tough for those people. And for those who needed IHSS they were in the same the same boat. There are still limits on it, and we still do a lot of work to advocate for expansions to those services. But for those who need to stay in a Skilled Nursing Facility or are on IHSS, being able to keep your assets for a rainy day or whatever it is that you need it for, and be able to get on full scope Medi-Cal is huge and I can't overstate that. 

PACHECO: And there are still income limits for Medi-Cal so what are those at this point? 

MUMFORD: For individuals who are looking to apply for Medi-Cal the annual income limit was $18,755 in 2022. And for a couple it would be $25,268. For those who are above that amount they can still apply for Medi-Cal. And this is something that counsel a lot of clients on who are receiving Medicare as well. So if you are not receiving Medicare that is the absolute limit, but if you were receiving Medicare and Medi-Cal and your income is above that income threshold, which is 138% of the federal poverty level, you can apply for Medi-Cal with what's called a share of cost. And a share of cost means you basically have a monthly deductible that you have to spend before Medi-Cal kicks in. And this might be a huge deductible for some people, who even have very very modest income, you are expected to spend a majority of your monthly income before Medi-Cal kicks in if you're above that limit. But for many people who experience a car accident, have a catastrophic injury that that leads to huge medical bills, or for those who need to go into school nursing care or receive IHSS, this would allow them to be on Medi-Cal, have Medi-Cal be a backup secondary insurance and cover those expenses when they come up. And so it's not if you are above that 138%, it's probably not going to affect you every single month, but when you need it. it'll be there. And so I recommend that a lot of people who are above the 138% and they're on Medicare, apply for Medi-Cal as well. Doesn't hurt, sits in the background and lies and waits until you need it.

PACHECO: One more thing maybe related to the Medi-Cal asset limits, and specifically the share of cost that I'm thinking about that lots of people are unaware of is the 250% Working Disabled Program. Which is, I think, confusing and often maybe a best kept secret benefit that does exist, but is sort of hard to pin down as to how it works. I don't know if somebody might be able to talk to that a little bit?

MUMFORD: The Working Disabled Program, yes, is a best guess kept secret. It is a very odd part of the code that created these programs, but what it does is it allows those who received a disability, who were on a disability program before becoming eligible for Medicare - so this is someone who is not a person who only became eligible for Medicare once they turned 65 and were getting retiree coverage -this is for someone who had some form of disability entitlement prior to turning 65, and their income is below 250% of the federal poverty level. So it almost doubles what you're eligible for income wise when it comes to Medi-Cal. It allows those who are in that income range, which can go up in 2022 was about $35,000 to $45,000 a year, it allows those to get full scope Medi-Cal without that share of cost or monthly deductible. And the only requirement is that you had a disability acknowledgment through Social Security before you turn 65, and you continue to do some work. 

So it's called the Working Disabled program because you were, you have to have a disability, and you have to be working. But that work that you do is - you can be very creative with. It's a very easy definition to meet. You can, you know, watch your neighbor's kids once a week and just for a couple hours as long as you're getting some income for some labor that you're doing you would be eligible for the Working Disabled program. There is a caveat, that is if you do so much work that you would indicate to the Social Security Administration that you are no longer disabled, you, it's possible you could be terminated from your SSDI benefits. But that aside, I mean we're talking generally about people who are who are disabled and have, they're performing some minimal work for a family member for a friend in their neighborhood. And so it can be a very very nominal, low amount of money that you receive and in very few hours a week or a month. It just has to be that you can show the County that you do some work and receive some money for it. And as long as you're below 250% of the federal poverty level and you had a disability acknowledgment by Social Security before turning 65 you would qualify.

SIGMOND: Great, and I just want to note for a national audience that we are really talking specifically about California here. I know a lot of states have some version of a working disabled Medicaid buy in program, but those programs vary state to state. 

MILLER: Thank you Carl for that clarification. In the past folks needed to pay a small premium a lot of times for the program. If anyone's paying a premium anymore they shouldn't be. During the public health emergency, which we're still in, those premiums were waived. And a new law in July that was passed on July 1st 2022 waived those premiums entirely. So if folks are paying, please contact the County or the state get that fixed retroactive.   

PACHECO: And one of the other changes that we've seen is really just an expansion of who could qualify for Medi-Cal coverage regardless of income, or sort of separate from income. So there was an expansion that happened in July of 2022 and I wonder if someone could talk to that.

SIGMOND: And Samuel, do you want to answer this one? 

SAMUEL JAIN: So what we're talking about is something that's called the Older Adult Expansion, and what that did is that made immigration status no longer an eligibility criteria for full-scope Medi-Cal for adults 50 and older. You know, when someone does apply for Medi-Cal, they can decline to state their immigration status on the application, that is something that they have the option of doing. 

MUMFORD: And for those who do apply for Medi-Cal, the state agencies that run the Medi-Cal program do not share your immigration status if you're undocumented with the federal government. So there should theoretically be no reason to worry that the federal government is, understandable as that would be, but they will not be sharing that information. So it should not flag your account or anything as though you're undocumented, or don't have the correct paperwork, or whatever else.

SIGMOND: But one of the things we hear a lot is people are worried about the estate recovery process of Medi-Cal, that Medi-Cal can seize part of your estate after you die if you are a Medi-Cal beneficiary. So, can one of you talk about what estate recovery is, and what it is not, and what people should consider when thinking about that? 

MILLER: You know the general basis is that when a when a Medi-Cal recipient dies, the state can seek repayment for the cost of certain services that that person received that were paid by Medi-Cal. So after they die the state will send the heirs or their survivors what's called an estate recovery claim. Now this doesn't mean that right away the state's going to put like say a lien on someone's home. The state won't take away your home automatically. But the state could try to collect from you if you can't get the state recovery claim waived, or you can't afford to pay back. The state could do what's called a, they could negotiate a voluntary lien. But there are a lot of nuances in this and some new laws were passed in 2017 that greatly restricted Medi-Cal recovery.

SIGMOND: Thank you, Denise. As we begin to wrap up, I’m just wondering on a broader level what does this say about our society as a whole that these programs are expanding eligibility, that we no longer have spend-down so people can have more in the bank, for a rainy day, that Social Security benefits are going up? What does this all say about how we view those of us who don’t have as many resources as some of us do?   

JAIN: That's a really good question Carl. I guess I'm a little bit of a pessimist in this area, I feel like there's so much more that we could be doing, and you know this is absolutely kind of the bare minimum of you know, these increases just keeping up with the rate of inflation as far as SSA. And then you know as far as these public benefits, you know, and Medi-Cal just kind of the bare baseline of services. So you know, I would say that, you know we are lucky to live in a state like California where there is a Democratic super majority. You know, we do have a Governor that's showed, you know compassion and, you know some will to increase access to public benefits. But I think there's just so much more we can do, you know, both in the state and as a nation. So I think we have our work cut out for us.

MUMFORD: Well I normally take the pessimistic approach, so I guess I'll do the optimistic approach. I mean, Samuel's completely right. But the US has some of the lowest rates of poverty for older adults anywhere in the developed world, which is really a testament to Social Security benefits and the fact that we've continued to increase benefits  during times of inflation means that we've committed ourselves further to making sure that older adults have a basic income stream that they can use to pay for basic expenses. And then when it comes to the Medi-Cal expansions, I really think this is a result of the nationwide advocacy efforts for Medicare for all and for health care for all efforts. I think that the California Legislature and the California's Governor are in many ways doing what they think is possible to reach those goals to expand healthcare access to everyone, to make savings options better for those who are lower income and need health insurance. We still have a long long way to go before we get to full health care coverage, and there's still lots of gaps in coverage, and other issues that we all work on every day. But I hope this means that we're heading the right direction and that these advocacy efforts are paying off.

MILLER: I would just add that you know I think we all know that that healthcare is a is a very big human rights issue. I think we're all hopeful that folks will have the ability to access the health services they need without suffering severe financial hardship in doing so. So I think that a lot of these new laws and these movements and changes are going in the right direction, but I think we all agree more needs to be done. 

PACHECO: Well we of course appreciate organizations like Disability Rights California, like Legal Services of Northern California for all the work that you guys do. Any final words on how people could get involved if they want to sort of join the fight?

MUMFORD: If you are experiencing an individual issue on your own, calling an advocacy organization can be very very helpful, not only for yourself, but because you're bringing these issues to advocates, we can use your case very often to make change and that can be incredibly important. And the better cases we get coming through our door, the better work that we can do to make sure that people have access to the care that they need. There's also, we partner with the Health Insurance Counseling and Advocacy Project, which gives free counseling to those who are looking at different Medicare programs and they're always accepting volunteers, they have a training program. So if you contact your local HICAP or Health Insurance Counseling and Advocacy Project you should be able to learn a little bit more about how to get involved there too. 

JAIN: And there are also a lot of Grassroots  organizations, you know grassroots disability movements, and I think that, you know, that that is super important too, advocating for these public benefits changes as well. So looking at your community and looking for those organizations is absolutely a really good way to get involved.

PACHCEO: That was Samuel Jain of Disability Rights California. Before that, we heard from Ted Mumford from Legal Services of Northern California, and Denise Miller with Disability Rights California.

And that does it for this show. Disability Rap is produced and edited by Carl Sigmond. Courtney Williams is our Production Assistant. You can go to our website, disabilityrap.org, to listen to past shows, read transcripts, and subscribe to the Disability Rap podcast. You can also subscribe to our podcast by searching Disability Rap on any of the major podcast platforms. We are brought to you by KVMR in partnership with FREED, and we’re distributed by PRX, the Public Radio Exchange. I’m Carly Pacheco with Carl Sigmond for another edition of Disability Rap.

[MUSIC]