250% Working Disabled Program Approval

Case Situation

A 56 year-old disabled man applies for the 250% Working Disabled Program (WDP) on 08/01/2016. He is employed part time and earns $300 a month. He was determined disabled by Social Security Administration and receives $1384 monthly disability benefit.

Note: To continue evaluating for the 250% WDP when a disabled recipient becomes aged, LEAVE income type as SS/RSDI: Disability benefits on the Collect Unearned Income Detail window.

CalSAWS (Pending CalSAWS process & screenshots for the case situation)

  1. On the Collect Case Question window:
    1. Select the Disability checkbox on the [Non-Financial] tab.
    2. Select the Earned checkbox on the [Income] tab.  
  2. On the Collect Case Individual Detail window:
    1. Select Yes on the Evaluate for Non-MAGI [Y/N] field on the [Program Requested] tab.
    2. Select Yes on the Client’s choice about 250% WD [Y/N] field on the [Other Information] tab.
  3. On the Collect Individual Attributes Detail window, [Employment] tab:
    1. Select Yes on the Are you Currently Employed [Y/N] field.
    2. Complete appropriate Verification & Source.
  4. On the Collect Individual Benefit Detail window:
    1. Select SSA/RSDI: Disability benefits on the Type of Benefit field and complete other required fields.
  5. On the Collect Employment History Detail window:
    1. Complete all required fields of Employer Information. Click [Earned Income] button.
    2. Complete all required fields on the Collect Earned Income Detail window. Click [Income Received] button.
    3. Enter the client’s income on the Collect Income Received Detail window.
  6. On the Collect Disability/Medical Conditions Detail window, complete the following information:
    1. Able to Work [Y/N]: Yes
    2. Disability Type: Permanent
    3. Is this a Federally Established Disability [Y/N]: Yes
    4. Does Individual Claim Disability [Y/N]: Yes
    5. Verification & Source: Received & Other Conclusive Verification
  • Complete other required fields. Click [DED Referrals/Results] button to complete Disability Evaluation Division action box as follows:
    • Status:Granted
    • Result: Disabled
    • Status Reason Date: Enter the date DDSD determination is received if applicable
    • Re-Examination Date: Enter the date as indicated on the DDSD decision if applicable
  • Click on [Diagnosis] button to complete the following information:
    • Diagnosis: Other-Not Presumptive. (If the DDSD approval letter is on file, select the diagnosis from the drop down menu.)
    • Diagnosis Date: Enter DDSD approval date if the DDSD approval is on file.
    • Verification & Source: Received & Other Conclusive Verification
  1. On the Collect Unearned Income Detail window:
    1. Select SSA/RSDI: Disability benefits on the Type field, enter the date of the disability approval on the Approval Date field, and select Approved on the Application/Approval Status field.
    2. Click [Income Received] button to enter the client’s income and complete all other required fields.  
  2. Complete other windows relevant to the case.
  3. Run EBDC, review the 250% WD budget for correct premium amount on the Initiate Wrap Up/Display Medi-Cal - QDWI/250% Working Disabled Income Eligibility window, and authorize a case with an expected result (premium amount $20 displays for this example.)
    1. The applicant is eligible for the 250% WDP under Aid Code 6G on the Display Individual Eligibility Summary window.
    2. The ‘Y’ in the Final Aid Code column signifies the Aid Code 6G that will be sent to MEDS.

Transactions Generated by CalSAWS to MEDS

Add (EW20) transactions for the past, current and future months are sent to MEDS. As CalSAWS considers each authorized month a closed period of eligibility, a TERM-DT of 08/31/2016 and a TERM-REAS of ‘99’ will be displayed on the [INQM] screen. Eligibility for September, the future month, will appear under the Pending column until MEDS renewal.

The monthly premium amount will also be sent to MEDS and will appear as a SOC in the SOC-AMT field.

Refer to Medi-Cal Chapter 26: 250% Working Disabled Program for detailed information on the 250% WD Program.

Related Topics

Individual File Clearance

Approvals - General Information

Approvals - MEDS/CDB - No Prior MEDS/CDB Record(s)

Approvals - MEDS/CDB - Prior MEDS/CDB Record(s)

 

 

AP19 Transactions to MEDS

Benefit Identification Card (BIC) Issuance