Active Work Requirement |
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The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.
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ADAP (AIDS Drug Assistance Program) |
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A program that pays for some or all of the costs associated with HIV/AIDS medications. ADAP only covers Federal Drug Administration (FDA) approved medications on its formulary (list of covered prescriptions).
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Adjusted Gross Income |
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Gross income minus deductions for certain expenses.
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Administrative Law Judge |
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Adult Basic Education |
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Classes offered to CalWORKs recipients that provide basic reading, writing, and math skills.
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Advance Earned Income Tax Credit (AEITC) |
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Advanced Pay |
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Money the government sends you to pay for your personal care before you actually receive those services. Then you pay your care provider directly once they provide those services.
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Affidavit of Support |
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A contract signed by the sponsor that shows that the immigrant applying for a green card is not likely to become dependent on the government for cash welfare or long-term care (nursing homes). There are two types of Affidavits of Support: Old (Traditional) and New (Enforceable). |
Age-18 Redetermination |
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Aged |
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The Cash Assistance Program for Immigrants considers individuals who are 65 years or older as aged.
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Ancillary Services |
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Protective shoes, clothing, tools, fees, or other services necessary for work.
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Annual Election Period |
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The period from November 15 through December 31 when you can enroll in and switch Medicare Part D plans. |
Any Income Deduction |
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Appeal |
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A process undertaken when an individual disagrees with an insurance carrier's decision to reduce services or deny treatment or payment.
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Assets |
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Things that are owned, such as a home.
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Assets for Independence Act (AFIA) |
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Legislation that established IDA programs for non-TANF applicants. The three goals of AFIA include: providing individuals and families with incentives to save earned income, increasing self-sufficiency, and improving the community.
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Association-Sponsored Group Health Coverage |
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Group coverage offered through an association like a union, guild, or trade organization.
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Asylees |
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Non-citizens who, while in the United States, are granted permission to remain because of well-founded fear of persecution in their home country.
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Base Period |
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The yearlong period that SDI uses to determine your regular wages. It starts around 17 months before your disability and ends around 5 months before then. Your base period is divided into 4 quarters, and the quarter with the highest wage is used to determine your benefit amount.
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Basic Plan |
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Benchmark Plan |
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Beneficiary |
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The person who is receiving a benefit.
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Benefit (California State Disability Insurance - SDI) |
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Weekly income replacement that generally lasts a maximum of 52 weeks. Benefits based on self-employment elective coverage are generally paid for a maximum of 39 weeks. Payments are based on an individual’s income during the SDI program’s base period, which is prior to the onset of disability.
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Benefit Period |
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The time period that Medicare uses to measure an individual’s use of hospital and skilled nursing facility care. A benefit period begins the day an individual enters a hospital or skilled nursing facility (SNF). The benefit period ends after the individual is released and hasn't received any further hospital care (or skilled care in a SNF) for 60 consecutive days. If an individual goes into the hospital after one benefit period has ended, a new benefit period begins. The inpatient hospital deductible may be charged for each benefit period. There is no limit to the number of benefit periods an individual may have. |
Benefits Planner |
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| Someone who can help you understand or apply for benefit programs when you become disabled or turn 65. Their goal is to help you avoid financial complications while developing a sustainable plan for the future.
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Benefits Planning Query (BPQY) |
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A report that summarizes your current Social Security disability benefits.
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Blind |
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Blindness in Social Security disability programs is "statutory blindness," which means:
- You have a central visual acuity of 20/200 or less in your better eye, even while you are wearing a correcting contact lens or glasses in that eye; or
- You have a limitation in the field of vision of your better eye, so that:
- You have a contraction of peripheral visual fields to 10 degrees from the point of fixation, or
- The widest diameter of your visual field subtends an angle no greater than 20 degrees, or
- You have a contraction of peripheral visual fields to 20 percent or less visual field efficiency.
If you have a visual impairment that is not "blindness" as defined above, but your reduced vision (alone or in combination with other disabilities) prevents you from working, you may still be eligible for Supplemental Security Income (SSI) benefits.
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Blind Work Expenses (BWE) |
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Documented expenses needed in order to work that are reported to Social Security with wage reports. BWEs are for individuals who are awarded Supplemental Security Income because they meet Social Security's rules for being blind.
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Break-Even Point (BEP) |
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This is the income amount which reduces your Supplemental Security Income payment to zero when Social Security uses the countable income calculation. Your break even point can be determined by your earned and unearned income, living arrangements, and applicable income exclusions. |
California Work Opportunity and Responsibility to Kids (CalWORKs) |
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The state welfare-to-work program that provides income support and access to health coverage on a temporary basis. CalWORKs was formerly Aid to Families with Dependent Children (AFDC).
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CalWORKs Residency Requirement |
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CAPI Residency Requirement |
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Living and intending to stay in California. Individuals living in a jail, prison, VA hospital, or other public institution are ineligible for benefits.
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CARE/HIPP (Comprehensive AIDS Resources Emergency/Health Insurance Premium Payment Program) |
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A program that pays for private health insurance premiums for individuals who are disabled due to HIV or AIDS and who do not qualify for Medi-Cal/HIPP. Enrollment is administered through AIDS organizations authorized by CARE/HIPP. |
Cash Accrual |
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The savings part of a whole life policy, which comes from a portion of the premiums paid by the insured.
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Cash Value |
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The amount of cash accrual and interest that the insured may be able to borrow money from.
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Childhood Disability Benefits (CDB) |
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Benefits for disabled adult children of recipients of Social Security disability or retirement benefits. Formerly known as Disabled Adult Child (DAC) benefits.
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Coinsurance |
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The portion of the payment for medical services that an individual is responsible for. For example, your health coverage may pay for 80% of the costs of a service, while you will have to pay the remaining 20%.
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Community Service |
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Temporary or transitional work that is performed in the public or private nonprofit sector that provides the Welfare-to-Work participant with job skills that can lead to employment. |
Community Work Incentives Coordinator (CWIC) |
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The federal government pays benefits planners in communities around the country to help people think ahead about work incentives and benefits issues. CWIC'S are benefits planners who are trained by the Social Security Administration to assist beneficiaries with programs including Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI) in addition to other related programs.
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Conditional Permanent Resident |
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U.S. Resident with a I-551 C Card.
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Consolidated Omnibus Budget Reconciliation Act (COBRA) Administrator |
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An outside company that processes COBRA and/or OBRA premiums. As this company may be located in another state, it may not be familiar with health insurance laws in the state of California.
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Continuation Coverage |
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Continuing Disability Review (CDR) |
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A periodic review to determine if there has been any medical improvement in your condition and/or to determine whether you continue to be eligible for Social Security benefits for other reasons. The two types of reviews are called a medical CDR and a work CDR.
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Copayment |
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A set amount an individual must pay upon receiving medical services. For example, you may have to pay $10 each time you visit the doctor.
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Countable Earned Income (CEI) |
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Countable Income Calculation |
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The calculation used to determine how much of your unearned and earned income is counted when determining your SSI benefit and eligibility.
Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.
Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide.
Step 3: Add your countable unearned income to your countable earned income to find your total countable income.
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Countable Income Calculation (CIC) |
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The formula used to determine income and to consider eligibility for SSI-Linked, Medically Needy, and Aged and Disabled Medi-Cal programs.
Step 1: If you have unearned income (for example, an SSDI benefit), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.
Step 2: If you have earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide by two.
Step 3: Add your countable unearned income to your countable earned income to find your total countable income.
Different Medi-Cal programs may include more deductions or exclude certain types of income. See the program descriptions for details.
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County Organized Health System (COHS) |
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Health-insuring organizations that are organized and operated by a governing board appointed by the county’s Board of Supervisors. All Medi-Cal beneficiaries residing within the county are required to enroll unless they have a voluntary aid code, which allows them to enroll in fee-for-service Medi-Cal. The first plan was implemented in Santa Barbara County in 1983. Five County Organized Health Systems plans operate in eight counties: Monterey, Napa, Orange, San Mateo, Santa Barbara, Santa Cruz, Solano, and Yolo. |
Coverage Effective Date |
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The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.
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Creditable Coverage |
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Coverage that is at least as good as that offered through Medicare Part D. Your health coverage plan can tell you whether or not your coverage is creditable. |
Creditable Coverage |
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Under HIPAA, creditable coverage is prior health coverage that allows you to reduce pre-existing condition exclusionary periods when applying for new coverage. Most forms of health coverage can count as creditable.
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Critical Access Hospital |
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A hospital facility that provides outpatient and certain inpatient services to people in rural areas. Critical Access Hospitals are given a special status by Medicare.
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Custodial Parent |
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A parent that lives with the child.
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Deductible |
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The amount an individual is responsible for paying before Medicare begins to pay. For Part A, the deductible must be paid each benefit period. For Part B, the deductible must be paid each year. |
Deductible |
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The amount an individual is responsible for paying for health care services before the insurer begins to pay.
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Deemed Income |
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The amount of another person’s income – spouse, sponsor, sponsor’s spouse, parent – that is considered to belong to the individual regardless of whether the person receives this money. |
Deeming Rules |
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Rules used by Social Security and Medi-Cal that determine an individual’s eligibility when living with a non-disabled spouse. If the individual is a minor, deeming rules apply to the parents.
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Dependent |
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A person, usually a child, who is economically dependent on another person. Different programs have different specific definition of when someone is a dependent.
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Disability (Definition used by California State Disability Insurance - SDI) |
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Any illness or injury which prevents an individual from doing their regular or customary work. SDI includes disabilities resulting from elective surgery, pregnancy, childbirth, or a related medical condition. The disability must be verifiable by a medical provider. The SDI program may require some applicants to undergo an Independent Medical Examination to determine disability status. |
Disability (Definition used by CalWORKs) |
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A condition that is expected to last at least 30 days and that significantly impairs the individual’s ability to be regularly employed or participate in Welfare-to-Work activities.
To qualify for an exemption from Welfare-to-Work activities due to a disability, a CalWORKs recipient must provide verification from a physician that states the disability, its expected duration, and the extent to which it impairs employment and/or Welfare-to-Work activities. The individual must also actively seek medical treatment to qualify for an exemption. |
Disability (Definition used by private insurers)
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Definition of disability may be two-tiered: an inability to participate in the employee's own occupation (regular work) on the first tier, and an inability to participate in any occupation (any work) on the second tier. Refer to policy for definitions of disability.
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Disability (Definition used by Social Security for Adults) |
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The inability to engage in any substantial gainful activity (SGA) due to any medically determinable physical or mental impairment which can be expected to result in death or last for a continuous period of at least 12 months. A person must not only be unable to do his/her previous work but cannot, considering age, education, and work experience, engage in any other kind of SGA which exists in the national economy. It is immaterial whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he/she applied for work. The worker’s impairment(s) must be the primary reason for his/her inability to engage in SGA.
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Disability (Definition used by Social Security for Children) |
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A child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
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Disabled Adult Child (DAC) Benefits |
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Disclosing a Disabling Condition |
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Gernerally, the only time it is required to disclose a disabling condition at the workplace is when requesting a reasonable accommodation. Even then, the requirement is to present the employer with a request that a reasonable accommodation is needed for the person to perform the essential functions of the job. |
Disregard |
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A specified amount of earned or unearned income that is excluded from consideration in the financial eligibility requirements for a Medi-Cal program.
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Domestic Abuse |
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Assaultive or coercive behavior that includes: physical abuse, sexual abuse, psychological abuse, economic control, isolation, stalking, and threats.
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Domestic Partner |
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• We have a common residence;
• Neither of us is married to someone else, or is a member of another domestic partnership with someone else that has not been terminated, dissolved, or adjudged a nullity;
• We are not related by blood in a way that would prevent us from being married to each other in this state;
• We are both at least 18 years of age;
• We are both members of the same sex or one/or both of us is/are over the age of 62 and meet the eligibility criteria under Title II of the Social Security Act as defined in 42 U.S.C. Section 402(a) for old-age insurance benefits or Title XVI of the Social Security Act as defined in 42 U.S.C Section 1381 for aged individuals;
• We are both capable of consenting to the domestic partnership;
• We consent to the jurisdiction of the Superior Courts of California for the purpose of a proceeding to obtain a judgment of dissolution or nullity of the domestic partnership or for legal separation of partners in the domestic partnership, or for any other proceeding related to the partners’ rights and obligations, even if one or both partners ceases to be a resident of, or to maintain a domicile in, this state.
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Domestic Violence Survivors |
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Donut Hole |
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The gap in Medicare Part D coverage when you have between $2,510 and $5,726.25 in total drug costs in a year. Medicare will not help pay for your drug costs during this period unless you qualify for a Low Income Subsidy. |
Dual-Eligibles |
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Duration of Ticket Services |
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Ticket program services may be used for sixty months (5 calendar years) and sometimes longer. Full use of sixty months of services under current rules is allowed once during each period of a Social Security disability.
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Earned Income (EI) |
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Salaries, wages, tips, professional fees and other amounts received as pay for physical or mental work actually performed. Funds received from any other source are not included. (Contrast unearned income.) |
Earned Income Deduction |
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Income received from work that is disregarded in the countable income calculation. This calculation evaluates an individual’s financial eligibility for Aged and Disabled Federal Poverty Level (ADFPL), Breast and Cervical Cancer Treatment Program (BCCTP), In Home Supportive Services (IHSS), Medically Needy (MN) and 250% California Working Disabled Program (250% CWD) Medi-Cal. |
Earned Income Tax Credit (EITC) |
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A federal income tax credit for low income working individuals and families. The credit reduces the amount of federal income tax owed and can result in a refund check.
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Elective Coverage |
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Optional State Disability Insurance (SDI) for the self-employed. Individuals must pay premiums based on self-employment taxes. Unlike SDI for employees, elective coverage generally provides income replacement benefits for a maximum of 39 weeks.
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Eligibility Category |
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One of several types of health coverage programs that Medi-Cal offers. Each eligibility category has specific requirements, and an individual may be eligible for more than one category.
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Eligible Non-Citizen |
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Either a:
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Employer-Sponsored Health Coverage |
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Health coverage offered through an employer.
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Employment Network |
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An employment services agency that is approved by Social Security. Employment Networks may offer a variety of services such as job readiness services, placement services, vocational rehabilitation, training, job coaches, transportation or other supports.
Employment Network examples:
- Employers
- Employers offering or arranging for job training
- An employer collaborating with a community based organization
- Transportation providers
- Staffing and placement agencies
- Consumer groups
- California Department of Rehabilitation
- Private providers of rehabilitation services
- One Stop Career Centers
- Vocational rehabilitation Service Projects for American Indians with disabilities
- Cottage industries such as benefits planning services combined with other services
- Public or private schools providing transitional education or career development services
- Organizations working with ethnic, disability, or religious faith groups
A current list of Employment Networks can be found on the MAXIMUS site .
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Empowerment Zone |
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A geographic area, such as a neighborhood, that meets certain population, size, and poverty guidelines. An area must be nominated by the local government and the state to become an Empowerment Zone. The Zone is marked by poverty, unemployment, and general distress. Empowerment Zones receive federal funding for community development. A list of Empowerment Zones can be found on the HUD website. |
Enterprise Community |
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Exception |
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A request to the plan to either cover a drug that is not on the formulary or to bypass utilization controls. |
Exclusion |
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A service that a health coverage plan won't pay for. Cosmetic surgery, for example, is not covered under most plans.
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Exempt |
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Expected Family Contribution (EFC) |
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The amount of money a family is expected to contribute to educational expenses. The Federal Student Aid Commission determines the EFC.
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Expedited Reinstatement of Benefits |
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Extended Period of Eligibility (EPE)
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The 36 consecutive months that start at the end of the Trial Work Period. During the Extended Period of Eligibility, any month in which gross earnings are or more (for 2008), an individual’s wages are considered Substantial Gainful Activity (SGA). When an individual’s earning first reach SGA, a three month grace period begins, allowing a beneficiary to continue receiving Social Security Disability Insurance (SSDI) payments regardless of wages. After the three month grace period, an individual will not receive SSDI income benefits for months when wages are at or above SGA. If wages fall below SGA, SSDI payments will resume. Beneficiaries who continue to earn SGA income after the EPE will no longer be eligible for SSDI payments. The SGA earnings for blind beneficiaries are different. In 2008, SGA for the blind is $1,570.
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Fail First Rules |
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A utilization control that requires you to use a cheaper drug before trying more expensive options. |
Federal Adjusted Gross Income |
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Total taxable income. This includes money, goods, property, and services from all sources after any adjustments or deductions that are shown on a federal tax return.
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Federal Benefit Rate (FBR) |
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The national benefit amount, established by the Social Security Administration (SSA), for Supplemental Security Income (SSI) recipients. The Federal Benefit Rate (FBR) is administered by SSA for all states and Commonwealths annually. For 2008, the FBR is $637 for an individual and $956 for a couple. |
Federal Poverty Level (FPL) |
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A table of income amounts used to determine financial eligibility for federal and state programs. Each year, the Department of Health and Human Services (HHS) issues the Federal Poverty Guidelines in the Federal Register. The Federal Poverty Level for one person is $10,400. For each additional person, add $3,480. For Medi-Cal programs, these figures go into effect in March or April of each year. |
FICA Requirements for Social Security Disability Insurance (SSDI) |
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One of the eligibility requirements for SSDI is to have worked and paid FICA taxes for specified periods of time. If you work and earn at least $1,050 for one quarter (three months), and pay FICA taxes, you earn one SSDI "work credit." You can earn up to four credits within a 12-month period.
The number of work credits needed to qualify for SSDI depends upon how old you were when Social Security determined that you are disabled.
If you were determined disabled before age 24, you need 6 credits within the past 3 years to be eligible for SSDI.
If you were determined disabled between the ages of 24 and 31, you need 12 credits within the past 6 years to be eligible for SSDI.
If you were determined disabled after you turned 31, you need the number of work credits shown in the table below. And unless you are blind, you need to have earned at least 20 of those credits in the 10 years prior to becoming disabled.
Work Credits Required for SSDI Eligibility for those Born After 1929
Became Disabled At Age: |
Number of Credits Needed |
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31 through 42 |
20 |
44 |
22 |
46 |
24 |
48 |
26 |
50 |
28 |
52 |
30 |
54 |
32 |
56 |
34 |
58 |
36 |
60 |
38 |
62 or older |
40 |
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Five-Year Window |
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The sixty consecutive months during which an individual works nine Trial Work Months.
The Window begins on the onset date of disability, but rolls forward until an individual has worked nine Trial Work Months that all occur within a 60 consecutive month period of time.
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Food Stamps |
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A federally funded program that helps people with low-income buy food.
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Foreign Income |
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Income received for services performed in a foreign county by an individual residing in that country.
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Formulary |
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A list of drugs that a health plan covers.
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Full-Scope Medi-Cal |
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Complete medical services offered to beneficiaries such as:
Inpatient hospital services (tests, surgeries, procedures) Outpatient hospital services Physician services Medical and surgical dental services Nursing services Home health care Family planning and supplies Rural health clinic and ambulatory services Laboratory and x-ray services Pediatric and family nurse practitioner services Nurse-midwife services Early and periodic screening Diagnosis and treatment (EPSDT) services Prenatal and delivery services Ambulatory services for individuals in an institution Home health services Clinic services Nursing facility services (under 21 years old) Intermediate care facility/mentally retarded services Optometrist services and eyeglasses Prescribed medication TB-related services for TB infected persons Prosthetic devices Dental services Preventative and rehabilitative services Case management Private duty nursing Home respiratory care services Personal care services Home and community based waivers Medical equipment and appliances Diagnostic screening
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Fully-Insured Plan |
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A plan where an insurance company takes on the risk. In general, health coverage protections specific to California only apply to fully-insured plans, and self-insured plans are regulated by federal laws. Ask your employer or health plan which type of plan you are participating in.
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General Enrollment Period |
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The period of time between January 1 and March 31 when a Medicare beneficiary can sign up for Part B coverage. Benefits will not begin until July 1 of that year, and a beneficiary may be subject to a late enrollment fee of 10% for each 12 month period they did not have Part B Medicare. |
General Income Exclusion (Supplemental Security Income Program) |
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The $20 of earned or unearned income that is not considered when determining the amount for the Supplemental Security Income (SSI) benefit.
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General Relief/General Assistance (GR/GA) |
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A county program that provides relief to those who are unable to support themselves by their own means, or by friends or relatives, other public funds, or other assistance programs.
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Grant |
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A monetary reward that does not have to be repaid.
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Gross Benefit Amount |
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