A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

1619(a)

Return to top
Rules that allow Supplemental Security Income (SSI) recipients to keep their SSI benefit at a lower level when they return to work.

1619(b)

Return to top
A rule that lets people who stop getting Supplemental Security Income (SSI) benefits due to work income keep their Medi-Cal health coverage while earning up to $36,738 per year. 1619(b) also makes it easier to get SSI benefits started up again if your countable income goes below SSI's income limit. For 1619(b), you must continue to meet other SSI eligibility rules, such as the resource limit.

Note: If your earnings are over this limit and you have high medical expenses, you might still qualify for 1619(b). Ask your local Social Security office about the 1619(b) Individualized Earnings Threshold.

401(k) Retirement Account

Return to top
A type of retirement plan in which people who are employed can automatically have money taken out of their paychecks and put aside into an account that is taxed less than a standard savings or investment account. This helps the account grow more quickly than other accounts. The person who puts the money aside can only use this money after reaching the age of 59 and a half. If money is withdrawn before that age, the person taking the money out has to pay a penalty.

ABLE Accounts

Return to top
A type of financial account for people who have disabilities that began before they turned 26. ABLE (Achieving a Better Life Experience) accounts have tax advantages and the money in these accounts does not affect eligibility for many benefits, including Supplemental Security Income (SSI), Medi-Cal, and CalFresh (formerly Food Stamps). Money in ABLE accounts must be used for specific things, like education, housing, transportation, health care, work-related expenses, assistive technology, or other approved living expenses. Note: If you have more than $100,000 in your ABLE account, the money will be counted by the SSI program.

ABLE accounts can only be opened through specific programs or financial institutions and a person can only open one account. Each state regulates which financial institution offers ABLE accounts in that state. You do not have to open your account in your own state: if another state offers a program, it may let you open an account there. That lets you compare which financial institution offers the right options for you and means you can open an account even if no financial institution in your state offers accounts.

California does not have an ABLE account program yet. You can choose to open an account in another state’s ABLE program.

Access for Infants and Mothers (AIM)

Return to top
A low cost health coverage program for uninsured, middle-income pregnant women and their infants.

Active Work Requirement

Return to top
The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.

ADAP (AIDS Drug Assistance Program)

Return to top
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).

Adjusted Gross Income (AGI)

Return to top
Total annual income, including earned and unearned income, minus deductions. AGI is used for calculating how much you owe in federal taxes and how much you get in tax credits.

Adjusted Income

Return to top
The amount a person pays taxes on after all allowed adjustments are made (deductions and credits).

Administrative Law Judge

Return to top
An official who oversees administrative hearings held to resolve a dispute between a government agency and a person affected by a decision of that agency. They oversee any initial appeal you may make with a government institution.

Adult Basic Education

Return to top
Classes offered to CalWORKs recipients that provide basic reading, writing, and math skills.

Adult Foster Care

Return to top
Facilities that provide sleeping accommodations and other services to adults with disabilities and others.

Advanced Pay

Return to top
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.

Affidavit of Support

Return to top
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).

Affordable Care Act of 2010 (ACA)

Return to top
A federal law, sometimes called Obamacare, that has led to significant changes in the United States health care system, including extending health care coverage to many more Americans. The changes in this law take effect over the course of many years, through 2020. For more information on the ACA, visit CoveredCA.

Affordable Coverage (Employer-Sponsored Health Plans)

Return to top
Health coverage offered by your employer that:
  • Would cost you, for your policy alone, less than 9.5% of your income for the monthly premium, and
  • Meets bronze-level standards.

If you have an option that meets these standards, you and your family cannot qualify for government subsidies to get private insurance on Covered California. If your income is low enough, you may still qualify for Medi-Cal.

Age-18 Redetermination

Return to top
The process of determining whether a child who is an SSI beneficiary will meet the adult definition of disability. The redetermination happens within a year of the 18th birthday.

Aged (CAPI)

Return to top
The Cash Assistance Program for Immigrants considers individuals who are 65 years or older as aged.

Aged and Disabled Medi-Cal

Return to top
A Medi-Cal eligibility category that gives free Medi-Cal to people who are disabled or at least 65 years old and who meet income, asset, and medical requirements.

Americans with Disabilities Act (ADA)

Return to top
A federal law that protects the rights of people with disabilities at work and in public places. The ADA makes it illegal for employers, the government, or other public agencies to discriminate against (to treat unfairly or unequally) disabled people at work and in most public places, places, such as restaurants, hotels, and theaters. The law also requires employers to make reasonable accommodations to allow employees with disabilities to do their jobs.

America's Job Centers of California (AJCCs)

Return to top
Offices around the state that offer free tools, resources, and services that can help you find employment or training and get help with other work-related needs. AJCCs used to be called One-Stop Career Centers.

AJCCs can help you with various things, including:

  • Giving you advice about local employers who are hiring
  • Teaching you the basics of how to do a job search
  • Helping you with your resume
  • Practicing job interviews
  • Showing you how to use online jobs websites like CalJOBS

Learn more about AJCCs or find a local AJCC.

Ancillary Services

Return to top
Protective shoes, clothing, tools, fees, or other services necessary for work.

Annual Election Period

Return to top
The period from October 15 – December 7 when you can enroll in and switch Medicare Part D plans.

Any Income Deduction

Return to top
The $20 of earned or unearned income that is not included when the Medi-Cal countable income calculation is used.

Appeal

Return to top
A request to have a third party review an agency’s decision. Requests may be verbal or written. Typically, appeals are requested when benefits, services, or treatments are denied, stopped, or reduced.

Appraisal

Return to top
An estimate of value.

Apprenticeship

Return to top
A work opportunity that provides you with a way to learn a skilled occupation, craft, or trade.

Asset Limit

Return to top
The maximum amount of assets you're allowed to own while maintaining eligibility for a particular disability benefits program. Most benefits programs do not count everything you own, including the home you live in and one car you own. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as assets. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called a "resource limit."

Assets

Return to top
Things that you own, like a car or a house. You can only own a certain amount in assets and still qualify for many health care and disability benefit programs. The home you live in and the car you drive to work are exempt under most Social Security and state disability benefit programs. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as assets. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.
Also called "resources."

Assets for Independence Act (AFIA)

Return to top
Legislation that established Individual Development Account (IDA) programs for applicants who are not on CalWORKs. The three goals of AFIA include: providing individuals and families with incentives to save earned income, increasing self-sufficiency, and improving the community.

Assistive Technology

Return to top
Technological devices that help people with disabilities carry out daily activities.

Assistive Technology Device (Federal Definition)

Return to top
According to the Technology Related Assistance to Individuals with Disabilities Act of 1988 (Tech Act):

Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

According to the same law, an assistive technology service is:

Any service that directly assists an individual with a disability in selection, acquisition or use of an assistive technology device."

Association-Sponsored Group Health Coverage

Return to top
Group coverage offered through an association like a union, guild, or trade organization.

Asylee

Return to top
A noncitizen who, while in the United States, is granted permission to remain because of well-founded fear of persecution in their home country.

At-Home Recovery Services

Return to top
Help with activities like bathing or dressing.

Bankruptcy

Return to top
Legal steps that involve a person or business that is unable to repay debts.

Base Period

Return to top
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.

Basic Plan

Return to top
A Medicare Part D plan that meets just the minimum requirements laid out by the Centers for Medicare and Medicaid Services (CMS).

Benchmark Plan

Return to top
A Medicare Part D plan that has its monthly premium fully covered by the Low Income Subsidy.

Beneficiary

Return to top
The person who is getting a benefit.

Benefit (California State Disability Insurance - SDI)

Return to top
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.

Benefit Period

Return to top
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

Return to top
A trained expert who can help you understand and apply for benefit programs. Their goal is to help you develop a plan for your future and organize your financial life to run as smoothly as possible.
  • For questions about work and your Social Security benefits, use Social Security's "Find Help" tool to locate a WIPA project near you. You can also call the Ticket to Work Help Line at 1-866-968-7842 / 1-866-833-2967 (TTY/TDD).
  • If you need assistance with your Medicare, the Health Insurance Counseling & Advocacy Program can help. HICAP provides free information and counseling to people with Medicare. You can call HICAP at 1-800-434-0222 or visit the HICAP website.
  • If you need assistance with Medi-Cal and have a disability, you can contact Disability Rights California at 1-800-776-5746 or visit their website. You may also be able to get help with Medi-Cal from a local legal aid organization. The Health Consumer Alliance website has a lot of useful information about Medi-Cal, including a web page that can direct you to a local legal organization for assistance.
  • If you have questions or need assistance with a program or benefit not listed here, contact an Independent Living Center (ILC). Independent Living Centers provide peer support and information on a wide range of topics for people with disabilities.

Benefits Planning Query (BPQY)

Return to top
A report that summarizes your current Social Security disability benefits and available work incentives. To order one, visit your local Social Security office or call 1-800-772-1213 (voice); 1-800-325-0778 (TTY). Be sure to review your BPQY carefully. If you have questions about it, contact a Benefits Planner or Social Security.

Tip: The BPQY is form number SSA-2459. If a Social Security Claims Representative does not know what a BPQY is, mention the form number.

Blind Work Expenses (BWE)

Return to top
Documented expenses for services or items that you need in order to work. Service animal expenses, transportation to and from work, and visual and sensory aids are examples of BWEs. You must be eligible for Supplemental Security Income (SSI) based on blindness to use BWEs.

For more information, refer to the Social Security Red Book, Special Rules for Persons who are Blind.

Blindness

Return to top
Eyesight that is very limited. To be considered legally blind, you must:
  • 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
  • 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% or less visual field efficiency.

Social Security and other agencies use this definition of blindness to decide if you qualify for benefits programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Some people with vision impairments that do not meet these standards may still qualify for benefits.

Blue Book (Listing of Impairments)

Return to top
The Social Security publication that provides detailed information about disability programs to physicians and other health care professionals. The Blue Book includes the complete Listing of Impairments, which lists and defines those conditions considered severe enough to prevent a person from doing any gainful activity. The Blue Book can now be accessed online.

Board and Lodge Establishment

Return to top
A facility that provides sleeping accommodations and food to adults with disabilities and others.

Break-Even Point (BEP)

Return to top
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.

Breast and Cervical Cancer Treatment Program

Return to top
A Medi-Cal program that pays for costs associated with breast and cervical cancers.

Budget Month (Benefits Eligibility)

Return to top
The month a benefits program looks at when it decides if you qualify and what you get in benefits. Programs look at your income and resources from the budget month.

The budget month may be the same as the current month, one month before the current month, or two months before the current month. Which month a program looks at depends on the program rules and your situation.

Note: DB101 Calculators use the correct budget month for each month and program.

Budget month examples from the Supplemental Security Income (SSI) program
  • If you have been getting SSI benefits for more than two months, the amount you get is usually based on your income from two months ago.
  • If you don't get SSI benefits, but your countable income drops below SSI's income limit, you might not have to wait two months to start qualifying for SSI. Instead, your first month of SSI benefits may be based on your income from the current month.
  • Usually, the second month of SSI benefits are based on income from one month ago.
  • If you have been getting SSI benefits for a while, but then your income goes over SSI's income limit, you don't still qualify for SSI benefits. Your benefits eligibility is based on your income from the current month.

Business Plan

Return to top
A tool that helps organize your goals for a new business, as well as concrete steps and resources that will help you reach those goals.

Cal MediConnect

Return to top
Combined managed care plans for some people with both Medicare and Medi-Cal. People who have Cal MediConnect plans have just one card for their Medicare and Medi-Cal and any billing automatically takes into account the benefits both programs provide.

Cal MediConnect plans exist in seven California counties: Alameda, Los Angeles, Riverside, San Bernadino, San Diego, San Mateo, and Santa Clara. County social service agencies will send letters to people on Medicare and Medi-Cal to notify them when they have the option to choose a Cal MediConnect plan.

Read more about combined managed care for Medicare and Medi-Cal or call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

CalFresh

Return to top
Formerly called Food Stamps, CalFresh is a county-run, federal program that helps people with low incomes buy food. Nationally the program is called the Supplemental Nutrition Assistance Program (SNAP). In California, the benefits are issued monthly on an electronic debit card (EBT) that can be used to buy most foods at many markets and food stores. To apply for CalFresh, go to the Department of Social Services website.

CalWORKs

Return to top
California Work Opportunity and Responsibility to Kids. 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).

CalWORKs Maximum Grant Levels

Return to top
This table shows CalWORKs maximum possible monthly cash benefit amounts. The maximum benefit for a family depends on how many people are in the family, whether the family is exempt because all caretakers are disabled, and whether it lives in Region 1 or Region 2.

Region I includes the more urban counties (Alameda, Contra Costa, Los Angeles, Marin, Monterey, Napa, Orange, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Sonoma, and Ventura) where cost of living is higher, so the maximum benefit is correspondingly higher. Region II includes the more rural counties (all of the ones not listed above).

CalWORKs Maximum Grant Amounts

Region 1

Region 2

Family Size

Exempt

Non-Exempt

Exempt

Non-Exempt

1

$392

$355

$374

$336

2

$645

$577

$616

$549

3

$799

$714

$762

$680

4

$949

$852

$904

$810

5

$1,080

$968

$1,031

$922

6

$1,214

$1,087

$1,157

$1,035

7

$1,334

$1,195

$1,272

$1,136

8

$1,454

$1,301

$1,385

$1,239

9

$1,571

$1,407

$1,498

$1,340

10

$1,689

$1,511

$1,610

$1,438

CalWORKs Residency Requirement

Return to top
To be eligible for CalWORKs, You must be a U.S. citizen, Qualified Alien or someone Permanently Residing Under Color of Law (PRUCOL).

CAPI

Return to top
The Cash Assistance Program for Immigrants. (CAPI) pays a cash benefit to some people with low incomes who cannot qualify for SSI because of their immigration status.

CAPI Residency Requirement

Return to top
Living and intending to stay in California. Individuals living in a jail, prison, VA hospital, or other public institution are ineligible for benefits.

Capital

Return to top
Money or other resources available for a particular purpose, such as starting a business or investing.

Capital Expense

Return to top
A one-time expense that will benefit a business in the future. Capital expenses are often related to buying equipment that that the business will need to get started.

CARE/HIPP (Comprehensive AIDS Resources Emergency/Health Insurance Premium Payment Program)

Return to top
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.

Catastrophic Plan

Return to top
A health coverage plan that generally has a lower premium and provides most benefits only after a large deductible has been paid. This sort of plan is most useful for people who do not have regular medical expenses, but wish to be covered in case of an accident or other sudden and significant medical needs. These plans may allow you to see your primary care provider up to 3 times per year and get preventive care without paying the deductible.

If you are under 30, you can sign up for a catastrophic plan on Covered California. If you are over 30, a catastrophic plan will not exempt you from having to pay the $695 tax penalty that people without health insurance have to pay because of the individual mandate.

Childhood Disability Benefits (CDB)

Return to top
Social Security benefits for adults who:
  • Became disabled before turning 22, and
  • Have a parent who died or who gets retirement or SSDI benefits.

Formerly known as "Disabled Adult Child" (DAC) benefits.

Citizenship Status

Return to top
Assuming they meet all other eligibility criteria, U.S. citizens and Qualified Aliens (inlcuding those who meet I-551 or I-94 status) are eligible for both Social Security and state public benefits programs.

Legal residents who don't have I-551 or I-94 status may be eligible for some state programs, but not for Social Security programs. This could include Legal Permanent Residents (LPRs), refugees, asylees, conditional entrants, people certified as victims of trafficking, certain people whose immigration status is pending, people under Temporary Protected or Family Unity Beneficiary Status, Lawful Temporary Residents, applicants for asylum, people who have been granted or are applying for withholding of removal, and all other people with a lawfully residing immigrant status.

People who are undocumented or non-immigrants are not eligible for any of these programs.

Closing Costs

Return to top
Costs associated with the completion of a sale of real estate. Closing costs are not usually included in the sale price of the property. Some examples of closing costs are applicable taxes, fees for appraisals and recording the deed (the deed is an official document that shows details of a legal agreement, especially about who owns a building or a piece of land).

Co-Insurance

Return to top
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%. That 20% is known as "co-insurance."

Community Service

Return to top
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.

Conditional Permanent Resident

Return to top
U.S. Resident with a I-551 C Card.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Return to top
If you lose your employer-sponsored health coverage, COBRA laws allow you to continue that coverage for up to 18 months in most situations.

Continuation Coverage

Return to top
If you lose access to group health insurance that you got through your employer for certain reasons, including a job change, divorce, or job loss, there are laws that allow you to continue your group coverage temporarily. This is known as continuation coverage. You will usually have to pay the full costs of your continuation coverage, including any portion of the premium your employer may have paid for in the past. The federal continuation coverage law is called COBRA. Many states also have their own continuation coverage laws.

Continuing Disability Review (CDR)

Return to top
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.

Conversion Policy

Return to top
A conversion insurance policy is something you can buy when your employer-sponsored group health insurance policy ends. It lets you keep buying insurance through the same insurance company. You may have to use up all your COBRA coverage first, before you can get a conversion policy, depending on the regulations in your state.

Cooking Facilities

Return to top
Having cooking facilities means that you have a refrigerator and at least 2 burners. Hotplates count as burners if they have temperature controls. You can substitute a microwave oven for one of the burners or hotplates.

Copayment

Return to top
A set amount you have to pay when you receive medical services. For example, you may have to pay $30 every time you visit the doctor or $20 to get a prescription refilled. This is also known as a "copay."

Countable Earned Income (SSI)

Return to top
Salaries, wages, tips, and any other money that you receive as pay for work that you do is considered "earned income."

Your countable earned income is the portion of that earned income that the Supplemental Security Income (SSI) program considers when deciding how much your SSI benefit should be. The SSI program uses a special calculation to determine your countable earned income, your total countable income, and ultimately, your SSI benefit.

Countable Income

Return to top
The amount of income that Social Security or the state counts when figuring out if you qualify for benefits and, if so, the level of benefits you should get. Not all of your income counts.

Example: Supplemental Security Income (SSI) counts most unearned income, but a bit less than half of earned income. So, if you have $500 in unearned income and $500 in earned income, your countable income for SSI would be just $697.50, even though your total income would be $1,000. Other programs, such as disability-based Medi-Cal and Medicare Savings Programs often use calculations similar to SSI's.

Countable Income Calculation (Medi-Cal)

Return to top
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.

Countable Income Calculation (SSI)

Return to top
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.

Example: If you have $500 in unearned income and $500 in earned income ($1,000 total), your countable income for SSI would be: $480 in countable unearned income + $217.50 in countable earned income = $697.50.

Countable Resources (SSI)

Return to top
Resources are things you own, like a home or car. To be eligible for SSI, you can only have up to $2,000 in resources ($3,000 for a couple).

When determining whether or not you qualify for SSI, Social Security excludes certain resources from your countable resource total. Your home and one car do not count as resources, for example. Income received from Earned Income Tax Credits (EITC), Child Tax Credits (CTC), CalFresh (formerly Food Stamps), grants, scholarships, fellowships, gifts, property essential to self-support, Individual Development Accounts (IDAs), and many other items may be excluded as well. Additionally, for SSI, the first $100,000 in an ABLE account are not countable resources.

Countable Unearned Income (SSI)

Return to top
Funds received from sources for which no paid work activity is performed are considered "unearned income" (for example, disability benefits such as SSDI, SSI, short- and long-term disability insurance; VA benefits; Workers' Compensation; income from a trust or investment; spousal support).

Your "countable unearned income" is the portion of that unearned income that the Supplemental Security Income (SSI) program considers when deciding how much your SSI benefit should be. The SSI program uses a special calculation to determine your countable earned and unearned income, your total countable income, and ultimately, your SSI benefit.

County Organized Health System (COHS)

Return to top
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

Return to top
The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.

Coverage Levels (Health Insurance)

Return to top
Labels for private health coverage options that give people an idea how much they would have in out-of-pocket expenses, such as copayments, coinsurance, and deductibles, when they use covered services. Plans that are the same coverage level should have roughly the same out-of-pocket expenses.

There are four different levels of plans available to most people:

  1. Platinum plans have the highest monthly premiums and the lowest out-of-pocket expenses when you get medical care.
  2. Gold plans have slightly lower premiums and slightly higher out-of-pocket expenses when you get medical care.
  3. Silver plans have lower premiums. The out-of-pocket expenses for medical services depend on your family’s income; if it is at or below 250% of the Federal Poverty Guidelines (FPG), the out-of-pocket expenses may be as low as a gold or platinum plan.
  4. Bronze plans have the lowest monthly premiums and the highest out-of-pocket expenses when you get medical care.

You may see plans with percentages ranging from as low as 60% for Bronze plans to as high as 90% for Platinum plans. A lower percentage means the plan has higher out-of-pocket expenses when you get medical care, while a higher percentage means the plan has lower out-of-pocket expenses. Plans with lower percentage ratings usually have lower monthly premiums. Note: These percentages do not tell you exactly what percentage of your family's expenses your plan will pay for. They are based on averages for thousands of families and how much your plan actually ends up paying for your family could be much higher, or much lower, than what the percentage rating says, depending on the services your family needs.

Credit

Return to top
The ability to borrow money based on your history and promise of repayment.

Credit History

Return to top
A record that shows when and how you borrowed and repaid money.

Credit Limit

Return to top
The maximum amount of money that a financial institution or other lender will make available to you.

Credit Report

Return to top
A summary of your financial history that is prepared by a credit bureau. It includes information on where you live, how you pay your bills, and whether you’ve been sued or arrested, or have filed for bankruptcy.

Credit Score

Return to top
A number (between 300 and 850) that is based on a person’s credit history, that is used by lenders to measure whether or not a person would be likely to repay debts. People who pay all of their debts on time will have a higher score; people who do not pay their debts on time will have a lower score. It is easier to get loans if you have a high credit score.

Creditable Coverage (Medicare)

Return to top
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.

Creditor

Return to top
A person or institution who has loaned you money and to whom you now owe money.

Custodial Parent

Return to top
A parent that lives with the child.

Customized Employment

Return to top
A process that allows a job seeker and potential employer to individualize a job description so that the job seeker's strengths would be utilized while the employer's needs would be met.

Deductible

Return to top
The amount an individual is responsible for paying for health care services before the insurer begins to pay.

Deductible (Medicare)

Return to top
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 Parts B and D, the deductible must be paid each year.

Deemed Income

Return to top
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.

Deemed Income (SSI)

Return to top
The amount of another person’s income (a spouse or parent, for example) that is considered to belong to the individual regardless of whether the person receives this money.

Deeming Rules

Return to top
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.

Department of Veterans Affairs (VA)

Return to top
A government-run military veteran benefit system. The VA has hundreds of Veterans Affairs medical facilities, clinics, and benefits offices and is responsible for running programs for veterans and their families. The benefits provided include disability compensation, pension, education, home loans, life insurance, vocational rehabilitation, survivors’ benefits, medical benefits, and burial benefits.

Visit the VA.gov website.

Dependent

Return to top
A person, usually a child, who is economically dependent on another person. Different programs have different definitions of when someone is a dependent.

Disability (Definition used by California State Disability Insurance - SDI)

Return to top
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)

Return to top
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)

Return to top
A level of impairment that causes private insurers to provide benefits to people who have paid a monthly premium for coverage.

There are two common levels of disability according to private insurers:

  1. Own-Occupation Disability (or “Own Occ” ) means your disability prevents you from performing your own occupation, which means you cannot do the work or job you have been trained to do and have experience in
  2. Any-Occupation Disability (or “Any Occ”) means your disability prevents you from performing any occupation:
    • Sometimes Any Occ means that your disability prevents you from performing any occupation that pays at least a specified percentage of what you earned before your disability

Own-occupation insurance policies pay you if you are unable to perform your own occupation, even if you are able to get a different type of job. They have higher premiums than policies that require you to be unable to perform any occupation. Check with your insurer to see which definition of disability your plan has.

Disability (Definition used by Social Security for Adults)

Return to top
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 doesn't matter 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.

Disability (Definition used by Social Security for Children)

Return to top
For a child under age 18, 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.

Disability (Definition used by the ADA)

Return to top
Under the Americans with Disabilities Act (ADA), you are disabled if you have, have a record of, or are regarded as having a physical or mental impairment that substantially limits one or more major life activities, such as hearing, seeing, speaking, walking, breathing, performing manual tasks, caring for oneself, learning, or working. Major life activities also include the operation of major body functions, including:
  • The immune system
  • Special sense organs
  • The skin
  • Cell growth
  • Digestive, genitourinary, bowel, and bladder functions
  • The nervous system and brain
  • Respiratory, circulatory, cardiovascular, endocrine, hemic, lymphatic, musculoskeletal, and reproductive functions

Disability Determination Process (SSA)

Return to top
The evaluation process the Social Security Administration (SSA) uses to decide whether a person's disability meets SSA’s disability criteria for disability-based benefits.

Disclosing a Disabling Condition

Return to top
The process of telling your employer – or potential employer – that you have a disability. Your employer does not have the right to ask you about your disability during the hiring process before a job offer is made. Even after a job offer, there are legal limits about when and what an employer can ask about disability.

Generally, 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 only to present the employer with information demonstrating that a reasonable accommodation is needed for the person to perform the essential functions of the job.

Domestic Abuse

Return to top
Assaultive or coercive behavior that includes: physical abuse, sexual abuse, psychological abuse, economic control, isolation, stalking, and threats.

Domestic Partner

Return to top
To qualify as domestic partners, you and your partner must register as domestic partners and meet the following requirements:
  • You live in the same residence
  • Neither person is married to someone else, or is a member of another domestic partnership with someone else that has not legally ended
  • You are not related by blood in a way that would make it illegal for you to be married to each other in your state
  • You are both at least 18 years of age
  • You are both members of the same sex, or one or both of you are over the age of 62 and meet the eligibility criteria under Title II of the Social Security Act for old-age insurance benefits, or Title XVI of the Social Security Act for aged individuals
  • You are both capable of consenting to the domestic partnership, and
  • You agree to go through the California courts to end the domstic partnership or legally separate, or any other legal decisions related to your partnership.

Domestic Violence Survivors

Return to top
Individuals who have endured domestic abuse.

Donut Hole

Return to top
The gap in Medicare Part D coverage when you have between $3,700 and $7,425 in total drug costs in a year.

People on Medicare who fall within the “donut hole” get a 60% discount on brand name prescription drugs and a 49% discount on generics. This discount will continue to grow until 2020, when the donut hole coverage gap is closed completely. These changes are happening as a result of the Affordable Care Act passed in 2010.

Down Payment

Return to top
The initial payment you make when you buy something on credit.

Down-Payment Assistance Program

Return to top
Help offered by some cities and counties that may reduce a homebuyer’s portion of the down payment to as little as 1% of the purchase price. The rules are different for every program, but usually the homebuyer does not need to repay this financial help until the homebuyer sells the home or finishes paying off the original mortgage. In some cases, the homebuyer may not have to repay it at all.

Dual-Eligibles

Return to top
A term used to describe individuals eligible for both Medicare and Medi-Cal.

Earned Income (EI)

Return to top
Salaries, wages, tips, professional fees, and other amounts you receive as pay for physical or mental work you perform. Funds received from any other source are not included. (Contrast: unearned income.)

Earned Income Deduction (Medi-Cal)

Return to top
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 Working Disabled Program (WDP) Medi-Cal.

Earned Income Disregard (EID)

Return to top
A rule that helps people with disabilities getting housing benefits, like Section 8, public housing, and Housing Opportunities for Persons with AIDS (HOPWA), try working.

If you have a disability and get a housing benefit that has an EID rule, you can start working and your new earnings will not be counted by the program during the first year after you start working. That means your rent won’t go up and you won’t lose the benefit because of your work. During the second year after you start working, only 50% of your earnings will be counted.

Earned Income Exclusion (SSI)

Return to top
$65 of earned income that is not considered when Social Security uses the SSI Countable Income Calculation to determine the benefit amount for a Supplemental Security Income (SSI) beneficiary. This $65 is in addition to the $20 general income exclusion, which may be earned or unearned income.

Earned Income Tax Credit (EITC)

Return to top
A federal income tax credit for low income working individuals and families. The credit reduces the amount of federal income tax you owe and can result in a refund check. Most people claim their Earned Income Tax Credit (EITC) when they file their federal income taxes.

Elective Coverage

Return to top
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.

Eligibility Category

Return to top
A way to qualify for Medi-Cal health coverage. There are several different ways to qualify, each with specific requirements. An individual may be eligible for more than one category.

Eligible Couple (SSI)

Return to top
A married couple where the partners live together and both qualify for Supplemental Security Income (SSI). The maximum SSI benefits amount for an eligible couple is $1,510.14, which is only about 150% of the individual maximum of $895.72.

Note: If you live in the same household as somebody else and the two of you act as though you are married and present yourselves to the community as being married, Social Security will consider you a married couple for SSI purposes. This is often referred to as "holding out."

Note: For SSI, Social Security only recognizes same-sex couples as married if they are legally married under California law. (The rules are different for SSDI.)

Eligible Noncitizen

Return to top
Either a:

Employer Mandate

Return to top
A part of the Affordable Care Act (ACA) that requires most employers with 100 or more employees to offer affordable insurance to their employees, or pay a fine.

To learn more about the employer mandate, visit CoveredCA.

Employer-Sponsored Health Coverage

Return to top
Health coverage offered through an employer as a benefit for employees and their families. Employers usually pay a portion of the monthly premium and the employee pays the rest.

Employment Network

Return to top
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
  • Employers collaborating with community based organizations
  • Transportation providers
  • Staffing and placement agencies
  • Consumer groups
  • State Department of Rehabilitation
  • Private providers of rehabilitation services
  • 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 Ticket to Work website.

Empowerment Zone

Return to top
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

Return to top

Entrepreneur

Return to top
A person who organizes and runs a business and takes responsibility for the financial risks of doing so.

Essential Functions

Return to top
The fundamental job duties that you must be able to perform on your own or with the help of a reasonable accommodation. An employer cannot refuse to hire you because your disability prevents you from performing duties that are not essential to the job. At the same time, you cannot ask for an essential function to be removed from your job description as a reasonable accommodation.

Essential Health Benefits

Return to top
Benefits that federal law requires all health coverage plans provide. These benefits include:
  • Ambulatory patient services (care you get without being admitted to the hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Preventive and wellness services and chronic disease management, including:
  • Prescription drugs
  • Laboratory services
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Pediatric services for children, including oral and vision care

Exception (Medicare)

Return to top
A request to an insurance plan to pay for a medication that is not on the plan formulary or to otherwise bypass the plan's utilization controls (the rules that help the plan lower costs).

Exclusion

Return to top
A service that a health coverage plan won't pay for. Cosmetic surgery, for example, is not covered under most plans.

Exempt

Return to top
When a CalWORKs recipient is not required to participate in the Welfare-to-Work Program.

Expected Family Contribution (EFC)

Return to top
The amount of money a family is expected to contribute to educational expenses. The Federal Student Aid Commission determines the EFC.

Expedited Reinstatement of Benefits

Return to top
A quicker way to get benefits restarted for individuals whose Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) ends due to employment. You get up to six months of benefits while SSA decides if you have medically improved or not. This provision is available for up to five years after your benefits end.

Extended Period of Eligibility (EPE)

Return to top
A three-year period (36 months) after your SSDI Trial Work Period ends, during which you can keep getting SSDI benefits in any month when you earn less than the Substantial Gainful Activity level ($1,170 in 2017; $1,950 if you're blind).

If you earn more than SGA, your SSDI benefits will be suspended. However, during the EPE, you are eligible to have your SSDI benefits restarted if your earnings drop below SGA.

Fail First Rules

Return to top
An insurance requirement that you use a cheaper medication before trying more expensive options. This helps the insurance plan reduce costs.

Fair Share (SSI)

Return to top
The amount that each individual in a household is responsible for spending each month on food and shelter. If you live alone, it is the full cost of food and shelter. If you live with others, it is an equal portion of the total food and shelter expenses. For example, if you and three other people live together and spend a total of $4,000 per month on rent, utilities, and food, a fair share for each of you would be $1,000.

For the Supplemental Security Income (SSI) program and some other programs, whether an adult pays the fair share of expenses may affect benefits eligibility or benefits amounts.

Family and Medical Leave Act (FMLA)

Return to top
A federal law that allows you to take up to 12 weeks off of work for the birth or adoption of a child, to care for a family member, or if you have a serious medical condition. You need to have worked for your employer for at least one year to qualify for FMLA coverage and your employer must employ at least 50 people.

Family Size

Return to top
For the purposes of comparing your household income to the Federal Poverty Guidelines (FPG), count the number of people you have living together as a family. Include yourself, your spouse, and any children, parents or other relatives who are listed on the same tax return. If there is a pregnant woman in your household, count the unborn baby as well.

Federal Adjusted Gross Income

Return to top
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.

Federal Benefit Rate (FBR)

Return to top
The national benefit amount, established by the Social Security Administration (SSA), for Supplemental Security Income (SSI) recipients. For 2017, the FBR is $735 for an individual and $1,103 for a couple.

Federal Housing Administration (FHA) Loan

Return to top
Loans offered by banks and mortgage lenders that are insured by the federal government. They allow buyers to make much smaller down payments and are typically available for people with lower credit scores.

Federal Poverty Guidelines (FPG)

Return to top
Monthly and annual income amounts used to determine financial eligibility for state and federal benefit programs.

Each year, the U.S. Department of Health and Human Services (HHS) issues the Federal Poverty Guidelines (FPG) in the Federal Register. The current FPG for one person is $12,060 per year; for two people, it's $16,240. Add $4,180 for each additional person.

Note: Different state and federal programs adopt the new Federal Poverty Guidelines on different dates each year.

FICA Taxes

Return to top
Taxes that are deducted from your paycheck when you work to help pay for Social Security and Medicare. FICA stands for Federal Insurance Contributions Act.

Five-Year Window

Return to top
The 60 consecutive months (five years) during which you can work nine Trial Work Months.

The window begins on the first TWP month, but rolls forward until you have worked nine Trial Work Months within 60 consecutive months.

Fixed-Rate Mortgage

Return to top
A home mortgage for which equal monthly payments of interest and principal are paid over the life of the loan, usually for a term of 30 years.

Foreclosure

Return to top
A situation in which a mortgage lender (or financial institution) takes possession of the property because the borrower has not made payments on interest or principal for a certain period of time. Once the lender takes over the property, it usually sells at a discounted price so as to recover the amount lost on the mortgage loan.

Foreign Income

Return to top
Income received for services performed in a foreign county by an individual residing in that country.

Formulary

Return to top
A list of drugs that a health plan covers.

Full-Scope Medi-Cal

Return to top
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

Fully-Insured Plan

Return to top
An insurance plan purchased for employees by an employer, through an insurance company. The employer pays premiums to that company, and the insurance company is responsible for providing the costs of health care, as agreed upon in the policy. Fully-insured plans are subject to federal and state regulation.

General Enrollment Period

Return to top
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 (SSI)

Return to top
The $20 of earned or unearned income that is not considered when determining the amount for the Supplemental Security Income (SSI) benefit.

General Relief/General Assistance (GR/GA)

Return to top
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.

Grace Period

Return to top
When a person has a pattern of work in which countable earnings exceed Substantial Gainful Activity (SGA), the first 3-months of that pattern are the Grace Period. A person gets full Social Security Disability Insurance (SSDI) payments regardless of wages during this period.

Grant

Return to top
Money that does not have to be repaid. Government agencies and foundations give grants to programs and individuals who need financial help.

Gross Benefit Amount

Return to top

The total benefit amount an insurance company pays before deductions. Deductions are made for an individual’s disability income and for earnings he/she is receiving.

Gross Income

Return to top
Your earned income (before taxes and other deductions are made) plus your unearned income.

Gross Misconduct

Return to top
A serious violation of company policy or the commission of a crime affecting the workplace that may result in the loss of COBRA benefits. Although "gross misconduct" is not defined in COBRA legislation, past examples include embezzlement, misrepresentation, theft, and non-work related violence.

Gross Monthly Earnings

Return to top
Your total earned income for the month before taxes and other deductions are made.

Gross Pre-disability Salary

Return to top
The total pre-tax income paid to an individual by an employer before a disability began and while the individual was covered by disability insurance.

Group Coverage

Return to top
Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.

Guardian

Return to top
A person who has the legal authority and duty to care for another person.

Habilitative Services

Return to top
Services or devices which help a person with a health condition to develop skills useful for everyday living, which they have never developed before.

This is different than rehabilitative services, which help a person with a health condition relearn skills that they knew how to do before an illness, accident, or injury.

Health Insurance Portability and Accountability Act (HIPAA)

Return to top
A law that protects the privacy and confidentiality of your health information, such as medical records and test results. It regulates how health care providers are allowed to handle and share your protected health information.

HIPAA also prevents group health plans from denying you coverage based on your health condition and provides protections for those buying individual health coverage. However, these parts of HIPAA are protections that are no longer needed, since the Affordable Care Act provides all the same protections, plus more.

Health Maintenance Organization (HMO)

Return to top
A common type of health care coverage plan. HMOs require that you only see certain doctors and that your primary care physician decides when you need to see a specialist.

Health Screening

Return to top
A process that allows Medicare supplement carriers to refuse coverage based on an individual’s health history. This process is also known as medical underwriting.

If a person enrolls in a Medicare supplement during the Medigap open enrollment period, an insurance company cannot use health screening. But, if a person tries to enroll in a Medicare supplement outside of the open enrollment period, then a private insurance company can still use health screening.

High-cost Medical Condition

Return to top
Medi-Cal has a list of certain conditions, like AIDS, that they automatically consider high cost. For other conditions, Medi-Cal estimates how much it would cost them to pay for your condition. They then estimate how much it would cost them to pay for your private insurance premiums. Conditions that are more expensive for Medi-Cal to cover are high cost conditions.

High-Deductible Plan

Return to top
A health coverage plan with a relatively low premium that usually doesn’t pay for the first few thousand dollars of health care expenses (this is your deductible) but will typically cover your expenses after you pay a certain set amount.

HIV/AIDS Disability Form 4814 for Social Security

Return to top
A form for individuals with HIV/AIDS who are applying for Social Security Disability Insurance (SSDI) benefits. The form requires physicians to identify whether an individual has one of the 41 opportunistic infections listed on the form, and to specify any "repeated manifestations" of other symptoms that restrict certain aspects of the individual's life.

Home Health Care (Medicare)

Return to top
Services covered by Medicare including part-time or periodic skilled nursing care; home health aide services; physical therapy; occupational therapy; speech-language therapy; medical social services; durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers); medical supplies; and other services.

Hospice Care (Medicare)

Return to top
Services covered by Medicare Part A for individuals with a terminal illness. Services may include prescriptions for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in an individual’s home; however, Medicare may cover some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).

Hospital Stays (Medicare)

Return to top
Services covered by Medicare Part A that include a semiprivate room, meals, general nursing, and other hospital services and supplies.

Household

Return to top
A group of people who live together as a family. Eligibility rules for benefits programs often vary depending on how many people live in your household.

The exact rules for who counts as a member of a household depend on the program. For most programs, your household includes the following people if they are living with you:

  • Yourself
  • Your spouse
  • Your children
  • Your spouse's children

If you are under 18, for most programs your household also includes the following people if they are living with you:

  • Your parents
  • Your stepparent if your other parent lives with you
  • Your siblings and stepsiblings

Many programs also consider these people part of your household if you over 18. And for some programs, other people living with you, such as grandparents, cousins, or others, may also be considered part of the household.

Housing Opportunities for Persons with AIDS (HOPWA)

Return to top
A program run through local housing authorities that can give rental help to people living with HIV/AIDS and their families. HOPWA funds can also give short-term rent, mortgage, and utility payment help.

Hunt v. Kizer

Return to top
A case law that allows a Medi-Cal recipient to use prior unpaid medical expenses to meet their monthly share of cost.

Impairment Related Work Expenses (IRWE)

Return to top
Documented expenses for services or items that are related to a serious medical condition or impairment and needed in order to work. Wheelchairs, physician visits, copayments for prescriptions, and other medical expenses are some examples of IRWEs. The expenses must be verified by original receipts and canceled checks and approved by Social Security.

In Arrears

Return to top
Payment received for the prior month.

Income

Return to top
Money from salaries, wages, tips, disability benefits, investments, dividends, and funds received from any other source. Includes both earned and unearned income.

Income Disregard (Medi-Cal)

Return to top
A specified amount of earned or unearned income that is excluded from consideration in the financial eligibility requirements for a Medi-Cal program.

Income Limit

Return to top
The highest income you can have while still qualifying for a particular benefits program.

Incurring Medical Expenses (Medi-Cal)

Return to top
Being responsible for medical expenses before Medi-Cal coverage begins.

Indemnity Plan

Return to top
A type of health insurance plan. You pay monthly premiums and usually have co-insurance and a yearly deductible as well. Also known as fee-for-service.

Independent living

Return to top
Living on one’s own, in the community, outside of an institution.

Independent Living Centers

Return to top
Offices that help people with disabilities live independently by offering information, teaching skills, and helping plan benefits. Your local Independent Living Center (ILC) has information about all aspects of living with a disability, including housing, transportation, Personal Assistance Services (PAS), employment, education, and benefits.Independent Living Centers are run by people with disabilities.

Independent Review Entity

Return to top
A person outside of a Part D plan who reviews an appeal. This is the first person outside of the plan to review an appeal during the Part D appeals process.

Indigent Exception

Return to top
A deeming exception for CAPI applicants whose sponsor signed an Old Affidavit of Support. An individual is considered to be indigent if he/she receives less than the federal Supplemental Security Income (SSI) benefit amount - $735 per month in 2017 for an individual ($1,103 for a couple).

Individual Development Account (IDA)

Return to top
A savings account in which your deposits are "matched" at a certain rate. If you have a 2-to-1 match, for example, an additional $2 will be deposited for every $1 that you deposit in your account. IDAs are usually used to save for school, purchasing a home, or starting a business.

Individual Disability Policy

Return to top
Wage-replacement coverage you buy directly from an insurance company, usually through an agent, that provides benefits if you become disabled. You are responsible for paying for the entire premium, and most individual policies require medical underwriting.

Individual Health Coverage

Return to top
Private health insurance an individual or family purchases. The individual or family pays a monthly premium and the plan agrees to pay a portion of the cost of approved medical services when needed, like for preventive care, lab tests, surgery, or prescription drugs. The easiest way to purchase an individual plan is through Covered California.

The government may help individuals and families with low to middle income who get their coverage through Covered California pay for their monthly premiums and a portion of the cost of approved medical services.

Individual Mandate

Return to top
A part of the Affordable Care Act (ACA) that requires most Americans to have health insurance that meets a minimum standard, or pay a fine. This fine is sometimes called the ACA “tax penalty.” Public insurance programs like Medicare or Medi-Cal, insurance offered through your employer, and insurance you buy through Covered California all count as meeting the individual mandate.

You do not have to pay a fine, even if you do not have health insurance, if:

  • You cannot afford the lowest cost plan option (because either the lowest cost plan is more than 8% of your income or your income is low enough that you don’t legally have to file taxes)
  • You have a religious objection
  • You are an American Indian
  • You are only without coverage for less than three months
  • You are an undocumented immigrant, or
  • You are incarcerated.

If you do not have health coverage, and you do not meet any of the exceptions, you will have to pay a fine each year you do not have coverage.

Individual Plan for Employment (IPE)

Return to top
A plan that lists the employment services and outcomes needed to achieve your PASS goal.

Individual Retirement Account (IRA)

Return to top
A type of retirement plan in which people who are employed can put aside money every year into an account that is taxed less than a standard savings or investment account. This helps the account grow more quickly than other accounts. The person who puts the money aside can only use this money after reaching the age of 59 and a half. If money is withdrawn before that age, the person taking the money out has to pay a penalty.

Individual Threshold Amount

Return to top
A personal income limit that enables an individual to retain Supplemental Security Income-linked Medi-Cal coverage when their earnings go above the state's threshold amount. Social Security will determine an Individual Threshold Amount if the individual has Impairment Related or Blind Work Expenses, a Plan to Achieve Self-Support, a publicly funded personal attendant, or medical expenses above the state average amount.

Individual Work Plan (IWP)

Return to top
A formal agreement between an individual in the Ticket to Work program and an Employment Network that describes how services will help the person to achieve an employment goal. The IWP includes specific steps and a time schedule that may span several years.

Individualized Education Program (IEP)

Return to top
An educational plan for a student receiving special education services. The IEP is created with input from parents, teachers, staff, and the student. It includes information on the student’s current performance, goals and evaluation, and on what specific services the student will need.

Informed Choice

Return to top
Making decisions based on complete and accurate information about your specific situation. Informed choice happens through talking with people that support you and doing things that help you make decisions about your life. It means that your concerns about myths and barriers about working and benefits are addressed. It also means that you understand all your options, how to get past barriers, and understand risks and benefits of your decisions. Part of this is seeing that your options are not limited to just disability programs. Professionals that help you in your decisions are being asked to use person centered ways to support informed choice in your life.

In-Home Supportive Services (IHSS)

Return to top
A program that provides domestic, paramedical, and personal assistance services for people with disabilities so that they can live independently or maintain employment safely. The IHSS program provides an alternative to living in an institution for many people.

Initial Enrollment Period (Medicare)

Return to top
The period when a beneficiary can first sign up for Medicare Part B or Part D. For Social Security Disability Insurance (SSDI) and Childhood Disability Benefits (CDB) beneficiaries, the initial enrollment period begins during the 24th month of a beneficiary’s SSDI or CDB payments. The initial enrollment period typically lasts about 10 months.

Initial Enrollment Period (Private Coverage)

Return to top
The first time an individual is eligible to enroll in a group’s benefits programs.

In-Kind Support and Maintenance (ISM)

Return to top
A Supplemental Security Income (SSI) term that describes food and/or shelter which is supplied or paid for by someone other than the SSI beneficiary. Shelter expenses can include rent, mortgage payments, property taxes, heating fuel, gas, electricity, water, sewer service, and garbage collection.

If you do not pay your fair share of food and/or shelter, your maximum possible SSI benefits amount may be reduced. Depending on your situation, your ISM may be calculated using SSI's Value of One-Third Reduction (VTR) rule or the Presumed Maximum Value (PMV) rule.

Note: ISM rules usually only apply to adults, not to children under 18 years old. For children, parent-to-child deeming rules usually apply instead.

Inpatient

Return to top
An individual who has been admitted to the hospital.

Inpatient Care

Return to top
Health services received after an individual is admitted to the hospital.

Integration

Return to top
The adjustment of payments when an individual is eligible for more than one benefit program.

Interest

Return to top
A charge for a loan, usually a percentage of the amount loaned.

Internship

Return to top
A short-term work experience that allows you to gain practical skills and learn about an occupation in a real-world setting.

Interval Steps

Return to top
Measurable milestones that show progress towards achieving a vocational goal in a Plan to Achieve Self-Support. For example, if the goal is to obtain a job, the job search would be considered an interval step.

Investment Income

Return to top
Dividends, capital gains net income, certain rental and royalty income, net passive activity income, and taxable and tax-exempt interest.

Job Coaching

Return to top
A service that helps a person with a disability to keep a job. A job coach may:
  • Help you transition into employment at the beginning of a job
  • Provide ongoing support as you work
  • Train you
  • Talk to your employer about how to support you
  • Help you figure out transportation to and from work

Lawful Permanent Residents (LPRs)

Return to top
Individuals living within the U.S. with a green card.

Legal Adulthood

Return to top
Being able to sign contracts, vote, and enjoy other rights and responsibilities of adulthood. Generally, in the United States, people become legal adults when they turn 18.

Lifetime Reserve Days

Return to top
The days following a 90-day hospitalization. Medicare allows an individual 60 lifetime reserve days per benefit period that may only be used once during an individual’s lifetime. Medicare will pay for lifetime reserve days, whether used at once or over the individual's lifetime. However, the individual must pay for the daily coinsurance of $658 in 2017.

Liquid Assets

Return to top
Cash or other property which can be converted to cash within 20 days, excluding non-work days. Liquid assets include: checking and savings accounts, stocks, bonds, mutual fund shares, promissory notes, mortgages, and life insurance policies.

Loan

Return to top
Money that has to be repaid over time. You may get a loan to pay for different things, like buying a home or a car or paying for college or other expenses.

Loan Underwriting

Return to top
The process of reviewing all information collected in loan paperwork to figure out whether or not the loan is a good risk. The loan is evaluated based on the lender’s guidelines and practical experience.

Long-Term Care

Return to top
Services that assist individuals with long-term medical and personal needs. Long-term care may include medical services, physical therapy, custodial care, and assistance with activities of daily living such as dressing, eating, and bathing. Long-term care may be provided at home, in the community, or in facilities, including nursing homes and assisted living facilities. Medicare will not pay exclusively for custodial care.

Long-Term Disability Insurance

Return to top
Private insurance that replaces some of your income when you can't work because of a disability. Long-Term Disability (LTD) generally covers disabilities that last more than a year. To apply for LTD, speak with your employer's human resources department, or contact a private insurance company.

Low Income Subsidy (LIS) (Extra Help)

Return to top
Help paying for Medicare Part D for people with low to moderate income and resources. Also known as "Extra Help".

There are two levels of the Low Income Subsidy:

  • The full subsidy is for people who also get Medi-Cal coverage or who are in a Medicare Savings Program (MSP). You may also qualify if your countable income is less than $16,281 per year and your resources are less than $7,390, if you are single (the limits are higher for larger households).
  • The partial subsidy is for people who can’t get the full subsidy, but have less than $18,090 in countable income and less than $12,320 in resources, if you are single (the limits are higher for larger households).
    • With the partial subsidy, you will pay 0%, 25%, 50%, or 75% of the Part D premium, depending on your income, and will only have to pay a $82 deductible before you get help paying for drugs. You will have to pay coinsurance and copayments for your medications, but they will be lower than they would be without the partial LIS.

Note: Not all of your income and resources are counted when you apply for the Low Income Subsidy. You can apply for the LIS even if you are not sure that you will qualify.

Maintenance Need Level (MNL)

Return to top
The amount of an individual’s income that Medi-Cal determines is used to cover living expenses such as food, clothing and housing.

Major Risk Medical Insurance Program (MRMIP)

Return to top
Health insurance for Californians who are unable to obtain coverage in the individual health insurance market, usually due to pre-existing condition exclusionary periods.

Managed Care

Return to top
Health coverage that requires you to get most services within a network.

With managed care, you have a primary care provider who oversees your care and refers you to specialists within the network when needed.

Match

Return to top
Funds paid by an IDA program when an individual deposits money into the account.

Maximum Aid Payment (MAP)

Return to top
Amount of cash aid a CalWORKs applicant is eligible for based on family size. Families who do not have any earned or unearned income are considered exempt and will receive a higher cash payment.

Medicaid

Return to top
A joint Federal and state program that provides assistance with medical costs to some low income individuals with limited resources. Medicaid programs vary from state to state. The federal Medicaid program is called Medi-Cal in California.

Medicaid Buy-In

Return to top
A program that allows individuals working with a disability to retain Medi-Cal (Medicaid) coverage through premium payments. In California, this program is called the Working Disabled Program.

Medi-Cal

Return to top
California's Medicaid program. It offers health coverage for people with low incomes. There are additional ways to qualify for people who are disabled, blind, or at least 65 years old.

Medi-Cal Managed Care

Return to top
A Medi-Cal program that requires most recipients to receive services within a network. Recipients are assigned a primary care provider who is responsible for managing their care. Also known as Medi-Cal Prepaid Health Plan.

Medi-Cal Prepaid Health Plan

Return to top

Medical Provider (SDI)

Return to top
The person who provides a medical certification of a disability. They can be a licensed physician, surgeon, U.S. government medical office, osteopathic physician, chiropractor, podiatrist, optometrist, dentist, designated psychologist, nurse-midwife, nurse practitioner, midwife, or accredited religious practitioner.

Medical Savings Account (Medicare)

Return to top
A Medicare Advantage (Part C) option where Medicare gives your plan money to deposit into a savings account. You can use this money to pay for Medicare costs. After you meet a high yearly deductible, the plan will help pay for Medicare services.

Medical Treatment/Care

Return to top
Any medical care that you receive for a medical condition. Some examples include being prescribed medication, visits to the doctor, and therapy for a mental health problem.

Medical Underwriting

Return to top
The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Medi-Cal/HIPP (Medi-Cal/Health Insurance Premium Payment)

Return to top
A state program that pays for private health insurance premiums.

Medically Necessary

Return to top
Services or supplies that are considered by Medicare to be appropriate and needed for treatment.

Medi-Cal's Working Disabled Program (WDP)

Return to top
A Medi-Cal eligibility category that allows you to have countable income up to 250% of the Federal Poverty Level. You pay a small premium for Medi-Cal that is based on your income.

Medicare

Return to top
A federal program that provides health insurance for people 65 or older and many people under 65 who have disabilities. After a person gets Social Security Disability Insurance (SSDI) benefits for two years, he or she qualifies to get Medicare as well.

Medicare + Choice Plan

Return to top

Medicare Advantage (Part C)

Return to top
A way of getting combined Medicare coverage through a health plan run by a private insurance company, instead of getting Original Medicare (Parts A, B, and D). Medicare Part C plans can be Managed Care (Medicare HMOs), Private Fee-for-Service, Preferred Provider Organization, and Special Needs Plans. If you get Medicare Parts A and B, you can choose whether you want to join a Part C plan or prefer staying enrolled in Original Medicare.

Medicare Advantage Prescription Drug (MA-PD) Plan

Return to top
Medicare Part D drug coverage that is offered through a Medicare Advantage plan.

Medicare Appeals Council

Return to top
A group of people within the Centers for Medicare and Medicaid Services (CMS) who hear Medicare appeals after they have gone to an Administrative Law Judge.

Medicare Carrier

Return to top
A private insurance company that contracts with Medicare.

Medicare Cost Plan

Return to top
A way to organize your Medicare benefits. When you use services within the plan’s network, it helps pay for costs. When you use services outside the plan’s network, Original Medicare helps pay.

Medicare Health Maintenance Organization (HMO)

Return to top
A Medicare Advantage option that can have lower copayments than the Original Medicare Plan, but generally limits individuals to visiting doctors, specialists, or hospitals within the plan's network. Plans must cover all Medicare Part A and Part B services, and some plans cover extras, like prescription drugs. Medicare Managed Care Plans are only available in some areas of the country.

Also known as "Medicare Managed Care Plan."

Medicare Managed Care Plan

Return to top

Medicare Part A

Return to top
The part of Medicare that helps pay for medical care you get while you’re in a hospital.

Medicare Part B

Return to top
The part of Medicare that helps pay for medical care you get when you are not staying in a hospital, such as when you go to see a doctor.

Medicare Part D

Return to top
The part of Medicare that helps pay for prescription drugs.

Medicare Plans

Return to top
Health coverage options that include: Original Medicare, Medicare Advantage Plans, and Medicare supplement policies.

Medicare Preferred Provider Organization (PPO) Plan

Return to top
A Medicare Advantage option that gives an individual the choice of visiting providers within the network or seeing a provider outside of the network for an additional cost. An individual does not need a referral from their primary care physician to see a specialist.

Medicare Private Fee-for-Service Plan

Return to top
A Medicare Advantage option that allows an individual to go to any Medicare-approved doctor or hospital. The insurance plan, rather than the Medicare program, decides what services it will cover and how much it will pay. Although an individual may pay more under this plan, he/she may have extra benefits that the Original Medicare Plan doesn't offer.

Medicare Savings Program (MSP)

Return to top
Medicare Savings Programs help people on Medicare pay for some of their out-of pocket Medicare costs. The costs paid depend upon your income but can include Medicare Part A and B premiums, co-insurance, copayments, and deductibles. You need to have countable income that is 135% of the Federal Poverty Guidelines (FPG) or less ($1,357/month for an individual, $1,827/month for couples) to qualify for a Medicare Savings Program.

There are three different Medicare Savings Programs you may qualify for:

  • Qualified Medicare Beneficiary (QMB), if your countable income is 100% of FPG or less ($1,005/month for an individual, $1,353/month for couples)
  • Service Limited Medicare Beneficiary (SLMB), if your countable income is 120% of FPG or less ($1,206/month for an individual, $1,624/month for couples)
  • Qualified Individual (QI), if your countable income is more than 120% of FPG, but at or below 135% of FPG ($1,357/month for an individual, $1,827/month for couples)

Medicare Supplement

Return to top
A supplemental insurance policy sold by private insurance companies to fill gaps in the Original Medicare Plan. In California, there are 12 Medicare supplement plans labeled Plan A through Plan L.

Medicare supplement plans are available only to individuals using the Original Medicare Plan, and it is illegal for an insurance carrier to sell a Medicare supplement to an individual who does not have Original Medicare.

Medicare supplements are also referred to as "Medigap."

Mentor

Return to top
A person who can provide you with guidance and support.

Microenterprise

Return to top
A business operating on a very small scale. Often a microenterprise is owned and run by 1 person and has a small number of employees.

Milestone

Return to top
A significant, visible step toward achieving a vocational goal.

Minimum Basic Standards of Adequate Care (MBSAC)

Return to top
A tool used by California’s Department of Social Services to determine CalWORKs eligibility.

The MBSAC is a limit that is compared to your countable income. If your family’s countable income is lower than the MBSAC for a family in your situation, your family will be eligible for a CalWORKs cash benefit. The MBSAC limit depends on how many people are in your family and whether you live in Region 1 or Region 2.

Region I includes the more urban counties (Alameda, Contra Costa, Los Angeles, Marin, Monterey, Napa, Orange, San Diego, San Francisco, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Sonoma, and Ventura) where cost of living is higher, so the MBSAC is correspondingly higher. Region II includes the more rural counties (all of the ones not listed above).

Note: THE MBSAC limit is not your benefit amount. Is is simply a tool to determine whether your family is eligible for CalWORKs.

Minimum Basic Standard of Adequate Care (MBSAC) Levels

Family Size

Region 1

Region 2

1

$636

$603

2

$1,042

$991

3

$1,292

$1,227

4

$1,533

$1,458

5

$1,750

$1,666

6

$1,968

$1,872

7

$2,163

$2,052

8

$2,354

$2,241

9

$2,554

$2,421

10

$2,772

$2,637

More than 10

Add $25 for each extra person

Add $25 for each extra person

Minimum Payment

Return to top
The amount shown on your monthly credit card statement that you must pay by the due date to not hurt your credit score.

Modified Adjusted Gross Income (MAGI)

Return to top
Total annual income of everybody living in a household, including most earned and unearned income. MAGI is used to help determine eligibility for income-based Medi-Cal and for subsidies that help households pay for individual health coverage on Covered California.

MAGI includes:

MAGI does not include:

  • Supplemental Security Income (SSI), CalWORKs, CalFresh, and veterans' disability benefits
  • Workers' compensation
  • Earned income that is placed in a 401(k) plan or Individual Retirement Account (IRA) (Income placed in Roth versions of these accounts is included in MAGI.)
  • Pre-tax deductions from a paycheck, including contributions to health savings accounts (HSAs) and flexible spending accounts (FSAs)
  • Child support received; and
  • Most other types of non-taxable income.

Get more information about what is included in Modified Adjusted Gross Income.

Mortgage

Return to top
A loan for funds used to buy real estate property.

Needs Assessment

Return to top
An evaluation that measures an individual's ability to complete activities of daily living (dressing, toileting, bathing, eating, respiration, getting around in the house) and instrumental activities of daily living (housekeeping, shopping, taking medication, meal preparation, managing finances, and getting around out of the house). The needs assessment determines an individual’s level of need for the In-Home Supportive Services Program.

Net Benefit Amount

Return to top
The benefit amount an insurance company pays after deducting income.

Net Countable Earned Income (Medi-Cal)

Return to top
The portion of an individual's earned income that is taken into account when evaluating financial eligibility for Medi-Cal.

Net Income

Return to top
The amount of income you have after certain amounts are subtracted from it.

Network

Return to top
A group of doctors or medical service providers who have signed a contract with a health coverage plan. If you have health coverage through a Health Maintenance Organization (HMO), you generally have to see doctors within the network. Preferred Provider Organizations (PPOs) and Point of Service (POS) plans allow you to see doctors outside of your network, but you will have to pay more.

No-Cost Medi-Cal

Return to top
Medi-Cal that you don't have to pay for.

Nonpreventive Care Services

Return to top
Health care services that are medically necessary and are aimed at treating illnesses, as opposed to preventing them. (Contrast: preventive care services.)

Notice of Action (NOA)

Return to top
The official name for correspondence between Medi-Cal and beneficiaries.

OBRA

Return to top
If you are on COBRA for 18 months, you may be able to extend your health care coverage for an additional 11 months via OBRA protections. Important: You must apply for OBRA within 30 to 60 days of the date that you're approved for Social Security Disability Insurance (SSDI).

Onset Date (Social Security)

Return to top
The date, after reviewing an individual's medical records, that Social Security determines that a disability began. The date Social Security receives an application does not necessarily establish the onset date.

On-the-Job Training (OJT)

Return to top
An employment activity under the Welfare-to-Work Program that provides skills to CalWORKs participants. An employer in the public or private sector can receive compensation for On-the-Job Training of a CalWORKs recipient.

Open Enrollment Period

Return to top
The annual time period when an individual may add or change private insurance plans offered by an employer, an association, or through Covered California. Certain situations, such as divorce, the birth of a child, or loss of another insurance plan may allow a person to sign up for an insurance plan outside of this time period.

Opportunistic Infection

Return to top
An infection that occurs when the immune system is weakened.

Original Medicare

Return to top
A pay-per-visit health coverage plan that allows individuals to go to any doctor, hospital, or other health care supplier who accepts Medicare and who is accepting new Medicare patients. The individual is responsible for paying a deductible and copayment. Under Original Medicare, Medicare pays a portion of the Medicare-approved amount, while the individual pays for his/her share (coinsurance).

Individuals with Medicare choose to either stay in Original Medicare or enroll in a Medicare Advantage Plan. Medicare Advantage plans will have different costs and covered services than Original Medicare.

Out-Of-Pocket Costs

Return to top
The health care related costs you pay yourself without help from Medicare, Medi-Cal, or other health insurance.

Out-Of-Pocket Maximum

Return to top
The maximum amount of money that you have to spend on health costs in a year. After you reach the out-of-pocket maximum, your policy will pay the entire cost of covered services. The out-of-pocket maximum does not count the premiums you pay, and certain other costs may or may not be counted.

Outpatient Services

Return to top
Health services received outside of hospital care, including after an individual is released from the hospital.

Overpayment

Return to top
Payment that exceeds the approved benefit amount.

Paramedical Services

Return to top
Services that are prescribed by a doctor and often administered by in-home care providers. They typically require some level of training or judgment and are essential to the health of the recipient. Common examples include injections, administration of medication, catheter insertion and care, tube feeding, ventilator and oxygen care, treatment of wounds, and other services requiring sterile procedures.

Parental Control

Return to top
Social Security uses this as one measure of whether or not a beneficiary should receive an independent living benefit rate. A child is considered to be under "parental control" if their parent has the authority to make decisions on their behalf.

Parent-to-Child Deeming

Return to top
Social Security’s process of figuring out how much of parents’ income is used to pay for a child’s basic needs. Some of the parents' income may be considered the child's when determining whether or not the child is eligible for disability benefit programs.The amount of deemed income is subtracted from the benefit amount.

PASS Cadre

Return to top
A group of specialists at the Social Security Administration (SSA) who review, monitor, and approve Plans to Achieve Self-Support (PASS). They can also help you as you write your plan.

Find a PASS specialist in California.

PASS Review

Return to top
A regular review of your Plan to Achieve Self-Support (PASS) that takes place at least once every six months. A PASS specialist will check how your plan is progressing and collect receipts for your PASS expenses.

Patient Assistance Program (PAP)

Return to top
A program administered by a pharmaceutical company that provides financial assistance with prescription drug costs. PAPs offer free and discounted prescription drugs to those who qualify.

Payer of Last Resort

Return to top
The insurer who pays medical claims last when an individual has multiple sources of health coverage.

Peer Counselor

Return to top
A person who helps another person who has had similar or related experiences. A peer counselor can listen, share information, and give advice.

Period of Entitlement

Return to top
The continuous period from the award start date of a benefit to the date when eligibility for the benefit or program stops.

Period of Incapacity

Return to top
At least four consecutive days when you are unable to do the basics of your job, attend school, or take care of yourself because of illness.

Permanent Resident

Return to top
U.S. Permanent Resident with either an Alien Registration Card or I-551 Card.

Permanently and Totally Disabled

Return to top
According to the Internal Revenue Service (IRS), a physical or mental condition which:
  • Is expected to last continuously for at least 12 months (one year) or result in death, and
  • Prevents a person from performing any Substantial Gainful Activity (SGA) (earning more than $1,170 per month; $1,950 if blind).

Permanently Residing in the U.S. Under Color of Law (PRUCOL)

Return to top
Noncitizens who are residing in the United States with the knowledge and permission of the Department of Homeland Security (DHS). This category includes noncitizens:
  • Subject to an Order of Supervision
  • On whose behalf an immediate relative petition has been approved and who are entitled to voluntary departure
  • Who have properly filed an application for an adjustment to lawful permanent resident status
  • Granted a stay of deportation
  • Granted voluntary departure and who are awaiting issuance of a visa
  • In deferred action status
  • Who entered and have continually resided in the United States since before January 1, 1972

Personal Assistance Services (PAS)

Return to top
Services designed to assist an individual with a disability perform activities of daily living at home or in the workplace.

Personal Care Assistant (PCA) Services

Return to top
Assistance and support services for people with disabilities who live independently in the community. A qualified personal care assistant provides the services in the person’s own home or in the community.

Pharmacy Network

Return to top
A group of local pharmacies you can buy prescription drugs from. If you purchase drugs from within your pharmacy network, your prescription drug plan should cover it.

Plan to Achieve Self-Support (PASS)

Return to top
A Supplemental Security Income (SSI) program that allows you to set aside income and assets for expenses related to a specific work goal. Income that you use for these expenses will not cause your SSI benefits to go down. Assets that you spend on PASS expenses won't count towards the SSI limit.

A PASS specialist can help you set up a Plan to Achieve Self-Support.

Point-Of-Service (POS) (Medicare)

Return to top
An option offered by some Medicare Managed Care Plans that allows an individual to use doctors and hospitals outside the plan at an additional cost.

Point-Of-Service (POS) Plan (Private Health Coverage)

Return to top
A type of health coverage that allows you to choose between HMO, PPO, and Indemnity coverage. You can choose to pay less and have your care managed by a physician, or pay more to have more choices in the doctors you can see.

Potentially Disabling Condition

Return to top
A condition that does not yet interfere with your abilities or keep you from working, but may one day develop into a disability that keeps you from working.

Power of Attorney

Return to top
A legal written document that lets someone else (called an agent) act for you in legal, financial, business, or personal matters. The agent can make decisions, sign legal documents, buy or sell items, or handle banking and other accounts for you.

Pre-Disability Income

Return to top

Pre-Disabled

Return to top
A person who is HIV-positive, but does not have an AIDS diagnosis, Opportunistic Infections (OI), or any other symptoms. Somebody who is pre-disabled is likely to become disabled without medical treatment.

Pre-Existing Condition

Return to top
Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Pre-Existing Condition Exclusionary Period

Return to top
The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Pre-Existing Condition Insurance Plan (PCIP)

Return to top
Government-run insurance plans for people who couldn’t get insurance because of pre-existing medical conditions, PCIPs ended on January 1, 2014. Now, insurance companies cannot deny people health coverage because of pre-existing conditions. People who don’t have health insurance can get coverage through Covered California.

Preferred Provider Organization (PPO)

Return to top
A type of health insurance plan. You pay a monthly premium and, when you use medical services, copayments and deductibles. PPOs have networks of physicians. You can see any doctor in the network without getting prior authorization from a primary care physician. Seeing a doctor outside of the network is more expensive.

Premium (General)

Return to top
A regularly scheduled payment to an insurer or health care plan.

Premium (Medicare)

Return to top
A regularly scheduled payment to an insurer or health care plan.

If you're on SSDI or CDB and Medicare, you likely won't have to pay a premium for Medicare Part A coverage. You may have to pay a Part B premium, however. For most people, the premium for Part B coverage is $109.00 per month. If you qualify, a Medicare Savings Program or other programs can help pay for your Part B premium.

If you sign up for Part D prescription drug coverage or have a Medicare Advantage (Part C) plan instead of Original Medicare, you will also usually have to pay a premium. The exact amount of your premium will depend on the plan you choose.

Prescription Drug Plan (PDP)

Return to top
A Medicare Part D plan that only offers drug coverage. Also known as a "stand-alone" plan.

Presumed Maximum Value (PMV) Rule

Return to top
A rule that sets a maximum value on the amount of certain types of in-kind support and maintenance that SSI counts. If the PMV rule applies, the most you can get in SSI benefits goes down.

The PMV rule applies if:

  • Somebody helps you with food and/or shelter, and
  • The Value of One-Third Reduction (VTR) rule does not apply to your case.
    • Examples: The VTR does not apply if you do not live in the same household as the person helping you with your food and shelter, or if the person helping you does not help with both food and shelter.

The exact amount your maximum SSI benefits go down depends on your situation:

  • By default, it will go down by one-third of the maximum SSI benefit plus $20. For 2017, this Presumed Maximum Value (PMV) is $265.00 for an individual.
  • However, if the actual help you get paying for food or shelter is worth less than the PMV, then your SSI benefits will only be reduced by the actual support amount.

Presumptive Disability

Return to top
A status granted to Supplemental Security Income (SSI) applicants who have a high chance of being found disabled according to Social Security Administration (SSA) standards. If the SSA finds you presumptively disabled, they will begin benefit payments while your application is still being reviewed.

The SSA may find you presumptively disabled if you meet the medical criteria of the Blue Book Listing of Impairments or if you have HIV/AIDS and meet the criteria of SSA Form 4814. In either case, you must also meet SSI financial requirements to be eligible for presumptive disability benefits.

Repayments of presumptive disability benefits are not required even if SSI benefits are ultimately denied.

Preventive Care Services

Return to top
Health care services aimed at keeping you healthy by preventing illness; for example, Pap tests, pelvic exams, yearly mammograms, and flu shots. (Contrast: non-preventive care services.)

Primary Care Physician (Medicare)

Return to top
A doctor who provides basic care and acts as an individual’s first point of contact when seeking health services. In many Medicare Managed Care Plans (Medicare HMOs), an individual may need to see their primary care doctor before going to a specialist.

Primary Care Provider (PCP)

Return to top
The doctor, nurse practitioner, or other medical service provider who is in charge of your medical care in a Health Maintenance Organizations (HMO). In HMOs, you have to see a PCP in order to get a referral to see a specialist. Other types of health coverage might not have PCPs, or might charge you more if you see a specialist without getting a referral from a PCP.

Primary Payer

Return to top
The first insurer to pay medical claims when an individual uses multiple sources of health coverage.

Principal

Return to top
The amount that a person borrows. For example, if a person borrows $100,000, the principal amount is $100,000. Interest is calculated over the principal.

Prior Authorization (Medicare)

Return to top
A requirement to get an insurance plan's permission to use a certain medication. This helps the insurance plan reduce costs.

Prior Authorization (Private Health Coverage)

Return to top
A health plan process of reviewing medical services or medications before they give you permission to go ahead with the service or use the medication. This is done to ensure that the service or medication is appropriate and necessary before the plan pays for it.

Private Duty Nursing

Return to top
The care of clients by nurses. Most nurses who provide private duty care are working one-on-one with individual clients. Sometimes such care is provided in the client's home, or an institution, such as a hospital, nursing home or other such facility.

Private Health Coverage

Return to top
Health coverage through a private company that pays for medical expenses. A monthly premium must be paid for this coverage by the individual or family covered, by an employer, or by an association. The individuals covered by private health plans must also make payments such as copayments or coinsurance each time they use certain medical services.

In some cases, the federal government may help low to middle-income families pay for private health coverage through tax subsidies if they are in very specific situations and do not have other affordable health coverage alternatives.

Private Health Insurance Policy (Med-Cal/HIPP)

Return to top
A health insurance policy from a private insurer, Health Maintenance Organization (HMO), or self-insured trust.

Private Mortgage Insurance (PMI)

Return to top
An additional fee charged to borrowers who have a down payment that is less than 20% of the sale price or appraised value of the home.

Probate

Return to top
A legal process after a person dies during which a court decides whether that person’s will is valid or not. If the person didn’t leave a will, the court will decide who gets the person’s money and property. The process can be complicated, and take anywhere from a few months to several years.

Property Essential to Self-Support (PESS)

Return to top
Anything that you own and need to support yourself. If the Social Security Administration (SSA) approves the property that you claim is Property Essential to Self-Support (PESS), Social Security will not count these things as resources when figuring out if you are eligible for Supplemental Security Income (SSI) benefits. Three types of property can be excluded as PESS:
  • Property that you use in a trade or business (for example, your inventory) or personal property you use for work as an employee (for example, tools or equipment)
  • Up to $6,000 of the value of nonbusiness property that you use to produce something that helps with your daily living (for example, land that you use to produce vegetables that you eat)
  • Up to $6,000 of the value of property if the property gives you a return of at least a 6% per year (for example, property you own and rent to someone else)

You must be using the property to support yourself or expect to start using it again within a reasonable period of time, usually 12 months.

Protective Supervision

Return to top
Monitoring the activities of a person with cognitive disabilities to assure that they are not a harm to themselves or others.

Public Housing Authority (PHA)

Return to top
A local agency that is in charge of assigning Section 8 housing vouchers, taking care of upkeep of public housing, and making sure that the housing is safe, decent, and affordable. The U.S. Department of Housing and Urban Development (HUD) oversees and assists PHAs.

Find a PHA near you.

Qualified Alien

Return to top
According to Social Security, you are considered a qualified alien if the Department of Homeland Security (DHS) says you are in one of these categories:
  • Lawfully Admitted for Permanent Residence (LAPR) in the United States, including "Amerasian immigrant" as defined in Section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988, as amended;
  • granted conditional entry under Section 203(a)(7) of the Immigration and Nationality Act (INA) as in effect before April 1, 1980;
  • paroled into the United States under Section 212(d)(5) of the INA for a period of at least one year;
  • refugee admitted to the United States under Section 207 of the INA;
  • granted asylum under Section 208 of the INA;
  • deportation is being withheld under Section 243(h) of the INA as in effect before April 1, 1997, or removal is withheld under Section 241(b)(3) of the INA; or
  • “Cuban or Haitian entrant” under Section 501(e) of the Refugee Education Assistance Act of 1980 or in a status that is to be treated as a “Cuban or Haitian entrant” for SSI purposes.

Qualified Disabled Working Individual (QDWI)

Return to top
A Medicare Savings Program that pays for Medicare Part A premiums. The QDWI program is for Social Security Disability Insurance (SSDI) beneficiaries who lose their free Medicare Part A due to earnings. To qualify, an individual must:
  • Be less than 65 years old,
  • Be eligible for Medicare Part A,
  • Have countable income that's 200% of the Federal Poverty Guidelines (FPG) or less ($2,010 or less per month for individuals, $2,707 or less for couples),
  • Have assets at or below the limit ($4,000 for individuals, $6,000 for couples), and
  • Meet all other Medi-Cal eligibility requirements.

Qualified Individual (QI)

Return to top
A Medicare Savings Program that pays for Medicare Part B premiums. To qualify, an individual must:
  • Be eligible for Medicare Part A and B
  • Have countable income that's 135% of the Federal Poverty Guidelines (FPG) or less ($1,357 or less per month for individuals, $1,827 or less for couples),
  • Have resources at or below the limit ($7,390 for individuals, $11,090 for couples), and
  • Meet all other Medi-Cal eligibility requirements.

Qualified Jobseeker

Return to top
A person who (a) has certain characteristics that the employer asks job applicants to have, such as education, work experience, skills, or licenses, and (b) can perform the essential functions of the job with or without reasonable accommodations.

Qualified Medical Expense

Return to top
Expenses for certain items or services that are approved by your Flexible Spending Arrangement (FSA). You should get a list of what things count as qualified medical expenses, so you know ahead of time which things will be covered by your FSA, and which things will not

Qualified Medicare Beneficiary (QMB)

Return to top
A Medicare Savings Program that pays for Medicare Part A and Part B premiums, coinsurance and deductibles. To qualify, you must:
  • Be eligible for Medicare Part A and Part B,
  • Have countable income that's 100% of the Federal Poverty Guidelines (FPG) or less ($1,005 or less per month for individuals, $1,353 or less for couples),
  • Have resources at or below the limit ($7,390 for individuals, $11,090 for couples), and
  • Meet all other Medi-Cal eligibility requirements.

This program does not apply benefits retroactively.

Qualifying Child

Return to top
An IRS classification that may allow a taxpayer to claim the EITC and certain other tax credits. In general, to be a taxpayer’s qualifying child, a person must satisfy four tests:
  • Relationship — the taxpayer’s child or stepchild (whether by blood or adoption), foster child, sibling or stepsibling, or a descendant of one of these.
  • Residence — has the same principal residence as the taxpayer for more than half of the tax year. Exceptions apply, in certain cases, for children of divorced or separated parents, kidnapped children, temporary absences, and for children who were born or died during the year.
  • Age — must be under the age of 19 at the end of the tax year, or under the age of 24 if a full-time student for at least five months of the year, or be permanently and totally disabled at any time during the year.
  • Support — did not provide more than one-half of his/her own support for the year.

Qualifying Events

Return to top
Events that may end individuals' employer-sponsored group health coverage but qualify them for COBRA or other continuation coverage.

For employees, qualifying events can include:

  • Quitting
  • Being fired for a reason besides gross misconduct
  • Being laid off
  • Having your work hours reduced

If you are covered under your spouse’s employer-sponsored health coverage, you can get continuation coverage if your spouse loses coverage for any of the above reasons or because:

  • The employee dies
  • There’s a divorce or legal separation
  • The employee becomes eligible for Medicare

Qualifying Family Member

Return to top
A spouse, domestic partner, or parent whose employer-sponsored health plan premiums are paid for by Medi-Cal/HIPP. Medi-Cal/HIPP pays premiums for qualifying family members when it is cost effective to enroll the family member in the employer-sponsored plan.

Quick Benefit Restart

Return to top
A feature of the SSI program that makes it easy to restart your SSI benefit if you lost it because of work alone. If you are 1619(b) eligible and you stop working, you will be able to get your SSI benefit restarted quickly without having to file a new application or wait for medical review.

Real Estate Rehabilitation Credits

Return to top
A tax credit given to persons or corporations for fixing up real estate property, often in lower-income communities.

Realtor

Return to top
A person who acts as an agent for the sale and purchase of buildings and land; a real estate agent.

Reasonable Accommodation

Return to top
An adjustment or modification to a job or workplace that enables an employee to successfully perform the essential functions of the job.

In education, a reasonable accommodation is a modification that allows a student with a disability to successfully participate in an activity, class, test, or other aspect of school.

Reasonable Accommodation Request

Return to top
A request to an employer to make a modification to a job or workplace that allows an employee to successfully perform the essential duties of a job. The request can come from the employee, or an employee's friend, family member, or medical provider. Reasonable accommodation rules are case-by-case situations, and employers and employees can negotiate the terms under the law.

Referral

Return to top
A written authorization to visit a specialist from an individual’s primary care doctor. In many Medicare Managed Care Plans (Medicare HMO), an individual must get a referral before receiving care from anyone except the primary care doctor. If an individual fails to get a referral, the plan may refuse to pay for care.

Refugee

Return to top
A noncitizen who, while outside the U.S. and their home country, was granted permission to enter and live in the U.S. because they had a well-founded fear of persecution in their home country.

Regular Attendance (SEIE)

Return to top
To be considered “regularly attending” school for the Student Earned Income Exclusion (SEIE), a student has to meet one of the following requirements:
  • Attend a college or university for at least 8 hours a week under a semester or quarter system
  • Be in grades 7 - 12 for at least 12 hours a week
  • Be in a course of training (with shop practice) for at least 15 hours a week to prepare for a paying job
  • Be in a course of training (without shop practice) for 12 hours a week

In some circumstances, like illness or unavailability of transportation, students may be allowed to spend less time than indicated above and still be considered “regularly attending” for the purposes of the SEIE.

Rehabilitative Services

Return to top
Services or devices which help a person with a health condition to relearn skills that they knew how to do before an illness, accident, or injury.

Renewal Community

Return to top

Reporting Agencies

Return to top
Agencies to which you need to report any changes in your income or living situation, if you get public benefits.

If you're on Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY), or visit your local Social Security office, and ask what's the best way for you to report. Note: Reporting rules for SSI and SSDI are different and if you get both benefits, you must report income for them separately.

If you're on Medi-Cal or any other state health coverage or cash assistance program, report any changes in earnings to your county social services agency.

Representative Payee

Return to top
A person who gets and manages benefits on someone else's behalf. Social Security does an investigation before making a relative, friend, or other person the representative payee of a beneficiary who needs help managing their benefits. For children under 18, a parent or guardian is usually the representative payee.

Resource Exclusions (CA programs)

Return to top
The following items do not count as resources:
  • The home, and any adjoining land
  • Household goods and personal effects that have a total value of $2,000 or less
  • One car if it is: necessary for employment, or necessary for medical treatment, or modified for use by a disabled person, or it provides necessary transportation to perform essential daily activities, or has a current market value less than $4500
  • Property of a trade or business that is essential for self-support
  • Non-business property which is essential to self-support
  • Resources of a blind or disabled individual necessary to fulfill an approved PASS
  • Certain stocks held by Alaskan natives
  • Life insurance, if the total face value of all policies on one person do not exceed $1500. Otherwise, the cash surrender values of life insurance policies will count as a resource
  • Restricted allotted Native American lands
  • Payments or benefits paid under other Federal statutes
  • Disaster relief assistance
  • Burial space of any value, and burial funds up to $1500
  • Title XVI (SSI) or Title II (SSDI) retroactive payments for 6 months
  • Housing assistance
  • Nine months of payments received as compensation for expenses or losses suffered as a result of a crime
  • Nine months of reallocation assistance

Resource Exclusions (SSI)

Return to top
In addition to the home you live in and one car, there are several other resources that may be excluded when determining your Supplemental Security Income (SSI) countable resource total. Earned Income Tax Credits (EITC), Child Tax Credits (CTC), CalFresh (formerly Food Stamps), grants, scholarships, fellowships, gifts, property essential to self-support, Individual Development Accounts (IDAs), and many other items may be excluded. Additionally, for SSI, the first $100,000 in an ABLE account are not countable resources.

For more information, you can read the SSI Spotlight on Resources.

Resource Limit

Return to top
The maximum amount of resources you're allowed to own while maintaining eligibility for a particular disability benefits program. Most benefits programs do not count everything you own, including the home you live in and one car you own. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as resources. For Medi-Cal, CalFresh (formerly Food Stamps), and some other programs, none of the money in an ABLE account is counted.

Also called an "asset limit."

Resources

Return to top
Cash or property that you own, can convert to cash, or can use to support yourself. Stocks, bonds, and savings accounts are a few examples of resources. The home you live in and the car you drive to work are exempt under most Social Security and state disability benefit programs. For Supplemental Security Income (SSI), the first $100,000 in an ABLE account is not counted as resources. For Medicaid, Food Stamps, and some other programs, none of the money in an ABLE account is counted.

Also called "assets."

Retirement, Survivors, and Disability Insurance (RSDI)

Return to top
Social Security program that provides monthly income to people with disabilities, survivors or dependents of people with disabilities, and retired people. Social Security Disability Insurance (SSDI) is one part of RSDI.

Retroactive Payments

Return to top
Payments made for the period between disability onset and application approval.

Revenue

Return to top
The total amount of money that a business earns before expenses are deducted.

Example: Julia's consulting business earns $5,000 per month, but spends $2,000 per month on expenses. Her company's total monthly revenue is $5,000; her company's monthly net income ($5,000 minus $2,000) is $3,000.

Room and Board

Return to top
Housing which includes meals and other household necessities, such as utilities, a bed, linens, and bathroom supplies.

Sanction

Return to top
A financial penalty imposed on an individual who is not following the requirements of the Welfare-to-Work Program.

Satisfactory Academic Progress

Return to top
An institution's minimum academic requirements that a student must meet to be eligible for federal student aid.

Satisfactory Participation

Return to top
Regular attendance and satisfactory progress in the Welfare-to-Work and Cal-Learn programs. In the Cal-Learn program, satisfactory progress is considered a grade point average of 2.0.

Secondary Payer

Return to top
A health insurance plan that supplements a primary insurance plan. Health care costs not covered by the primary plan can be submitted to the secondary payer, which often covers some or all of the deductibles, copayments, and other services not covered by the primary insurance provider.

Section 301

Return to top
A rule that allows certain people to keep their Social Security benefits after being found to no longer be medically disabled. For Section 301 to apply, a person who gets benefits has to be participating in a Social Security approved employment support program, and participation in that program has to increase the likelihood that he or she will not need Social Security benefits after completing the program. Vocational rehabilitation and PASS are two examples of “Social Security approved employment support programs."

Section 8

Return to top
A program that helps people with low income pay for housing. Federally funded and administered by local public housing authorities (PHAs), Section 8 has three main programs:
  • The housing choice voucher program, which helps pay for rent in any privately owned housing that accepts a Section 8 voucher. This is the most common Section 8 program.
  • Project-based Section 8, which also helps pay for rent in privately owned rental housing, but only in specific privately owned buildings.
  • The Section 8 Homeownership Program, which helps buy a home and meet the monthly homeownership expenses.

Self-Assessment

Return to top
An analysis of how you're suited for different types of work settings and jobs. The analysis might look at your strengths and weaknesses as well as your likes and dislikes.

Self-Employment

Return to top
Working for yourself rather than someone else. If you run your own business, you're "self-employed."

Self-Initiated Program

Return to top
Full-time vocational training or education that also fulfills the work activity requirements under the Welfare-to-Work Program. The training or program must be expected to be completed within 24 months and take place at an approved school.

Self-Insured Plan

Return to top
A plan that covers an individual’s medical expenses with company funds set aside to pay health claims. In general, self-insured plans are subject to federal, but not state, health coverage laws. Ask your employer or plan to find out if you are in a self-insured plan.

Self-Petitioners

Return to top
Individuals who file a visa petition for themselves, without the assistance of their sponsor, under the Violence Against Women Act (VAWA). To file a Self-Petition, you must be a victim of abuse.

Service Wait

Return to top
The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirement.

Share of Cost (SOC)

Return to top
The amount of money an individual pays for health care costs before Medi-Cal coverage begins.

Short Sale

Return to top
The sale of real estate property for less than the existing loan amount owed for that property.

Short-Term Disability Insurance

Return to top
Private insurance that replaces some of your income when you can't work because of a disability. Short-Term Disability (STD) generally covers disabilities that last a year or less. To apply for STD, speak with your employer's human resources department, or contact a private insurance company.

Skilled Nursing Facility Care

Return to top
Services that include a semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies. Medicare covers skilled nursing facility care after the individual has been in the hospital for three days.

Social Security Administration (SSA)

Return to top
A federal government agency that runs important programs like:

Social Security offices also handle some aspects of Medicare.

To contact SSA, call 1-800-772-1213 or 1-800-325-0778 (TTY) or visit your local Social Security office.

Visit the SSA.gov website.

Social Security Child's Benefits

Return to top
A Social Security cash benefit for children with a parent who gets Social Security retirement benefits or Social Security Disability Insurance (SSDI). Children with a deceased parent may also qualify.

Social Security Disability Insurance (SSDI)

Return to top
A Social Security Administration program that gives money each month to people who have a disability that meets Social Security disability rules and who, in the past, worked and paid FICA taxes for enough time to qualify. SSDI has no income limits and no resource limits. The amount you get in SSDI benefits depends on your Social Security earnings record. After getting SSDI benefits for two years, you automatically qualify for Medicare health coverage.

SSDI also offers benefits to family members, including children and widows, when a primary wage earner in the family becomes disabled or dies. Additionally, adults whose disabilities began before they turned 22 may be able to get Childhood Disability Benefits (CDB).

Special Enrollment Period (Medicare)

Return to top
The period when an individual can apply for Medicare coverage without a late enrollment penalty and can sign up for Medicare supplement without a pre-existing condition waiting period. The special enrollment period typically spans the first eight months following the loss of group health coverage.

Special Enrollment Period (Private Health Coverage)

Return to top
When you get private group health coverage through your employer, you can only sign up for, or make changes to, an insurance plan during the open enrollment period. However, under certain circumstances, such as marriage, birth of a child, or loss of other insurance, a group health plan offers a special enrollment period. This special enrollment period lets you sign up for group health insurance, or make changes to your plan, without having to wait for an open enrollment period.

Special Need Payment

Return to top
A one-time cash payment to homeless CalWORKs families for temporary or permanent housing.

Special Needs Plan (SNP)

Return to top
A Medicare Advantage option that provides health care focused on certain health conditions. These plans provide comprehensive Medicare coverage to manage a particular disease or condition, such as congestive heart failure, diabetes, or End-Stage Renal Disease (ESRD). Medicare Special Needs Plans are only available in some areas of the country.

Learn more about Special Needs Plans on Medicare.gov.

Special Needs Trust

Return to top
A legal arrangement that lets someone else (a person or an organization, called the trustee) manage resources or assets for a person with disabilities (called the beneficiary). If a Special Needs Trust is set up correctly, the money in the trust won’t count toward the resource or asset limits for benefits programs like Supplemental Security Income (SSI) or Medi-Cal (Medi-Cal), and it can be used to pay for the beneficiary’s expenses that aren’t covered by their public benefits. If you are the beneficiary of a Special Needs Trust, your trust can have more assets in it than the resource limits for benefits programs usually allow, and the money can pay for things like recreation, telephone bills, education, and vacations.

The Special Needs Alliance can help you find an attorney who specializes in Special Needs Trusts.

Special Needs Trust (SNT)

Return to top
A legal document with instructions about the management and distribution of the assets placed in the Special Needs Trust (SNT). The person who benefits from the SNT is the “beneficiary.” The person or organization (such as a bank) that manages the SNT and distributes the funds for the beneficiary is the “trustee.” Special Needs Trusts are set up to protect public benefits. The assets are used for support and services, other than food and housing, for a person with a disability.

Specified Low-Income Medicare Beneficiary (SLMB)

Return to top
A Medicare Savings Program that pays for Medicare Part B premiums. To qualify, you must:

Sponsor

Return to top
A person who, by signing an affidavit of support, agrees to support an immigrant as a condition of the immigrant’s admission for permanent residence in the U.S.

Sponsorship

Return to top
The act of legally sponsoring an immigrant to enter the U.S.

SSA-approved Vocational Rehabilitation Plan

Return to top
An employment support program that meets Social Security's criteria for Section 301.

SSI Unearned Income Exclusions

Return to top
Types of unearned income that do not affect Supplemental Security Income (SSI) program eligibility or benefits amount.The main unearned income exclusions are:
  • The first $20 per month
  • Income set aside or being used for a Plan to Achieve Self-Support (PASS)
  • State or locally funded assistance based on need
  • Rent subsidies under HUD programs
  • CalFresh (formerly Food Stamps) and other food or meal programs, and
  • The first $60 of infrequent or irregularly received income in a quarter.

Social Security has a complete list of the types of unearned income that are not counted by the SSI program. Some of the SSI exclusions on the list are:

  • AmeriCorps programs
  • Burial Funds (Interest on Excluded)
  • Child Care Assistance Under the Child Care and Development Block Grant Act
  • Department of Education (DE) and Bureau of Indian Affairs (BIA) Student Assistance
  • Disaster Assistance
  • Educational Assistance
  • Energy Assistance
  • Federal Perkins Loan
  • Federal Supplemental Education Opportunity Grants (FSEOG)
  • General Assistance
  • Gifts Occasioned by Death
  • Gifts of Domestic Travel Tickets
  • Grants, Scholarship, Fellowships, and Gifts
  • Home Energy Assistance
  • Home Produce
  • Housing Assistance
  • Individual Development Accounts (IDAs) (Demonstration Project)
  • Individual Development Accounts (IDAs) (TANF Funded)
  • Leveraging Educational Assistance Program (LEAP)
  • Low Income Energy Assistance
  • Pell Grants
  • Private Nonprofit Assistance
  • Refunds of Taxes Paid on Real Property or Food
  • Relocation Assistance
  • School Breakfasts
  • School Lunches
  • State Assistance Based on Need
  • Women, Infants, and Children Program (WIC)

SSI-Linked Medi-Cal

Return to top
A Medi-Cal eligibility category that gives free Medi-Cal to those on SSI.

State Disability Insurance (SDI)

Return to top
A California program that replaces some of your income when you can't work because of a non-work related disability.

State Health Insurance Assistance Programs (SHIP)

Return to top
State programs that receive money from the federal government to provide free, local health insurance counseling on Medicare. In California this program is known as Health Insurance Counseling and Advocacy Program (HICAP).

State Supplemental Payment (SSP)

Return to top
A voluntary state supplement to the Federal Benefit Rate. The SSP in California is $160.72 for an individual and $407.14 for a couple.

Student (SEIE definition)

Return to top
For the purposes of the Student Earned Income Exclusion (SEIE), a student is generally someone who is under 22 and regularly attending school.

Student Earned Income Exclusion (SEIE)

Return to top
An exclusion that allows most students to work without their SSI benefit decreasing. The SEIE lets you keep the first $1,790 in earnings each month without affecting the countable earned income calculation. But there is an annual cap of $7,200, so if you earn more than this in any given year, the income starts counting again.

Subsidized Employment (Public & Private)

Return to top
Employment in which the CalWORKs program partially or fully reimburses a Welfare-to-Work participant’s employer for wages and/or training.

Subsidy (Individual Health Coverage)

Return to top
A support provided by the federal government that helps people and families with low to middle income pay for their health coverage when they purchase it through Covered California. This support means that individuals and families may qualify to get health plans with lower premiums and other expenses.

Families with income at or below 400% of the Federal Poverty Guidelines (FPG), $47,080 for an individual in 2017 ($97,000 for a family of four), may get help paying for their health coverage premium.

Families with income at or below 250% of FPG, $29,425 for an individual ($60,625 for a family of four), may also get qualify to get health coverage with lower expenses, such as reduced copayments, coinsurance, or deductibles, as long as they choose to get a silver plan.

Substantial Gainful Activity (SGA)

Return to top
The amount of monthly earned income that shows a person is doing significant work according to Social Security. People who cannot earn more than SGA due to their disabilities may be considered disabled by Social Security and other agencies that use Social Security’s definition of disability.

In 2017, SGA is $1,170 per month ($1,950 for people who are blind).

SGA levels for previous years:

Year Disabled, Non-blind Blind
2016 $1,130 $1,820
2015 $1,090 $1,820
2014 $1,070 $1,800
2013 $1,040 $1,740
2012 $1,010 $1,690
2011 $1,000 $1,640
2010 $1,000 $1,640

Social Security lists the SGA levels for earlier years.

Supplemental Security Income (SSI)

Return to top
A Social Security Administration program that gives cash benefits to people with disabilities who have limited income and resources. The amount you get in SSI benefits is based on your financial need and your living situation. The maximum monthly SSI benefit is $895.72 for individuals and $1,510.14 for eligible couples.

Supported Employment Services

Return to top
Services to help people with disabilities find a job or remain employed. Services include things like job skills training, job coaching, or help requesting workplace accommodations.

Surrender Value

Return to top
If you were to cancel a life insurance policy prior to death or maturity, you would likely receive some portion of the full value of that policy. The amount you would receive is known as the “surrender value.” The surrender value of your policy should be written into it. If you do not know the surrender value, contact your policy administrator to find out. Not all policies have a surrender value (i.e. - burial insurance and many term insurance policies).

Targeted Group

Return to top
One of the following nine groups eligible for either the Work Opportunity Tax Credit (WOTC) or the Welfare-to-Work Tax Credit:
  • CalWORKs recipients
  • Veterans receiving CalFresh
  • Ex-felons
  • Youth at risk
  • Vocational Rehabilitation and Employment Network referrals
  • Summer youth employees
  • Youth (18-24 years old) receiving CalFresh (formerly Food Stamps), and
  • SSI recipients.

Tax Credit

Return to top
A dollar for dollar reduction in taxes owed. If the tax credit is greater than the amount of taxes you owe, the remaining credit will be sent to you by check or direct deposit.

Tax deduction

Return to top
The amount that a person or business can subtract from their taxable income. The more you can deduct, the less you pay. Items which reduce your taxes are referred to as deductable expenses. If you earn $10,000 dollars in a year, and have $2,000 dollars in tax deductions, you only pay taxes on $8,000 ($10,000-$2,000= $8,000).

Tax Penalty (Individual Mandate)

Return to top
A fee that people without health coverage may need to pay. The fee in 2017 is $695 or 2.5% of your income, whichever is greater.

Uninsured people won’t have to pay the fee if they:

  • Are uninsured for less than 3 months of the year
  • Have very low income
  • Do not file a tax return because their income is too low
  • Earn 138% of the Federal Poverty Guidelines (FPG) or less ($16,643 or less for an individual; $33,948 for a family of four) and live in a state that hasn’t expanded Medi-Cal eligibility
  • Are a member of a federally recognized Indian tribe
  • Have religious objections to health insurance

Temporary Assistance for Needy Families (TANF)

Return to top
A federal welfare program, formerly known as Aid to Families with Dependent Children (AFDC), that provides income support and access to Medi-Cal for low-income adults with children. In California, TANF is known as CalWORKs.

Ticket

Return to top
A standard electronic form that indicates eligibility for the Ticket to Work Program.

Ticket on Demand

Return to top
An option for requesting a Ticket to Work by calling the Ticket Program Manager: 1-866-968-7842.

Ticket to Work Program

Return to top
A Social Security Administration (SSA) program that helps adults with disabilities prepare for, find, and keep jobs. To qualify, you must be 18 – 64 years old and currently be getting Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits.

Ticket to Work offers free services, such as:

Learn more on the Ticket to Work website.

Tiered Drug Levels

Return to top
Different levels of coverage offered by Medicare Part D (prescription drug) plans. Drugs in lower levels usually have lower copayments and drugs in higher levels usually have higher copayments.

Timely Progress

Return to top
Active participation in the Individual Work Plan (IWP) during the first two years of the Ticket program. Thereafter, timely progress is referred to as "increased work activity and earnings" (Year 3, 4, and 5).

As long as an individual is making timely progress on the IWP, Social Security will not initiate a medical Continuing Disability Review (CDR).

Trial Work Month (SSDI)

Return to top
Any month when gross monthly earnings are above $840 (for 2017). Impairment-Related Work Expenses (IRWEs) cannot be deducted when figuring out Trial Work month earnings.

Trial Work month income levels are indexed annually for increases or decreases in the average wage. Previous Trial Work month gross income levels were:

  • $780 in 2015
  • $770 in 2014
  • $750 in 2013
  • $720 in 2012
  • $720 in 2011
  • $720 in 2010
  • $700 in 2009
  • $670 in 2008
  • $640 in 2007
  • $620 in 2006
  • $590 in 2005
  • $580 in 2004
  • $570 in 2003
  • $560 in 2002
  • $530 in 2001
  • $200 from 1990 to 2000, and
  • $75 before 1990.

Trial Work Period (TWP)

Return to top
The Trial Work Period is the nine Trial Work months occurring within a five-year window when you can work and continue to get your full SSDI benefit. These work months can occur one right after the other or be spread out over time.

U.S. Citizen

Return to top
A person who is:
  • Born in one of the 50 states, Washington D.C., Puerto Rico, Guam, Northern Mariana Islands, U.S. Virgin Islands, American Samoa, or Swain’s Island
  • Born outside of the U.S. to at least one parent who is a U.S. citizen
  • Granted citizenship status by U.S. Citizenship and Immigration Services (USCIS)

When applying for benefits, contact the agency you are applying to to find out what documents are acceptable for proving citizenship.

Underinsured Individual

Return to top
An individual who has insurance that covers only some health care costs.

Undue Hardship

Return to top
A reasonable accommodation you request that is too difficult or too expensive for an employer to get, in relation to the employer's size, financial resources, and the needs of the business. If a reasonable accommodation request causes an employer "undue hardship," then the employer does not have to get the requested accommodation.

Unearned Income (UI)

Return to top
Funds received from sources for which no paid work activity is performed. Disability benefits such as SSDI, SSI, short-term disability insurance, and long-term disability insurance; VA benefits; Workers' Compensation; income from a trust or investment; spousal support; dividends, profits, or funds received from any source other than work are all usually considered unearned income.

Unemployed (CalWORKs)

Return to top
CalWORKs generally defines unemployed as having worked less than 100 hours in the previous 4 weeks. In a two parent household, one of the parents can work more than 100 hours per month so long as the family income after deductions (countable income) is below the income limit for the program.

Unemployment Insurance

Return to top
A state program that provides temporary benefit payments to people who lose their job through no fault of their own.

Uniformed Services Employment and Reemployment Rights Act (USERRA)

Return to top
The Uniformed Services Employment and Reemployment Rights Act (USERRA) is a federal law that protects veterans’ and service members’ employment rights. It says that a person can miss up to five years of work because of military duty and have the right to be re-employed by the employer they had before going on duty. It also requires employers to make reasonable accommodations for disabled veterans.

Unincurred Business Expenses

Return to top
Financial or other assistance from an agency or individual to help establish or sustain a self-employed person’s business. Examples include a government agency paying for some of your business expenses, or providing you with things of value (e.g. office space) free of charge.

Social Security rules do not penalize you for receiving unincurred business expenses. Instead, Social Security deducts the value of any unincurred business expenses from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level for any given month. SSA uses fair market value to assess the value of any unincurred business expenses.

Uninhabitable Residence

Return to top
A home that is unfit for living.

Unpaid Help

Return to top
The estimated value of any unpaid assistance from your spouse, children or others provided to your business. If someone provides your business with 10 hours/month of free web design work, and the prevailing wage for that kind of work in your community is $25/hour, the value of that unpaid help is $250/month.

Social Security rules do not penalize you for receiving unpaid help. Instead, Social Security deducts the value of any unpaid help that your business receives from your net income when deciding if you have reached the Substantial Gainful Activity (SGA) level each month.

Unsubsidized Employment

Return to top
Employment that is not reimbursed to an employer by the CalWORKs Program.

Untaxed Income

Return to top
Income that is not subject to state or federal taxes. Income from Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are examples of untaxed income.

Utilization Controls

Return to top
Rules that insurance plans use to keep their prescription drug costs down. You may, for example, need prior authorization from the plan to use a particular drug.

Value of One-Third Reduction (VTR) Rule

Return to top
An in-kind support and maintenance rule that says that the most you can get in SSI benefits goes down by one-third if:
  • You live in somebody else’s household, and
  • Somebody in that household helps with both food and shelter.

If you get help paying for food and/or shelter, but the VTR rule does not apply, then the Presumed Maximum Value (PMV) rule may apply instead.

Vesting Requirement

Return to top

Victim of Trafficking

Return to top
An individual who is a victim of sex trafficking; or, a victim of the forced or fraudulent recruitment, harboring, transport, or provision of a person for labor or services that subject the person to involuntary servitude, peonage, debt bondage, or slavery.

Victim of Violence/Victim of Abuse/Domestic Violence Survivor

Return to top
An individual who has endured assaultive or coercive behavior that includes: physical abuse, sexual abuse, psychological abuse, economic control, isolation, stalking, and threats.

Violence Against Women Act (VAWA)

Return to top
A law that allows qualified immigrants in an abusive situation to apply for a lawful immigration status directly to the Department of Homeland Security, without the assistance of a sponsor.

Vocational Assessment

Return to top
A service to help a person examine their work skills, education level, employment background, and interests, in order to help them decide on a career path that will be well matched to their skills and interests.

Vocational Counselor

Return to top
A counselor who works with people to help them identify potential job options.

Vocational Rehabilitation

Return to top
State agency that helps people with disabilities prepare for, find, and keep jobs that are consistent with their skills, strengths, and interests. California's VR agency is called the Department of Rehabilitation (DOR).

Wage Replacement

Return to top
A type of benefit that provides money each month to make up for wages you no longer receive due to disability. It can be either a percentage of your pre-disability income or a fixed dollar amount. Short-Term or Long-Term Disability Insurance are private wage replacement programs, while Social Security Disability Insurance (SSDI) is a public program. Wage replacement is also known as pay replacement or income replacement.

Wage Subsidy and Special Conditions

Return to top
For the purposes of calculating Substantial Gainful Activity (SGA), wage subsidy and special conditions are support you get on the job that may result in your getting more pay than the actual value of the services you perform. Wage subsidy refers to support you get from your employer; special conditions are generally given to you by someone other than your employer, for example a vocational rehabilitation agency.

Social Security looks at wage subsidy and special conditions when they make an SGA decision. They only use earnings that represent the real value of the work you perform to decide if your work is at the SGA level. If Social Security decides that wage subsidy or special conditions exist, you can earn more while continuing to get your benefits.

Wage subsidy or special conditions may exist if:

  • You get more supervision than other workers doing the same or a similar job for the same pay
  • You have fewer or simpler tasks to complete than other workers doing the same job for the same pay, or
  • You have a job coach or mentor who helps you perform some of your work

Note that Social Security uses wage subsidy and special conditions rules when they are deciding if you have earned Substantial Gainful Activity after your SSDI Trial Work Period is over. Social Security does not use these rules during your Trial Work Period or in any Trial Work month.

Wages

Return to top
Money you earn from work.

Waiting List

Return to top
A list of names of people who applied for services or benefits or products that are not immediately available.

Waiting Period (Medicare Supplement)

Return to top
A delay in covering services for an individual with a pre-existing condition. Individuals are exempt from a waiting period if they have had 6 months of previous, continuous coverage.

Waiting Period (Short- and Long-Term Disability)

Return to top
The amount of time you have to wait between becoming disabled and receiving a benefit. For example, many private disability plans begin paying benefits 7 days after an illness forces you to leave work.

Welfare-to-Work Activities

Return to top
Activities that meet the Welfare-to-Work requirement. Most CalWORKs recipients must participate in 20 hours of core activities. Your county may include all or some of the following as acceptable core activities:
  • Subsidized or unsubsidized employment
  • Work experience
  • On-the-job training
  • Work-study
  • Self-employment
  • Community service
  • Vocational education and training
  • Job search and job readiness assistance

The rest of the Welfare-to-Work requirement can be fulfilled with non-core activities, which may include:

  • Adult basic education
  • Job skills training directly related to employment
  • Education directly related to employment
  • Secondary school
  • Mental health, substance abuse, and domestic violence services

Welfare-to-Work Tax Credit

Return to top
An employer tax credit that targets individuals who are long-term CalWORKs recipients.

Work

Return to top
Physical or mental activity that is actually performed and results in earned income.

Work Credits (SSDI)

Return to top
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 $1,300 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
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

Work Experience

Return to top
Welfare-to-Work training activities or community service that provide job skills that will lead to unsubsidized employment.

Work Goal

Return to top
The specific job an individual wishes to have after completing a Plan to Achieve Self-Support. Also known as a vocational or occupational goal.

Work Incentives

Return to top
Rules used to encourage people to work when they use public benefits. Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Medicare, and Medi-Cal all have work incentive rules.

Work Opportunity Tax Credit (WOTC)

Return to top
A federal program that encourages employers to hire job seekers from one of nine targeted groups by offering employers a federal tax credit. The purpose of the WOTC is to help job seekers in the targeted groups overcome barriers to employment.

Workers' Compensation

Return to top
A program that replaces income and provides for medical treatment when you can't work because of on-the-job injuries.

Workplace Personal Assistance

Return to top
Services that enable an employee with a disability to perform the essential duties of a job.

Work-Study

Return to top
A program that you may qualify for if you apply for financial aid at your college or university. If you qualify, it will be easier for you to get a part-time job on campus or nearby, because the federal government will help some employers pay your salary.