Social Security Administration Disabled Adult Child (SSA DAC)

A very common problem when someone on Medi-Cal loses eligibility after starting to receive Social Security Administration (SSA) Disabled Adult Child (DAC) benefits from a deceased parent’s work record.

WHY THEY LOST MEDI-CAL

When the parent died, the adult child started receiving Childhood Disability Benefits (CDB), also known as DAC benefits, based on the parent’s Social Security record. That benefit amount — around $2,000/month — pushed them over the regular SSI income limit, which automatically cut off their SSI, and therefore Medi-Cal was terminated.

The system doesn’t automatically apply the DAC protection. The county has to flag it manually.

WHY THEY STILL QUALIFY

Under the DAC Protection rule (a.k.a. “Pickle/DAC Medi-Cal”), people who:

  1. Were receiving SSI before receiving DAC benefits, and
  2. Lost SSI only because of the DAC benefit increase,

    must remain eligible for Medi-Cal — regardless of their new income level.

This protection is part of federal law (Section 1634 of the Social Security Act), and California must honor it.

HOW TO GET MEDI-CAL BACK

Contact the County Medi-Cal Office


Ask to speak with a supervisor or eligibility worker familiar with DAC or Pickle Medi-Cal. Many front-line workers miss this.


1. Tell them clearly:

“I lost Medi-Cal only because I started receiving DAC benefits based on my deceased parent’s record. I previously received SSI. I want to be evaluated for DAC Medi-Cal eligibility.”

2. Provide Proof

  • Proof of prior SSI receipt (SSA award letter or printout).
  • Current DAC award letter showing the new benefit amount.
  • Death certificate or SSA documentation tying the benefit to the parent’s record.
  • If you can’t find the SSI proof, ask SSA for a “Benefit Verification Letter” showing prior SSI.

3 Request DAC/Pickle Evaluation


They must evaluate the case under the DAC or Pickle Medi-Cal category. Under this rule: The DAC benefit amount is disregarded in the eligibility calculation. If they would still be eligible had they not received the DAC, Medi-Cal must be reinstated.

Do not let them push you into “spend-down” or “share of cost” if you qualify for DAC protection. That’s a common error.

4. If Denied — Appeal

If the county refuses or gives wrong information, file a state hearing through California Department of Social Services (CDSS). https://www.cdss.ca.gov/hearing-requests

  • You can request a hearing online or by phone.
  • DAC protection is federal entitlement.

When filing, clearly state:

“I lost Medi-Cal due to receiving DAC benefits. I previously received SSI and should be covered under DAC/Pickle protection. I am requesting a state hearing to reinstate my Medi-Cal eligibility.”

If the person did not receive SSI, we need to go through the Medi-Cal Aged & Disabled Federal Poverty Level (A&D FPL) Program.

The Medi-Cal Aged & Disabled Federal Poverty Level (A&D FPL) Program is a Medi-Cal eligibility category for low-income adults who are either:

Age 65 or older, or Under 65 but have a disability determined by Social Security Administration or the state.

This program is often used when someone no longer qualifies for SSI, but still needs full-scope Medi-Cal.

Eligibility Based on Income and Assets

Monthly income limit (2025):

  • About $1,732 for an individual

  • About $2,351 for a couple

Asset/resource limit:

California eliminated the asset test for most Medi-Cal programs starting January 1, 2024, so assets usually no longer disqualify you. However, they just brought it back in 2025 so I don’t know what is going on here.

If your income is slightly over the limit, some counties use “Medi-Cal disregards” that can still get you approved.

For People With Disabilities

If someone is under 65 but disabled (e.g., receiving SSDI, DAC, or has a disability determination), they can qualify through A&D FPL even without SSI.

This is a common fallback for adults with developmental or physical disabilities who lose SSI due to DAC income.

Unlike SSI-linked Medi-Cal, this program is run directly by the county Medi-Cal office.

That means you can get Medi-Cal even if SSA denies SSI, as long as you meet the disability and income requirements.

How to Apply

Contact the county Medi-Cal office where you live.

Submit:

  1. Proof of disability (SSDI/DAC award letter or medical records if applying for disability through the state).
  2. Proof of income.

Ask specifically:

“I want to be evaluated under the Aged & Disabled Federal Poverty Level (A&D FPL) Medi-Cal Program.”