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However, neither Medicare nor private health insurance cover all medical costs. Unfortunate illness or extensive care at a nursing home could wipe out your entire savings in a few short years.
The GOOD NEWS is that financial help from the Federal and State governments still exists. Through Medi-Cal planning, you can preserve your savings and qualify for Medi-Cal which will pay for most of the uncovered medical expenses.
Let our Medi-Cal attorney determine your Medi-Cal eligibility. Call us for Medi-Cal qualification before the laws change.
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Examples of Medi-Cal coverage:
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• Nursing Home Stay
• Home Care
• Prescription Medication
• Surgeries
• Chemotherapy
• Doctor Visits, etc.
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Medi-Cal Planning FAQs:
1. What is Medi-Cal?
2. Who is eligible for Medi-Cal?
3. What are the Income Limits?
4. Can Nursing Home Residents be eligible for Medi-Cal?
5. What is exempt property under Medi-Cal rules?
6. Can you qualify for Medi-Cal with the REVERSE MORTGAGE?
7. Are you allowed to spend down your resources?
8. Can you qualify for Medi-Cal by gifting your assets away?
9. What is a Share of Cost?
10. Is there anything I need to know signing a nursing home Admission
Agreement?
11. What if your application is improperly denied?
12. How does Medi-Cal treat resources in Well Spouse's name when the
other spouse is in a nursing home?
13. How does Medi-Cal treat IRAs and pension funds in well spouse's name
when the other spouse is in a nursing home?
14. How does Medi-Cal treat annuities?
15. Can a well spouse keep any of institutionalized spouse's income?
16. Can a well spouse request to increase income or resource allowance
when the other spouse is in a nursing home?
17. Can I transfer a home if I receive Medi-Cal benefits?
1. What is Medi-Cal?
Medi-Cal is California's version of the Medicaid program designed to help pay medical bills for eligible individuals. Medi-Cal is not related to Medicare insurance. Eligibility for Medi-Cal mainly depends on amount of income and recourses that a person has.
2. Who is eligible for Medi-Cal?
SSI recipients are automatically eligible. Others may also qualify if their income and resources are within the Medi-Cal limits, (current resource limit is $2,000 for a single individual and $3,000 for a couple). This includes:
1. Low-income persons who are 65 or over, blind or disabled may qualify
for the Aged and Disabled Federal Poverty Level Program
2. Low-income persons with dependent children
3. Children under 21
4. Pregnant women
5. Iindigent adults in skilled nursing or intermediate care or
those who qualify for Medi-Cal funded home and community based
option programs.
Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal eligibility if your assets exceed Medi-Cal set limit.
3. What are the Income Limits?
California law has a fixed maintenance need standard for those who are living at home. The need standard for a single elder (at least 65) or disabled person is $600 per month, for a couple - $ 934 per month.
Generally, if your monthly income is higher than the need standard, you will have a "share of cost" for your medical bills each month. Once you pay your monthly share of cost towards your medical bills, Medi-Cal will cover the rest of the expenses.
Medi-Cal share of cost works similar to an insurance deductible and is determined by the Medi-Cal case worker. The amount of the share of cost is equal to the difference between your gross monthly income, minus certain deductions like Medicare or private insurance and minus the need standard.
However,you may not have any share of cost if you qualify for the Aged & Disabled Federal Poverty Level Program.
4. Can Nursing Home Residents be eligible for Medi-Cal?
Due to the enormous cost of nursing home care, many California's nursing home residents have Medi-Cal program pay for their care. If your resources meet the Medi-Cal standard, you will be eligible for Medi-Cal.
The share of cost for the nursing home residents is determined a little bit different than for those who are still living at home. It could be best understood through the following example:
Larry enters a skilled nursing home. His gross income, consisting of Social Security and a small pension, is $1600, he also maintains a private health insurance with Blue Cross that is $100. The share of cost he must pay each month to the nursing home is $1600 minus $100 (health insurance) minus $35 (Personal Needs Allowance for Long Term Care), amounting to $1465.
If a nursing home resident is married, his spouse may be able to keep his income without surrendering it to the nursing home as a share of cost.
5. What is exempt property under Medi-Cal rules?
Under Medi-Cal rules property is classified as "exempt" and "non-exempt". Determining Medi-Cal eligibility exempt property is not counted towards resources.
Some examples of exempt property:
1. The Home if it is a principal residence. Warning: you may be able to
own a home and still qualify for Medi-Cal benefits, but be aware that
your home is still subject to Medi-Cal recovery claims. Please call our
law offices at 1-866-822-7211 to find out how to protect your home
from future Medi-Cal claims.
2. Business Property will be excluded if it is used in whole or in part as a
business. Iit must meet business property guidelines.
3. Household Goods.
4. One Car if used for the benefit of the applicant.
5. Jewelry under certain amount.
6. Whole Life Insurance policies with the total face value of $1500 or
less. However, if the total value of the policies exceeds $1500, then the
entire cash surrender value is counted towards available resources.
7. Term Life Insurance.
8. Burial Plots.
9. Prepaid Irrevocable Burial Plan.
10. IRAs and work related pensions may be exempt. However, special
guidelines apply.
Please call our law offices at 1-866-822-7211 to find
out how to protect IRA and certain other pension plans.
11. Limited Cash Resources. Applicant may retain up to $2,000 in liquid assets.
12. Community Spouse resource allowance. At-home living spouse
who is not receiving Medi-Cal benefits may retain up to $113,640
(as of 2012) in liquid assets, not including other exempt assets
listed above.
Any assets exceeding the property limit of $2,000 and assets that do not fall within the category of "exempt assets" will be counted by Medi-Cal when determining eligibility. The benefits may be denied without proper Medi-cal planning.
Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options.
6. Can you qualify for Medi-Cal with the reverse mortgage?
Many elderly individuals choose to reduce the equity value of their homes by getting reverse mortgage and home equity loans. However, Medi-Cal applicants have to be cautious, as any lump sum of money could disqualify from Medi-Cal benefits. Reverse Mortgage that comes in a form of credit line will not be counted towards non-exempt assets as long as it is not drawn down.
While reverse mortgage could be a great option for some homeowners, they rarely make a good choice for individuals who may need Medi-Cal benefits in the future.
Please call our law offices at 1-866-822-7211 to consult regarding the Medi-Cal planning options that you may have even if you have gotten a reverse mortgage.
7. Are you allowed to spend down your resources?
Even if an applicant has too much assets to qualify for Medi-Cal benefits, he is allowed to spend down to meet the eligibility criteria of $ 2,000 resource limit.
One of the ways to spend down is by converting your non-exempt property into exempt assets, that is, by buying the property that Medi-Cal allows you to have. All of the expenditures have to be documented with receipts and later presented to the Medi-Cal case worker.
Please call our law offices at 1-866-822-7211 to consult regarding other Medi-Cal planning and asset protection options.
8. Can you qualify for Medi-Cal by gifting your assets away?
Many have heard about a "look back" period for gifted assets. An "improper" transfer of assets (when nothing of equal value is received in return) will trigger the look back period of 30 months and can disqualify Medi-Cal applicant from certain Medi-Cal benefits for up to 30 months. For example, if a nursing home resident gifts his $200,000 cash resources to his kids, he will not be able to get Medi-Cal benefits for all 30 months.
The period of ineligibility can be reduced or even eliminated when gifts are made in compliance with the Medi-Cal rules. Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options.
9. What is a Share of Cost?
Even if you are eligible for Medi-Cal benefits, you may still be responsible to pay a share of cost. When you are in a nursing home most of the Social Security and pension will be your share of cost and Medi-Cal will pay the rest of the costs.
Private health insurance premiums that the resident has to pay will be deducted from the share of cost. If you have any outstanding medical bills prior to you becoming eligible for Medi-Cal, your share of cost could be applied towards those bills instead of paying a share of cost to the nursing home. Also, any medical expenses that are not covered by Medi-Cal can also be deducted from the share of cost as long as the prescription is provided.
A nursing home resident should pay the "estimated" share of cost while his application is pending and not allow the income accumulate in the account as this can impact his Medi-Cal eligibility.
10. Is there anything I need to know signing a nursing home Admission Agreement?
If you are signing a nursing home admission agreement for another, you should do so in a capacity as an "agent" (under power of attorney; conservatorship) rather than "responsible party". Otherwise you may make yourself personally liable for the expenses.
If you are acting as an agent for the nursing home resident's assets, always use the resident's income to pay the share of cost as willful avoidance of this duty can be a misdemeanor. An agent will be held responsible for the funds that were received by the resident but not distributed by the agent and not for any of the resident's debts.
11. What if your application is improperly denied?
If your application for the benefits is improperly denied you can file for the fair hearing. It is important to apply for the hearing in a timely manner, which is indicated in the notice of action of denial letter.
12. How does Medi-Cal treat resources in Well Spouse's name when the other spouse is in a nursing home?
According to Medi-Cal rules, the spouse that is staying at home can retain a certain amount of resources. This limit increases each year. In the year of 2012 the spouse that is not in a nursing home can keep up to $113,640.00 (including community and separate property) and the spouse that is in a nursing home can keep up to $2,000. Any exempt resources (discussed before) are excluded and not counted towards $113,640.00 allowance.
13. How does Medi-Cal treat IRAs and pension funds in well spouse's name when the other spouse is in a nursing home?
Such funds In the name of at home spouse are excluded and do not have to be liquidated or cashed out.
A spouse that is in need of Medi-Cal benefits will have to take periodic distributions from IRAs so that they would be excluded. However all of the periodic payments taken on such funds will be included towards income and taken into consideration when determining the share of cost.
Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and IRA, Pension plans', other assets protection options.
14. How does Medi-Cal treat annuities?
Annuities are usually treated differently from IRAs and work-related pensions. The periodic payments have to be set up so that the full amount of the annuity is exhausted by the time of life expectancy however any unpaid amount, depending on when the annuity was purchased, can be recovered by Medi-Cal. All periodic payments will be included towards income and added to the share of cost.
Please call our law offices at 1-866-822-7211 to consult regarding your Medi-Cal planning and asset protection options if you have purchased an annuity.
15. Can a well spouse keep any of institutionalized spouse's income?
A well spouse can keep all of his or her own income and sometimes some or all of the institutionalized spouse's income. As of 2012, California law states that there is a "minimum monthly maintenance need allowance" set of $2,841 which is increased each year. What it means is that if the at home spouse does not have her own income or gets very little, then she can keep up to $2,841 of the institutionalized spouse's income. For example, if the well spouse gets $1,000 of her own income, she can keep $1,841 of nursing home spouse's income accordingly.
16. Can a well spouse request to increase income or resource allowance when the other spouse is in a nursing home?
Yes, that can be done through a Fair Hearing or obtaining a court order. The resource allowance of $113,640 can be increased if the income between both spouses does not add up to "minimum monthly maintenance need allowance" of $2,841.
The "minimum monthly maintenance need allowance" of $2,841 can also be increased if hardship is proved.
17. Can I transfer a home if I receive Medi-Cal benefits?
Warning: you may be able to own a home and still qualify for Medi-Cal benefits, but be aware that your home is still subject to Medi-Cal recovery claims.
The financial support extended to a Medi-Cal recipient can be recovered by the state after Medi-Cal recipient's death. Medi-Cal recovery department can recover up to the amount available after the house is sold, but not more than the actual expenditures.
California now seeks recovery from real or personal property or any other assets that the individual had any legal interest in at the time of death, which means that state can claim against living trusts, joint tenancies and tenancies in common, etc.
There are ways of protecting the property from future Medi-Cal recovery that you should be aware of. Please call our law offices at 1-866-822-7211 to find out how to protect your home from future Medi-Cal claims.
You should also be very careful when transferring the residence out of the Medi-Cal recipient's name as there are many rules governing such transfers.
Please call our law offices at 1-866-822-7211 to consult how to transfer the property properly without triggering ineligibility for benefits or future recovery by Medi-Cal.
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