Whether you, or someone you know, is interested in learning more about Medi Cal, then you will find this article to be an informative overview of the topic. Oftentimes, adult children find themselves in the position of making health care and quality of life decisions for their elderly parents, and it is easy to become confused and overwhelmed by the complexity of these important issues. Seniors, as well, may have questions about, or unaware of, their options when it comes to qualifying for aid.
Medi Cal is the name of California's Medicaid health care program, which is a combined federal and state health insurance program that provides assistance for low income families and individuals, seniors, disabled persons, and families enrolled in AFDC (Aid to Families with Dependent Children)
For Elderly and disabled individuals, Medi Cal can assist in paying for hospital and doctor's bills, prescription drugs, medical equipment and supplies, home health assistance, nursing home care, adult day care medically related transportation, and many other services and items. In most cases, Medi Cal covers 100% of the costs of these items, with no co pay. In some situations, a small co pay may be required, depending on the income status of the individual.
How Does Medi Cal Differ From Medicare?
Medi-Cal and Medicare are two separate health insurance programs. Medicare is health insurance that comes with Social Security benefits and requires the payment of monthly premiums, deductibles and, by choice, coinsurance for many of its benefits. Medi-Cal, on the other hand, is not tied to Social Security benefits and does not require payment of premiums or deductibles. It provides 100%, comprehensive coverage of most medical expenses. In addition, health care providers who accept Medi-Cal are not allowed to bill covered individuals for any additional charges as is the case with patients under Medicare.
In a nursing home situation, Medicare will only cover individuals who have been admitted to a nursing home after a minimum three day hospital stay and who require skilled nursing, physician, or rehabilitation services every day. Needing custodial care only, i.e. help with personal care, daily activities, or taking medications, does not qualify Medicare to pay for nursing home expenditures. Medi-Cal does pay for custodial care, however, and can take over the payments after Medicare benefits stop for nursing home residents who find themselves unable to afford the nursing home private pay rates.
Individuals who are pregnant, under twenty one, or who meet other specific criteria may also qualify for Medi Cal, but for the purposes of this article, only the criteria relating to Seniors will has been listed.
If you, or someone you know, currently receives monetary assistance under the SSI SSP program, you may be automatically eligible for Medi Cal. You, or your parent, friend, other relative may also be eligible for Medi Cal if you meet the following criteria aged 65 or older, legally blind, disabled, have been diagnosed with breast or cervical cancer.
Currently resides in a skilled nursing or intermediate care facility
In addition, elderly persons defined as over age 65 and or disabled persons possessing less than $2,000 in countable assets, or $3,000 for couples, for whom payment of medical expenses would leave them with less than the available need standard for living expenses, may also be eligible for Medi Cal. Need standard is defined as roughly $600 per month for an individual and $934 for a couple.
Even people with relatively high incomes often qualify for Medi Cal assistance with nursing home and other expenses, due to the high cost of nursing home care.
In determining Medi-Cal eligibility, there are specific assets that are not counted which includes, but is not limited to, the following: the home with an intent to return to the home, whole life insurance policies with a face value of $1,500 or less, term life insurance, burial plots, prepaid (irrevocable) burial plan of any amount (and up to $1,500 in specific burial funds), on care used by the beneficiary or for the applicant or used for medical reasons, rings and/or jewelry, cash, periodic payments on interest and principal of pension funds and annuities, and up to $2,000 in cash reserve.
It is necessary to be a California resident in order to apply for, and receive Medi Cal benefits. A resident is defined as someone who lives in California and plans to continue to do so, but can also be defined as a person working, or searching for work in California.
Is A Persons Home Considered a Medi Cal Asset? No. As the above paragraph explains, a home is not considered to be an asset that can count against an individual for eligibility purposes, as long as it is a primary residence. If a covered individual becomes a resident of a nursing home, their home will still not be considered a Medi Cal asset as long as any one of the following is true: The individual is expected to be able to return home. The individual's spouse or children who are under twenty one years of age and/or blind or disabled currently reside(s) in the home. A sibling lives in the home who is part owner and has lived with the individual in question for at least a year prior to their entering the nursing home. An adult child who has lived with the individual for at least a year prior to their entering a nursing home currently resides in the house. The individual's home is considered a multiple dwelling unit
How Can A Person Protect Their Assets And Still Qualify For Medi Cal? There are several ways to do this: Do not transfer money or property without consulting a licensed, elder law professional for advice as Medi-Cal eligibility can be delayed as a penalty for transferring assets without receiving fair value in return.
This penalty period is determined by dividing the amount transferred by what Medi-Cal determines to be the average private pay cost of a nursing home. This period of ineligibility begins on the first day of the month of the transfer.
Be aware that Medi-Cal may look at transfers made 30 months prior to your Medi-Cal application or longer if the transfer was made to specific trusts. An elder law professional will can advise you about this, and many other rules and regulations. That being said, here are a few examples of how to best retain your assets:
Generally speaking, you can transfer money or property to your spouse at any time before or after applying for Medi-Cal. After becoming eligible for Medi-Cal, your home can be transferred to anyone, not just your spouse, as long as it is an exempt asset at the time of transfer and should be transferred out of your name to avoid estate liens by the state after you die.
Resources can also be spent down to the $2000 eligibility limit on any item or service for your own benefit as long as you what you purchase will not make you exceed the $2000 limit at the end of the month in which you desire Medi-Cal eligibility Because you must provide evidence of what you spend after you apply for benefits, keep all receipts, canceled checks or other documentation of your expenditures.
What Is The Procedure For Applying For Medi Cal?Interested persons can apply for Medi Cal for themselves or someone else by visiting their local county social services office, either in person or online, and obtaining an application. Once the application is complete, it is sent to an eligibility worker for review.
This review process can take anywhere from 45 to 60 days depending on individual circumstances and materials required to complete the application. In cases of immediate need, an application may be eligible for faster processing.
When making crucial health and quality of care decisions for yourself or someone else, it is important to know all of your options, research them thoroughly, and consult with your financial planner and/or an attorney specializing in elder law.