2000 Alameda de Las Pulgas, Suite 250, San Mateo, CA 94403-1271 • Phone 650-341-2900
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Medi-Cal Benefits and Nursing Home Care

Let a knowledgeable legal team help you navigate California’s Medicaid program

Medi-Cal is California’s implementation of the Medicaid program. The state of California administers Medi-Cal, which is supported by the federal government. It is designed to help pay for a variety of health and medical services for adults and children receiving public assistance or with limited income and assets. Medi-Cal covers most of what the state determines are “medically necessary” services including hospital visits, prescription drugs, long-term nursing home care, physical therapy and in-home healthcare. Medi-Cal is different from Medicare, which is a federal insurance program that is not based on need. Many people automatically qualify for Medi-Cal under a variety of programs, including Supplemental Social Security Income. Others, whose income and assets make them ineligible for public assistance benefits, may otherwise qualify for Medi-Cal if their income and assets are within the Medi-Cal limits. Our knowledgeable legal team at Fox, Shjeflo, Hartley & Babu LLP can help you navigate the Medi-Cal program.

Medi-Cal eligibility

California Medi-Cal imposes a $2,000 asset or resource limit on a single individual and $3,000 on a married couple. This limit applies only to countable resources and not to exempt or unavailable resources, as defined by Medi-Cal. For example, cash and business interests are common countable resources, whereas the primary residence and automobile are two common exempt resources.

A Medi-Cal recipient living in the community may receive $600 per month of income benefits in California, whereas a recipient living in a nursing facility may only receive $35 per month. Medi-Cal recipients who are living in a nursing facility must contribute all additional income, above the $35 allowance, toward medical bills or to the facility. The individual essentially pays a share of the cost.

For a married person in a nursing facility in California, Medi-Cal allows the spouse living at home (not in a nursing facility) to retain $115,920 in assets for 2013. This is the community spouse resource allowance (CSRA). An at-home spouse may also receive unlimited income of his or her own. If an at-home spouse receives less than $2,841 per month of income, he or she can take some or all of the institutionalized spouse’s income to make up the difference — up to $2,898 (the minimum monthly maintenance needs allowance (MMMNA) for 2013). The CRA and MMMNA are designed to protect the spouses of institutionalized Medi-Cal recipients from impoverishment.

Asset transfers and Medi-Cal

Medi-Cal is designed to provide medically necessary services to people with limited income. Transferring assets before applying may trigger a period of ineligibility.

Medi-Cal penalizes applicants for transferring or gifting assets without receiving equal value in return, unless the assets are transferred to a spouse or disabled child. A person triggers the transfer rules when he or she enters a nursing facility and applies for Medi-Cal. Medi-Cal reviews all transfers made in the 30 months prior to the application to determine whether an ineligibility period exists.

California caps the ineligibility at 30 months. To calculate the ineligibility period, Medi-Cal divides the transfer amount by the average private pay rate (APPR) of nursing home care in California. The 2012 California APPR is $7,092.

For example: A $100,000 gift creates 14 months of ineligibility:

April 2012 Gift Date
$100,000 Gift Amount
÷$7,092 APPR
14.10 Months Ineligible

If the gift was made in April 2011, the applicant would be ineligible until June 2013. California does not count partial months, so the .10 is ignored and the period runs from the transfer date.

Penalties for giving away assets apply only if the individual enters a nursing home. An individual may spend down their resources to become Medi-Cal eligible without encountering a penalty.

Finding a Medi-Cal-certified facility

If an applicant seeks Medi-Cal assistance to pay for nursing facility care, he or she must select a Medi-Cal certified facility. Many nursing facilities may prefer private pay and/or wealthy residents to Medi-Cal recipients in admission decisions. Therefore, applicants may consider moving into a nursing facility prior to applying for Medi-Cal. If a private-pay nursing facility resident later qualifies for Medi-Cal, the nursing facility cannot refuse to accept Medi-Cal.

Estate recovery

Lastly, when a Medi-Cal recipient dies, Medi-Cal can recover benefits paid during the recipient’s life. To do this, Medi-Cal makes a claim on the recipient’s estate. The claim is limited to the value of the estate at the time of death. California defines “estate” broadly, and Medi-Cal can recover almost all assets, including those exempt from the eligibility requirements.

Medi-Cal recipients can avoid estate recovery by leaving nothing in their estates. A number of legal options exist to minimize the effect of Medi-Cal recovery.

Medi-Cal laws are complex and constantly changing. To learn more about Medi-Cal, contact an estate planning attorney experienced in handling Medi-Cal issues.

Contact a skilled attorney today

For more than 35 years, our attorneys at Fox, Shjeflo, Hartley & Babu LLP have provided residents of Northern California, San Mateo County, San Francisco, the Silicon Valley and the San Francisco Peninsula with dependable legal guidance regarding all aspects of Medi-Cal. Conveniently located at the intersection of Route 92 and U.S. 101, we offer evening and weekend appointments as needed. For a complimentary consultation, contact us today at (650) 341-2900 or leave a brief message on our contact page.

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Fox, Shjeflo, Hartley & Babu LLP
2000 Alameda de Las Pulgas, Suite 250
San Mateo, CA, 94403-1271 USA
650-341-2900