MEDI-CAL IN 2016

Medi-Cal is California’s version of Medicaid. Medicaid is needs based financial help for people who cannot afford to pay for their medical care at home or for nursing home care when that becomes necessary. All California counties have Medi-Cal offices which are governed by the state Department of Health.

I handle Medi-Cal issues for long-term nursing home care. Medi-Cal in California are still in a sort of flux. The rules that governed California Medi-Cal had not changed since 1993. In 2005 the Deficit Reduction Act produced “draft” regulations which had been “under review” until the Department of Health Care Services, Medi-Cal Eligibility Division, released updates in 2012. These, too, are still under review! This may be one of the few areas in which California’s notoriously slow legislative procedures have benefitted the consumer.

What follows is a review of Medi-Cal Resource Allowances for 2016 for someone in a Skilled Nursing Facility (SNF)

As a needs-based program, Medi-Cal places limits on the resources a person may have to be eligible.

2016 Resource Allowance for the Medi-Cal recipient ($2,000.00)

In order to be eligible for Medi-Cal in a Skilled Nursing Facility (SNF), an applicant’s resources, excluding ‘exempt ‘assets, must be below $2,000.00  for at least one day of the month in which s/he, (the “elder” over 55 years in age) applies for Medi-Cal. In order to make this determination, an accounting must be done of both your exempt and non-exempt assets.

2016 Community Spouse Resource Allowance (CSRA) is $119,220.00)

The amount of liquid assets (savings, CDs) which an at-home spouse may have in his/her separate name for purposes of the other spouse’s Medi-Cal eligibility.

2016 Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,981.00)

The minimum amount of income the at-home/community spouse must have. If s/he earns or receives less (from Social Security for example), the Medi-Cal spouse’s monthly income (which would otherwise go as the “share of cost” directly to the SNF thus saving Medi-Cal payment) may be ordered transferred to the community spouse by a Superior Court order to make up the difference between the at-home spouse’s income and the MMMNA.

2016 Average Private Pay Rate (APPR) is $8,092.00

This is the average monthly nursing home care cost that Medi-Cal uses as the divestment penalty divisor to determine the number of months of ineligibility that a “gift” or divestment of money (for no consideration) made within the past thirty (30) months.  The math here is not difficult although the concept is.  Basically, Medi-Cal wants to make sure that no one has given away money (gifted) to impoverish him/herself in order to be eligible for Medi-Cal. Elder law attorneys well-versed in Medi-Cal regulations can help families manage their assets in anticipation of someone going into a nursing home.

Medi-Cal defines assets as either EXEMPT or NON-EXEMPT for purposes of Eligibility

“EXEMPT ASSETS”

Your Home

*Your Principal residence with “Intent to Return Home” checked on the Medi-Cal Application

*Other Real Property – certain limits

*Business Property – certain limits

*Household Goods

*Personal Effects *Jewelry

*One Car

*Whole Life Insurance *Term Life Insurance

*Burial Plot (any amount, paid for)

*Prepaid/Irrevocable Burial Plan * Designated Burial Funds

*Pension Funds *IRAS

*Annuities   (must be annuitized, and within SSA Life Expectancy Tables)

“NON-EXEMPT ASSETS”

CASH                                                                    BONDS

STOCKS                                                               TRUST PRINCIPAL

”OTHER” REAL PROPERTY                        NOTES RECEIVABLE

WHAT SHOULD YOU DO WITH “NON-EXEMPT” ASSETS?

(1)        SPEND DOWN (Before Medi-Cal Application is filed): on necessities; ordinary expenses like paying off medical/legal bills; paying off a mortgage on a primary residence; burial funds; prepaying health insurance premiums; prepaying board and care .

(2)       CONVERT (To an Exempt Asset): Use liquid assets to purchase an exempt new car, or a home.

(3)       TRANSFER (Out of Medi-Cal Recipient’s Estate):  There is a penalty for transfer or “giving away” without consideration. This must be done very carefully with an attorney’s guidance.

THE THREE STAGES OF MEDI-CAL

ELIGIBILITY                      Becoming eligible for Medi-Cal

SHARE OF COST                Income that goes to the nursing home

STATE RECOVERY          After death, California will look to see if there is anything in the Medi-Cal recipient’s name/estate that it is authorized to take in order to cover Medi-Cal costs. Even though a house is an exempt asset for purposes of ELIGIBILITY, if it is still in the name of the Medi-Cal recipient, the state may take up to the value of the Medi-Cal expenses it has paid for. This is another reason why one should consult an attorney regarding eligibility and estate planning for the at-home spouse.

CANHR – California Advocates for Nursing Home Reform shutterstock_188461511

For the most up-to-date “hot off the press” information about the status of Medi-Cal regulations, I urge you to check out the awesome website of California Advocates for Nursing Home Reform (www.CANHR.org).  The Staff, under the watchful eye and quicksilver tongue of its founder and Executive Director, Patricia McGinnis, takes the pulse of Medi-Cal on an almost daily basis. The website offers a wealth of information for consumers and attorneys interested in Medi-Cal in California. CANHR also sponsors annual attorney trainings. Consumer publications are available for purchase on their website.