Medi Cal Long Term & Nursing Home Benefits & Qualification

but Beware:

Medi Cal can take your home and assets to pay back Nursing Home  & Long Term Care Expenses

Get Private Individual Coverage for Long Term Care

How to qualify for Medi Cal Nursing Home Coverage

Jump to section on:

• Understanding Medi Cal Long Term Care
• Medi Cal Recovery Laws 2017 UPDATE
• Definition Health Care Services mean:
• How to qualify for Medi Cal to pay for Nursing Home
• IHSS In Home Supportive Services
• CA Department of Aging – Long Term Care Booklet

Strategic Planning for Nursing Home Benefits

gift in contemplation of death

n. (called a gift causa mortis by lawyers showing off their Latin), a gift of personal property (not real estate) by a person expecting to die soon due to ill health or age. Federal tax law will recognize this reason for a gift if the giver dies within three years of the gift. Treating the gift as made in contemplation of death has the benefit of including the gift in the value of the estate, rather than making the gift subject to a separate federal gift tax charged the giver. If the giver gets over an apparently mortal illness, the gift is treated like any other gift for tax purposes.

See also: gift tax unified estate and gift tax law.com

Medi-Cal FAQ’s DHCS.gov – Look back only 30 month look back in CA

Resources

• FAQ our website on trusts
• Living Trust – Bank Accounts?
  • Sample – Example California Will – Where does your stuff go? Health Care Directive
    • Probate
  • Special Needs Trust
•  medi helper.com
  • 
  • Pdf Brochure   –  I was told their fee is $3k

Trusts 

• If the property is not subject to probate in California, the State cannot recover it. California’s state probate law excludes property held in living trusts, joint tenancies, life estates, and other types of probate-avoiding transactions. canhr.org/medi-cal_recovery_FAQ
• For those beneficiaries who die on or after January 1, 2017, the definition of “estate” from which the State can recover is severely limited. Now California can only recover for the amount of benefits paid for the decedent or the value of any of the decedent’s property received by the recipient by distribution, whichever is less. If you leave your estate in a will, for example, this would be by “distribution” and your estate could be subject to recovery.
• The beneficiary’s estate that can be subject to recovery now includes only real and personal property or other assets included within the individual’s estate, as defined for the purposes of State probate law.
• See above in the website for attorney’s that can help you draw up a trust. There is also Nolo.com where they do have do it yourself… but then it might be way better to have the planning done professionally.
• We can help you with life and health insurance, see the menu above.
• I’m not an attorney and can’t give you legal advice or interpret law for you. I can only show you the law or the interpretations from government or other attorneys.
• if your home is still in your name when you die and if it is subject to probate under California law, then it is considered to be part of your “estate”. The State may make a claim against your estate for the amount of the Medi-Cal benefits paid or the value of the estate, whichever is less. elder law california.com/how-to-avoid-the-medi-cal-estate-recovery/
• On June 27, 2016, Governor Brown signed SB833: legislation which reduces Medi-Cal Estate Recovery’s ability to seek reimbursement from the estate of a surviving spouse. In short, this means that you can now use a revocable living trust to protect your assets from being clawed back by Medi-Cal after you or your loved one passes away.
• The prior law was criticized for its devastating effect on families of recipients who were forced to sell a family home to pay for Medi-Cal benefits received by family members.
• Under the new law, for decedents dying after January 1, 2017, assets held in a living trust would be immune from recovery. Under SB 833, Medi-Cal’s ability to seek reimbursement for amounts paid from a Medi-Cal recipient’s estate would be limited to assets which pass as part of the deceased Medi-Cal recipients “probate estate” – the assets outside a trust, in other words. hbplaw.com/living-trusts-can-now-exempt-assets-from-medi-ca/
• dennis fordham law.com/major-reform-to-ca-medi-cal-estate-recovery/

What type of trusts can protect family assets?

• The creator of a trust can retain the income and life use of assets contributed to an irrevocable living trust (ILT). Assets transferred to an ILT are subject to a 60-month look-back rule under Medicaid.
• Yes, this is all VERY confusing and complicated.
  California Medi Cal is 30 months…
  So, it might be best to use an attorney to set up and check over your final plans and documents.
• Because of the retained life interest under IRC section 2036, the trust property will receive a stepped-up income tax basis upon the death of the creator.
• The 60-month look-back period applies to assets transferred to and from any type of trust. An individual with a revocable grantor trust should first transfer assets from this entity to her name before making gifts in order to have the shorter 36-month rule apply. With respect to trust disbursements of income or principal, any creditor ?steps in the shoes? of a beneficiary (i.e., to the extent that this individual is entitled to receive any benefits, so would the creditor). The Exhibit summarizes when income and principal from a trust can be considered as an available resource for Medicaid. This chart reflects that the look-back rules are not applicable to testamentary trusts, although a provision should be included that no benefits are payable to any beneficiary who otherwise would qualify for governmental benefits nysscpa.org/

• Our Webpages on:
• Estate Planning
  • Estate & Gift Taxes
    • Gift Income? Covered CA MAGI? Taxable?
  • Living Trust – Bank Accounts?
    • Executor – Successor Trustee – What are the duties?
    • Sample – Example California Will – Where does your stuff go? Health Care Directive
      • Probate
      • Will Contests – Disinherit a child
    • Special Needs Trust

IHSS Qualification 

FAQ’s

Can IHSS Providers – Care Workers – Get Medi Cal regardless of their income?

Here’s what the PASC-SEIU Homecare Workers  website says –

As long as you are authorized  work 74 hours or more per month for two consecutive months.  You will continue to be eligible as long as you continue to be authorized to work at least 74 hours per month. View actual wording

On the other hand:

IHSS workers would be presumptively eligible, for 6 months  – you can get temporary coverage until official eligibility is determined ^{Law Insider} *  for full [Medi Cal] benefits and there would be no means test – they won’t look at your income, resources – assets or your ability to pay for health insurance. Sooner or later though, A Medi Cal application would eventually have to be completed.    ^Investopedia *  ^Dhcs *  ^{Report to CA Health Care Foundation by USC  June 2000}    

On the other hand:

Here’s an optometrist making $200k that was the IHSS caretaker for his mother.  He states:

i was never asked about income if i remember correctly ^{email dated 5.9.2022}

On the other hand:

I don’t do phone calls – especially when I don’t get compensated to help people with IHSS – here’s a number to call

Providers who are eligible for the plan will automatically be sent an enrollment packet that describes what the PASC- SEIU Homecare Workers Health Care Plan provides. If you are eligible for the health plan, you may contact the PASC Health Plan Call Center at 1-855-PASC-PLN, (1-855-727-2756), to request an enrollment form.

If you are already enrolled in L.A. Care plan and have additional questions about specific benefits provided by the Plan, please call L.A. Care at 1-844-854-7272, or go to their website at www.lacare.org/members/ihss.

• Visit our historical webpage on IHSS
  • FAQ’s

Medi Cal Estate Recovery

FAQ’s

• Question I getting a divorce and my x spouse has a chronic debilitating illness.   Is my share of the equity in the family home subject to Medi Cal recovery?

• ANSWER  The general rule is that there must be an “equitable distribution” of the assets and income of the couple   REad More .
  • agingcare.com/divorce-husband-eligible-for-medicaid
  • Divorce: Allows a married couple to divide their assets equally. Thus, the at-home spouse can keep half of the property outside the reach of Medi-Cal. (This makes sense (if at all!) only for persons with substantial assets or for an at-home spouse with substantial separate property in a new marriage.) glantzlegal.com/tips
  • Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility even if the transfers occurred during the look-back period. These exempt recipients include the following:
    • A spouse (or a transfer to anyone else as long as it is for the spouse’s benefit)
    • A blind or disabled child
    • A trust for the benefit of a blind or disabled child
    • A trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medicaid applicant, under certain circumstances). ^{elderlawanswers.com/how-does-the-medicaid-look-back-period-work}

FAQ’s Estate Recovery

• Can Estate Recovery take a home if there is a surviving spouse? 
  • MAGI Medi Cal 1095 B no longer relevant… Insure Me Kevin.com
  • Are you responsible for an X Spouse who goes into Medi Cal Nursing home?  That is, can Medi Cal take recovery from the family home?

Limitations on Medi Cal Estate Recovery

Federal and State laws #require DHCS to seek recovery

from the estates of deceased Medi-Cal beneficiaries, or from any recipient of the decedent’s property by distribution or survival, for services and premiums paid on behalf of the decedent on or after age 55.

• California Code of Regulations (CCR) sections 50960-50966
• Welfare and Institutions Code (W&IC) section 14009.5
• Probate Code section 215
• Probate Code section 9202
• Probate Code section 19202
• United Stated Code (USC) section 1396

Here’s the Actual NEW CA Law

MISC & Historical

What is the

CA Assisted Living Waiver?

Participants in the ALW have access to the following services:

• Assisted Living Services: The following is a list of some of the services that must be provided to ALW participants.  These services may be provided in an RCFE, or by a licensed Home Health Agency to residents in public housing.
  • Assisting in developing and updating an individualized care plan for each resident
  • Personal care and assistance with activities of daily living
  • Laundry
  • Housekeeping
  • Maintenance of the facility
  • Providing intermittent skilled nursing care
  • Meals and snacks
  • Providing assistance with self-administration of medications
  • Providing or coordinating transportation
  • Providing recreational activities
  • Providing social services

• Care Coordination: These services include identifying, organizing, coordinating and monitoring services needed by participants .
• Nursing Facility Transition Care Coordination: These services help transition participants from a nursing home to the community.  ^{CA Assisted Living Waiver}

Resources & Links

• DHCS.CA.Gov – CA Department of Health Care Services
• Assisted Living Waiver
• Elder Options – Private Website – DHCS subcontractor that can help people in Sacramento Area
• Nolo Press

FAQs / Ask Us a Question

Question

My 92 year old mother is on Medi-cal and Scan, but needs to go into assisted living with waiver application.  They won’t accept Scan.  They said she has to drop it.  Does she automatically go on Medi–Medi and will her new doctor take it? The application takes 3-6 months for approval but I have to drop her from Scan insurance before I fax over the waiver form…

Answer

***I don’t have enough background to answer your question.   I did learn though, my first day at my Father’s & Grand Fathers Insurance Agency, to NEVER cancel coverage till new coverage was confirmed!

Links & Resources

• California Advocates for Nursing Home Reform html
  • New Medi-Cal Recovery Laws 1.1.2017 pdf
• Daily Kos
• CA Health Care Foundation
• Simple Explanation CA HealthLine 12.23.2016
• Insure Me Kevin.com –
  • 1095 B Confusion
• Check out Long Term Care Coverage
• DHCS.CA.Gov Explanation
• Insurance and Annuity Disclosure form – might trigger change in Medi Cal eligibility?
• Set up an Advance Directive 5 Wishes

Low Income – Assets – Alternatives

Resources & Links

• Veteran’s Home Health Care
• Jewish Free Loan Assoc.
• Medicare.Gov Home Health Compare