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

Contact Us - Ask Questions - Get More Information
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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

What are Home and Community-Based Services?

Medicaid-covered HCBS are services that support older adults and people with disabilities with activities of daily living in settings of their choice, including their homes, assisted living facilities, and adult day health centers. Supports include, for example, personal care assistance, care coordination, medically-tailored nutrition, transportation, medication management, home modifications, and, for individuals with high care needs, 24-hour nursing and supervision. California’s HCBS programs include:

• Assisted Living Waiver provides care and supervision in licensed board and care settings such as Residential Care Facilities for the Elderly and at a limited number of public subsidized housing sites.
• Community-Based Adult Services Program provides social, therapeutic, nutrition, and personal care services at adult day health centers.
• California Community Transitions/Money Follows the Person assists residents in skilled nursing facilities transition to community housing by identifying, adapting, and setting up housing.
• Home and Community-Based Alternative Waiver provides personal care, 24-hour nursing, and other supports to people with complex needs.
• Home and Community-Based Services for the Developmentally Disabled coordinates and purchases support services for consumers with developmental disabilities through the Department of Developmental Services’ Regional Centers.
• In-Home Supportive Services (IHSS), a consumer-directed personal care program serving over 800,000 older adults and people with disabilities, provides assistance with activities of daily living like dressing, bathing, eating, and household chores.
• Medi-Cal Waiver Program provides case management and personal care services to individuals living with HIV/AIDS as an alternative to nursing facility care.
• Multipurpose Senior Services Program includes intensive care and service coordination, social supports, home repairs, and adult day programs for older adults age 65 and over.
• Program of All-Inclusive Care for the Elderly (PACE) provides coordinated health and home and community-based services to older adults at site-based PACE centers.    Source  Justice in Aging  *

AI Summary

Can Medi Cal Recover for IHSS?

• Age 55+: For individuals who received long-term care services, including IHSS, after age 55.
• Institutionalization: For anyone, regardless of age, who was permanently institutionalized.
• Services Covered: Nursing facility care, home and community-based services (like IHSS), and related hospital/prescription drug costs. [2, 5, 6, 7]
• Post-2017 Changes: For deaths on or after January 1, 2017, recovery is limited to nursing facility services and HCBS, including IHSS, but only for payments made for those specific services.  dhcs.gov * dhcs.gov pdg *  CANHR.org FAQ’s * 

• Surviving Spouse/Minor/Disabled Child: If a surviving spouse, minor child, or disabled dependent lives in the home.
• No Probate Assets: If the estate has no assets subject to probate (e.g., held in a properly structured trust).
• Specific Service Exclusions: Costs for Medicare premiums/co-pays for certain low-income beneficiaries are exempt, and some Personal Care Services (PCS) under specific waivers might also be excluded. [1, 2, 4, 8]

• Estate Planning: Tools like irrevocable trusts can help protect assets from recovery claims.
• Notification: The state sends a notice (itemized bill) to heirs after the recipient dies.
• Professional Advice: Because rules are complex, consulting a California estate planning attorney experienced with Medi-Cal is highly recommended. [2, 7, 8, 9, 10]

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}

Here’s the Actual NEW CA Law

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

Probate Estate?

Trusts?

• Estate Planning
  • Estate & Gift Taxes
  • Living Trust – Bank Accounts?
    • Sample – Example California Will – Where does your stuff go? Health Care Directive
      • Probate California
• Life Insurance – Instant Quotes – Universal – Key Man Life
• Long Term Care Nursing & Home Health Care
  • Medi Cal – Long Term Care & Nursing Home Estate Recovery – Strategic Planning
    • Cal AIM – Board & Care – Medi Cal no index

Learn More at Long Term Care.Gov

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Find an Attorney

• Legal Match
• Findlaw.com
• American Bar Association
• Attorney Search Network
  • Follow the links on this webpage.  Many of them go to articles on Attorney Websites
  • Also, see our appeals webpage
• Medi Cal Contact
  • State Bar of California  Attorney Referral Service

  #Attorney  's  ---  Social Security Disability maze

  • • west coast disability.com/
  • Sellers Law 
  • Hill & Ponton
  • premier disability.com
  • Cantrell & Green
  •  
  • • We don't necessarily know these attorney's...
      • Editorial: Lawyers are fighting innovative proposals for more affordable legal assistance. That’s wrong LA Times 1.30.2022

      Estate Planning

      • Ray Green Esq.  San Pedro, CA
      • Barbara Craig Esq.

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

• 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
• Set up an Advance Directive 5 Wishes
• Visit our Webpages
  • 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 California
        • Special Needs Trust

Low Income – Assets – Alternatives

Resources & Links

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