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
Medi Cal Nursing Home Estate Recovery
Medi Cal can take your home for nursing care! There are ways to plan for this to comply with all the new laws. Read this entire page along with our pages on Long Term Care Insurance for information or details.
MAGI Medi Cal under ACA – No longer has premium recovery for Health Insurance
ACA Obamacare Medi-Cal no longer has asset recovery for Health Insurance Premiums – Capitation. under MAGI Medi-Cal.
CA changed the law as CA had extra $$$ pre COVID and the new budget includes $30 million to limit Medi-Cal estate recovery only to that required by federal law. Based on the definition of what “Health Care Means.” actual code SB 833 14009.5 . KQED News 6.16.2016 * 3.24.2015 * SB 33 * SB 833 * Simple Explanation CA HealthLine 12.23.2016 * DHCS.CA.Gov
- MAGI Medi Cal 1095 B no longer relevant… Insure Me Kevin.com
#Understanding Medi-Cal Long Term Care
Archive Rev 2001
- CANHR California Advocates for Nursing Home Reform
- Our Webpage on Redetermination Requalification
- Our webpage on how to qualify for Medi Cal Nursing Home Benefits
- When will California's Medi-Cal Will Pay for a Nursing Home, Assisted Living, or Home Care Nolo.com
- Long-Term Services and Supports in Medi-Cal Fact Sheet CHCF.org
Learn More at Long Term Care.Gov
Then visit our page to enroll and learn more on Long Term Care.
Medi-Cal #Recovery Laws
Canhr
including FAQ's (Rev 6.2019)
- Canhr Fact Sheet FAQ's updated to 9.2021
- DHCS Comparison. before & after
- 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?
- FYI Web Visitor that doesn't believe there is no more estate recovery for Medi Cal Health Insurance capitation
- Medi Cal still takes estate recovery during Covid i newssource 5.20.2022
FAQ's Estate Recovery
How do I do a revocable trust for my parents?
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/
Can Estate Recovery take a home if there is a surviving spouse?
See the CANHR publication above
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?
helsell.com/medicaid-divorce-an-overview/The general rule is that there must be an “equitable distribution” of the assets and income of the couple. 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
California Health Benefit Advisors cahba.com – More Forum & Comments
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
#IHSS
In Home Supportive Services
If you are aged, blind or disabled * IHSS, having someone help you with your daily tasks, is an alternative to help you stay in your home.
Resources & Links
FAQ’s
IHSS 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 IHSS and FAQ's
- Visit our historical webpage on IHSS
More IHSS FAQ
How to #qualify for
Medi-Cal to pay your Nursing Home Costs
California Advocates for Nursing Home Reform (CANHR) –
- Medi-Cal vs. Medicare
- Medi-Cal Eligibility
- $2k for a Single
- Our Webpage on Redetermination – Requalification MC 262
- Share of Cost
- What Does Medi-Cal Cover?
- Nursing home care is covered if there is prior authorization from the physician/health care provider. Residents are admitted on a doctor’s order and their stay must be “medically necessary“. (Clinical Guidelines Explained so much better and in logical order!) Residents are allowed to keep $35 of their income as a personal needs allowance.
- Resource Limitations (Property/Assets)
- The Home
- Other Real Property/Business Property
- Spending Down/Gifting Assets
- Spousal Impoverishment Laws
- medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/
- Graphic Chart
-
#Our Historical webpage on Redetermination
Medi-Cal Consulting Services
Medi Helper.com They can help you qualify – fee charged based on complexity of your case.
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
Elder Options – Private Website – DHCS subcontractor that can help people in Sacramento Area
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!
Low Income – Assets – Alternatives
Resources & Links
True #Freedom Home Health Plans
True Freedom Plan Details - Brochure
- Enrollment Form
- Be sure to add our Broker Information or email [email protected] the form to us
- Rate Chart
- VIDEO Explanation on True Freedom Plan
- The Long Road Ahead Video
- The application disclaimers
- FAQ's
- True Freedom website, but be sure to enroll with us!
"Prepaid Home Health Care?"
Watch 3 minute simple plain English Video
- Email us for more information [email protected]
- Our webpage on Long Term & Home Health Care
- Our webpage on True Freedom
Insurance – Disability Calculators
- calculate your chances of being disabled and how much income loss there might be?
- Broad Ridge Advisors Tool
- Income Needs
- Chances of Becoming Disabled Quiz
- Social Security Administration – Estimate Your Potential Benefit Disability & Retirement Benefit
- whats my Earned Income Quotient.org How much might you earn in your future?
How does Medicare pay for #SkilledNursing Homes - 10153
Our Introductory You Tube VIDEO based on this manual
- Your costs for Skilled Nursing in Original Medicare You pay:
-
Days 1–20: $0 for each benefit period .
- Days 21–100: $194.50 coinsurance per day of each benefit period.
-
Days 101 and beyond: All costs. Medicare.gov *
-
- Clinical Guidelines explain the coverage so much better and in logical order!
- Medicare's VIDEO Nursing Home / Long-Term Care
- Planning for Discharge from a Health Care Setting VIDEO
- Long Term #Acute Care Publication # 11347
- Long-Term Acute Care Hospital (LTACH) Clinical Guidelines - Oscar
- Differences between Skilled Nursing, Long Term Acute Care & Inpatient Rehabilitation Facility
- Our FAQ on Sub Acute Care
- Find & compare nursing homes, hospitals & other providers near you Medicare.Gov
- Learn more about providers
- Calculate Cost of Long Term Care in your Area Genworth
- Our Webpagse on Long Term Care
- MAGI Medi Cal 1095 B no longer relevant… Insure Me Kevin.com
Here’s the Actual NEW CA Law
#SB 833 §14009.5. Effective 1.1.2017
(a) It is the intent of the Legislature, with the amendments made to this section by the act that added subdivision (g), to do all of the following:
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
CA Dept of Aging – Home & Long Term Care ---
Please note, there are updates all the time, double check everything.
#Taking Care of Tomorrow
- Get Quote - Proposal for Long Term Care
- Borden Hamman Long Term Planning Guide
- Nolo Long Term Care
- Medi Cal IHSS In Home Support Services
- Long Term Care.gov
- Calculate Cost of Long Term Care in your Area Genworth
NAIC Shoppers Guide to Long Term Care
Flyer - Americans Unprepared for Future Health Care Expenses
Our Main Webpage on
Links & Resources
- California Advocates for Nursing Home Reform html
- Daily Kos
- CA Health Care Foundation
- Simple Explanation CA HealthLine 12.23.2016
- Insure Me Kevin.com –
- 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
Resources, Child Pages & Sibling Pages
Medi Cal and Medi Cal Technical Info.
LIS Low Income Subsidy Part D Rx Medicare
[child-pages]
[sibling-pages]
What’s the difference in The Aged-FPL Program, no share of cost, and Medi-Cal with a share of cost.
Which overrides if you have IHSS. In Home Support Services
See our Share of Cost page, link above.
If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program, but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC).
I don’t know that IHSS is relevant as to whether you qualify for Aged and Disabled and your income is low.
Check all of my links for the reference material.
My client has a share of cost with Medi-Cal of $439, and they currently have IHSS. and IHSS states NO SHARE OF COST
Here’s my question, that is complicated to me.
They also qualify under the Aged-FPL Program which is has NO share of cost.
So does that mean they do not have to Pay the $439 to their Care-provider.
They have a Medicare Part B premium,
an additional policy for vision, and dental as a medical deduction.
Please advised.
Do they have to pay in sharing the cost for a CAREGIVER $439 or NOT
We are in Alameda County.
Please double check your paper work and let me know for sure, if your client qualified under Aged & Disabled with or without a share of cost. See our answer to your other question. It depends on the clients income.
Which of four IHSS Programs did your client qualify for?
The IHSS Residual (IHSS-R) Program is for people who are not eligible for full-scope Medi-Cal. It provides a maximum of 283 hours of services per month for people with severe disabilities and a maximum of 195 hours for people with disabilities that are not severe.