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understanding long term care medi cal

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

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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

 

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#Understanding Medi-Cal Long Term Care
Archive Rev 2001

Understanding Medi-Cal Long Term Care

Understanding Long-Term Care Medi-Cal

understanding long term care medi cal

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Steve Shorr
Website Video #Introduction

Steve Video's

Corona Virus Covid

Medi-Cal #Recovery Laws
Canhr
including FAQ's (Rev 6.2019)

2017 SB 833 Medi Cal Recovery Law

Compare sb 833 estate recovery medi cal magi

FAQ's Estate Recovery

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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

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#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

More IHSS FAQ

    • 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.

      Reply

  2. 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.

    Reply

    • 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.

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How to #qualify for
Medi-Cal to pay your Nursing Home Costs

California Advocates for Nursing Home Reform (CANHR) –

Medi-Cal Consulting Services

Medi Helper.com They can help you qualify – fee charged based on complexity of your case.

Free Intake – Assessment Form

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!

Low Income – Assets – Alternatives

Resources & Links

True #Freedom Home Health Plans

True Freedom Plan Details - Brochure

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"Prepaid Home Health Care?"

Watch 3 minute simple plain English Video

True freedom home health

Insurance – Disability Calculators

How does ​Medicare pay  for #SkilledNursing Homes - 10153

Our Introductory You Tube VIDEO based on this manual

video medicare skilled nursing

(4) “#HealthCareMeans – services” 
 
only those services required to be recovered under Section 1396p(b)(1)(B)(i) of Title 42 of the United States Code.
 
.
(B) In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of—
(i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or
(ii) at the option of the State, any items or services under the State plan (but not including medical assistance for medicare cost-sharing or for benefits described in section 1396a(a)(10)(E) of this title).
 
 
 
 
Plain English explanations showing that MAGI Medi-Cal no longer has Estate Recovery
 
 
California  can only make claims for costs primarily related to nursing home care and “home- and community-based services,” such as adult day health care and a pilot program testing the use of assisted living as a Medi-Cal benefit.  KQED News 6.16.2016  *  3.24.2015   * SB 33  * SB 833 * Simple Explanation CA HealthLine 12.23.2016 * DHCS.CA.Gov  This is based on new rules under SB 826 & SB 833 which  limits recovery to the federal minimum.
 
 
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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:

(1) Limit Medi–Cal estate recovery only for those services required to be collected under federal law.
 
Jump to definition of what “Health Care Means.” 
 
(2) Limit the definition of “estate” to include only the real and personal property and other assets required to be collected under federal law.
(3) Require the State Department of Health Care Services to implement the option in the State Medicaid Manual to waive its claim, as a substantial hardship, when the estate subject to recovery is a homestead of modest value, subject to federal approval.
(4) Prohibit recovery from the estate of a deceased Medi-Cal member who is survived by a spouse or registered domestic partner.
(5) Ensure that Medi-Cal members can easily and timely receive information about how much their estate may owe Medi-Cal when they die.
(b) Notwithstanding [without being prevented by] any other provision of this chapter, the department shall claim against the estate of the decedent, or against any recipient of the property of that decedent by distribution, an amount equal to the payments for the health care services [definition  Nursing home & Medicare Cost Sharing] received or the value of the property received by any recipient from the decedent by distribution, whichever is less, only in either of the following circumstances:
(1) Against the real property of a Medi-Cal member of any age who meets the criteria in Section 1396p(a)(1)(B) of Title 42 of the United States Code and who was or is an inpatient in a nursing facility in accordance with Section 1396p(b)(1)(A) of Title 42 of the United States Code.
(2)
(A) The decedent was 55 years of age or older when the individual received health care services. [definition  Nursing home & Medicare Cost Sharing]
(B) The department shall not claim under this paragraph when there is any of the following:
(i) A surviving spouse or surviving registered domestic partner.
(ii) A surviving child who is under 21 years of age.
(iii) A surviving child who is blind or disabled, within the meaning of Section 1614 of the federal Social Security Act (42 U.S.C. Sec. 1382c).
(c)
(1) The department shall waive its claim, in whole or in part, if it determines that enforcement of the claim would result in substantial hardship to other dependents, heirs, or survivors of the individual against whose estate the claim exists.
(2) In determining the existence of substantial hardship, in addition to other factors considered by the department consistent with federal law and guidance, the department shall, subject to federal approval, waive its claim when the estate subject to recovery is a homestead of modest value.
(3) The department shall notify individuals of the waiver provision and the opportunity for a hearing to establish that a waiver should be granted.
(d) If the department proposes and accepts a voluntary postdeath lien, the voluntary postdeath lien shall accrue interest at the rate equal to the annual average rate earned on investments in the Surplus Money Investment Fund in the calendar year preceding the year in which the decedent died or simple interest at 7 percent per annum, whichever is lower.
(e)
(1) The department shall provide a current or former member, or his or her authorized representative designated under Section 14014.5, upon request, a copy of the amount of Medi-Cal expenses that may be recoverable under this section through the date of the request. The information may be requested once per calendar year for a fee to cover the department’s reasonable administrative costs, not to exceed five dollars ($5) if the current or former member meets either of the following descriptions:
(A) An individual who is 55 years of age or older when the individual received health care services. [definition  Nursing home & Medicare Cost Sharing]
(B) A permanently institutionalized individual who is an inpatient in a nursing facility, intermediate care facility for the intellectually disabled, or other medical institution.
(2) The department shall permit a member to request the information described in paragraph (1) through the Internet, by telephone, by mail, or through other commonly available electronic means. Upon receipt of the request for information described in paragraph (1), the department shall work with the member to ensure that the member submits documentation necessary to identify the individual and process the member’s request.
(3) The department shall conspicuously post on its Internet Web site a description of the methods by which a request under this subdivision may be made, including, but not limited to, the department’s telephone number and any addresses that may be used for this purpose. The department shall also include this information in its pamphlet for the Medi-Cal Estate Recovery Program and any other notices the department distributes to members specifically regarding estate recovery.
(4) Upon receiving a request for the information described in paragraph (1) and all necessary supporting documentation, the department shall provide the information requested within 90 days after receipt of the request.
(f) The following definitions shall govern the construction of this section:
(1) “Decedent” means a member who has received health care under this chapter or Chapter 8 (commencing with Section 14200) and who has died leaving property to others through distribution.
(2) “Dependents” includes, but is not limited to, immediate family or blood relatives of the decedent.
(3) “Estate” means all real and personal property and other assets in the individual’s probate estate that are required to be subject to a claim for recovery pursuant to Section 1396p(b)(4)(A) of Title 42 of the United States Code.
 
       (4) Health Care means – jump to the rest of the code and annotations
 
(5) “Homestead of modest value” means a home whose fair market value is 50 percent or less of the average price of homes in the county where the homestead is located, as of the date of the decedent’s death.
(g) The amendments made to this section by the act that added this subdivision shall apply only to individuals who die on or after January 1, 2017.
 
Let’s read the law 3 more times and when we think we understand it, we’ll read it again. Justice Felix Frankfurther.
 
 
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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.

CA Dept of Aging – Home & Long Term Care ---

Revision  2018 pdf

Please note, there are updates all the time, double check everything.

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2 comments on “Medi Cal – Long Term Care & Nursing Home Estate Recovery – Strategic Planning”

  1. https://khn.org/news/article/medicaid-estate-repayments/

    https://www.latimes.com/california/story/2022-12-06/l-a-county-to-set-aside-money-to-boost-wages-for-caregivers-for-elderly-and-disabled

    https://www.wiseandhealthyaging.org/

    https://independenceathome.org/about-us

    https://www.dhcs.ca.gov/services/ltc/Documents/Medi_CalQandA.pdf

    https://www.norcalplanners.com/understanding-the-medi-cal-look-back-period/

    https://bridgetmackaylaw.com/blog/medi-cal-faq-look-back-period-ineligibility/

    Reply

  2. This is an OLD Question from July 2016, before SB 833 became effective and various news articles and pamphlets cited above became available to make it CLEAR that there is no estate recovery for premiums under MAGI Medi-Cal.

    **************************

    I read your helpful links carefully. I read them VERY CAREFULLY. I STILL run into the medical estate recovery situation, even after it was changed to hide that it still continues to leave out most people in my age group.

    The only asset I have is my home. It is the only asset I have built (literally, by hand, to the point of breaking two ribs working on the construction site while pregnant) over the last 30+ year of my life. I don’t have a disabled child or meet the “home worth 50% less than the homes in my area” test. The only equitable situation would be for the state to follow its own laws and not create government programs that discriminate on the basis of age. I’m sorry if this sounds like a rant, is not your problem and there is nothing you can do about the regulations as they now stand.

    I am not on disability and I don’t collect one thin dime from the state. I have a life-threatening medical condition but I will literally choose to stay home and die rather than hand all I own to the state as punishment for seeking health care. If I can avoid medical care until I am 65, the state fails to become my heir.

    I cannot die in peace knowing the state would take the only inheritance I could muster for my children during my entire life.

    Because of my age, the state has specially selected people in my decade of age to be treated differently when it comes to health care and estate recovery rules. Obama-Care is theft-care which targets people on the verge of retirement and their heirs.

    If I were under 55 or over 65, I could consider medi-cal and would have applied last year, when my income took a nose-dive, but I held off. The old AND “NEW” rules STILL discriminate against me until I am 65.

    Reply

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