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

Medi Cal Nursing Estate Recovery


Medi Cal can still take your home for nursing care!  There are ways to plan for this and the new laws updated Nursing Home Recovery too.  Read this entire page along with our pages on Long Term Care Insurance for information or details.

ACA – No premium recovery for Health Insurance

However, under ACA Obamacare Medi-Cal no longer has asset recovery for   Health Insurance Premiums – Capitation. under MAGI Medi-Cal.  Jump to definition of what “Health Care Means.”   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. See actual code below. KQED News 6.16.2016  *  3.24.2015   * SB 33  * SB 833 * Simple Explanation CA HealthLine 12.23.2016 * DHCS.CA.Gov

Strategic Planning for Nursing Home Benefits

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/

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 – only 30 month look back in CA

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


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


***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

Veteran’s Home Health Care

Jewish Free Loan Assoc.

Medicare.Gov Home Health Compare

(4) “Health care services” means
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).
Here’s simpler plain English explanations showing that MAGI Medi-Cal no longer has Estate Recovery
The new rules adopted by lawmakers limit recovery to the federal minimum. That means the state 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

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 MediCal 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.
(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).
(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.
(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.

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.

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

  1. 4 comments on “MC 262 Long-Term Care Medi-Cal Renewal”

    1. Judith M says:

      How do I fill out Section 6. b. on the MC262, namely, “Expenses on property: $_____________?”

      • Steve Shorr says:

        See schedule E from your income tax if this is a rental property. At least the IRS makes it clear that they are asking for a total of expenses, which I believe Medi-Cal is trying to do. See our contact page and you can talk to someone there who gets paid to help you.

    2. Teddi A. C says:

      My sister is on disability (stroke) and she lives with me. Am I a “family member” as stated on the form?
      I just don’t understand why they would need information about my insurance, etc. Other than the fact that
      I do take care of her, I am not legally responsible for her, so I should not have to answer any personal questions about myself. Correct?

      Thank you.

      ***We will answer that question on this new page.

  2. Anonymous says:
    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

  3. I’m looking to do a revocable trust for my parents.

    Thanks for putting up the information on some of the newer laws that we’re passed in 2017 for California, above on this webpage.

    I wasn’t actually sure if putting a home in a revocable trust would still protect from the stage being from the state trying to recover nursing home facility fee.

    So I just didn’t know if that was a thing or not so can you explain further or guide me to where I can get proper help?

    • After January 1, 2017, if the Medi-Cal recipient is survived by a spouse or a registered domestic partner, a claim is prohibited and forever barred regardless of when the Medi-Cal spouse died. However, if the surviving spouse or registered domestic partner also received Medi-Cal services subject to recovery, his/her estate could be subject to an estate claim after his/her death if steps are not taken to avoid recovery. canhr.org

  4. How does Medi-Cal keep track of the expenses and how much they will bill your estate?

    How often do they have to let you know what the running balance is?

    • As of January 1, 2017, a Medi-Cal beneficiary who may be subject to recovery, or their authorized representative, can submit a request to find out the amount of the Medi-Cal claim, for a fee of $5, once per year. The new claim request forms are available on the Recovery Branch website at: https://www.dhcs.ca.gov/ Source

  5. This is an OLD Question from July 2016, before SB 833 became effective and various news articles and phamplets 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.

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