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
#Understanding Medi-Cal Long Term Care
Archive Rev 2001
- CANHR California Advocates for Nursing Home Reform
- Our Historical Webpage on Redetermination Requalification
- Our webpage on how to qualify for Medi Cal Nursing Home Benefits
Understanding Long-Term Care Medi-Cal
Learn More at Long Term Care.Gov
Then visit our page to enroll and learn more on Long Term Care.
Steve Shorr
Website Video #Introduction
Our webpages on our qualifications, reviews, testimonials, etc.
Our Webpage on Insurance Coverage for
COVID 19
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
Resources
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 vs. Medicare
- Medi-Cal Eligibility
- $2k for a Single
- Our Historical 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 Plans
- 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
Click here to calculate your chances of being disabled and how much income loss there might be?
Medicare Coverage for #SkilledNursing - 10153
Our Introductory You Tube VIDEO based on this manual
(Clinical Guidelines Explained so much better and in logical order!)
VIDEOs
- Medicare's VIDEO Nursing Home / Long-Term Care
- Our Webpage on Long Term Care
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
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?
Resources, Child Pages & Sibling Pages
Medi Cal and Medi Cal Technical Info.
LIS Low Income Subsidy Part D Rx Medicare
4 comments on “MC 262 Long-Term Care Medi-Cal Renewal”
How do I fill out Section 6. b. on the MC262, namely, “Expenses on property: $_____________?”
Is this a home that you live in or rent out?
Are you able to answer the questions on expenses for Insurance, taxes & utilities?
This form was last revised over 10 years ago. It looks to me like I would just draw a line through it and answer the questions for the more specific expenses.
See our page on rental properties. https://taxcredits.healthreformquotes.com/magi-modified-adjusted-gross-income-line-37/magi-faqs/rental-income/
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.
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.
Is my share of the equity in the family home subject to Medi Cal recovery?
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
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?
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.
Thus, 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. http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_recovery_FAQ.htm
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.
Steve, thank you for the response.
I am not sure however if a person would be safe from estate recovery if there were nursing home expenses. Even if it’s in a trust, would the state still come after our property if there were nursing home expenses?
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.
This is from the same organization as my prior citation. Let me see if I can find one elsewhere.
http://www.canhr.org/publications/PDFs/Medi-Cal_Recovery.pdf
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. https://elderlawcalifornia.com/medi-cal-planning/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.https://www.hbplaw.com/blog/2016/09/living-trusts-can-now-exempt-assets-from-medi-ca/
https://dennisfordhamlaw.com/major-reform-to-ca-medi-cal-estate-recovery/
How does one qualify for Medi-Cal to pay nursing home expenses?
Check these references:
The Qualification Section of our webpage above
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/
https://www.myflfamilies.com/service-programs/access/docs/esspolicymanual/a_09.pdf
How is your parents health now?
Income to pay premiums?
Check out Long Term Care and Home Health Care
Can Estate Recovery take a home if there is a surviving spouse?
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
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
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.
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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.