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Understanding Medi-Cal Long Term Care
Medi Cal Estate Recovery<br />

California Medi-Cal Estate Recovery & Long-Term Care Planning

 

Worried Medi-Cal will “take the house”?
Many California families misunderstand the estate recovery rules.

California Medi-Cal estate recovery rules changed significantly for people who died on or after January 1, 2017. According to the California Department of Health Care Services (DHCS), recovery generally applies only to certain benefits received after age 55 and only if the person owned assets at death.

Official DHCS Estate Recovery Program Information

Quick Answer:
Medi-Cal does not automatically “take your house.” CANHR explains that California does not take away anyone’s home “per se,” although a home may be subject to an estate claim after death in some cases.


CANHR Medi-Cal Estate Recovery FAQ

1. What Estate Recovery Really Means

 

 

Estate recovery is not the same thing as Medi-Cal eligibility, a nursing home bill, or a tax. It is a possible claim after death against certain assets owned by a deceased Medi-Cal member.

DHCS describes estate recovery as repayment from the estates of certain deceased Medi-Cal beneficiaries.

DHCS Estate Recovery Brochure PDF

2. When California Can Recover Assets

3. What Usually Triggers Estate Recovery?

  • Medi-Cal paid for nursing home care
  • The person was over age 55
  • The person died owning assets or real estate
  • The estate may go through probate
  • Family members receive a DHCS notice
  • CANHR Estate Recovery Information

4. Common Ways Families Plan Ahead

Common Myths About Medi-Cal Estate Recovery

Myth: “Medi-Cal automatically takes your house.”
Reality: CANHR says California does not automatically take the home itself, although estate recovery may apply after death in some situations.

CANHR FAQ

Myth: “Everyone on Medi-Cal has estate recovery.”
Reality: Recovery generally applies only to certain benefits received after age 55.

Myth: “There is nothing families can do.”
Reality: Families may benefit from reviewing Medicare, trusts, probate, long-term care insurance, and Share of Cost strategies.

Frequently Asked Questions

Can Medi-Cal take my home while I am alive?
Generally no. The more common issue is whether there may later be an estate recovery claim after death.

Does Medicare pay for long-term custodial nursing home care?
Generally no. Medicare may cover limited skilled nursing care, but not indefinite custodial care.
Medicare Skilled Nursing Facility Coverage

Should I talk to an attorney?
Yes, for trusts, probate, real estate transfers, estate claims, or legal planning.

Educational information only. Not legal, tax, or estate planning advice.

Medi-Cal #Recovery Health Premiums

Plain English  MAGI Medi-Cal no longer has Estate Recovery
for Medi Cal premiums
 
 
 
 
Medi Cal Recovery after 2017

no more medi cal premiums - estate recovery
Source DHCS.CA.Gov 

 
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Want More Details? (Optional)
Supporting documents, rules, and deeper explanations are below if you want them — most people don’t need them.

Medi Cal Estate Recovery

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

 

FAQ’s

 

  • California’s Medi-Cal Recovery Program Frequently Asked Questions  Canhr.org  Fact Sheet
  • Medi-Cal Recovery Recovery rules for Medi-Cal beneficiaries who die on or after January 1, 2017
  • Avoiding Estate Recovery  Canhr.org
  • The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal beneficiaries. Repayment only applies to benefits received by these beneficiaries on or after their 55th birthday and those who owned assets at the time of death. If a deceased beneficiary owns nothing when they die, nothing will be owed.  dhcs.gov
  • What you need to know and how to avoid Medi Cal Estate Recovery  canhr
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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

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Here’s the Actual NEW CA Law

#SB  833  §14009.5.  Effective 1.1.2017

(1) Limit Medi–Cal estate recovery only for those services required to be collected under federal law.
 
 
 
 
 
Let’s read the law 3 more times and when we think we understand it, we’ll read it again. Justice Felix Frankfurther.
(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).

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.

Probate Estate?

Trusts?

 

Learn More at Long Term Care.Gov

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What is the

CA Assisted Living Waiver?

 

The California Assisted Living Waiver (ALW) is a Medi-Cal program that helps low-income, eligible seniors and persons with disabilities move into or remain in assisted living facilities instead of a nursing home. It covers the cost of care services in a Residential Care Facility for the Elderly (RCFE) or subsidized housing, but participants must pay their own room and board. [1, 2, 3]

 

Key Aspects of the ALW Program
  • Eligibility: Must be full-scope Medi-Cal eligible with zero share of cost, require a nursing facility level of care, and be able to pay for room and board.
  • Coverage & Availability: The program is authorized in 15 California counties (including Los Angeles, San Diego, and San Francisco) through February 28, 2029.
  • Services Provided: Includes care coordination, personalized care plans, 24-hour care, and routine, scheduled nursing visits.
  • Goal: To provide a less restrictive, home-like environment, avoiding unnecessary institutionalization.
  • Waitlist/Limitations: It is not an entitlement program, and spots are limited, often leading to waitlists. [1, 2, 3, 4, 5]
How to ApplyInterested individuals must work with a Care Coordination Agency (CCA) to conduct a nurse assessment and complete an application. A list of participating RCFEs and CCAs can be found on the California Department of Health Care Services (DHCS) website. [2, 6, 7, 8, 9]

 

 

AI responses may include mistakes.

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

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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!

 

assisted living chart - acute care to home

Learn more  chcf.org what-is-assisted-living/ 

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