Medi-Cal Notice Regarding Standards of Eligibility

THE FOLLOWING IS AN EXCERPT OF INFORMATION PROVIDED BY THE STATE OF CALIFORNIA, DEPT. OF HEALTH SERVICES, REGARDING MEDI-CAL ELIGIBILITY. IF YOU HAVE ANY QUESTIONS REGARDING THE CONTENT OF THIS INFORMATION, YOU MAY CONTACT OUR OFFICE TO DISCUSS, OR YOU MAY CONTACT DHS, THE AUTHOR OF THIS INFORMATION.

If you or your spouse is in, or is entering a nursing facility, read this important message!

You or your spouse do not have to use all your resources, such as savings, before Medi-Cal might help pay for all or some of the costs of a nursing facility.

You should be aware of the following to take advantage of these provisions of the law:

UNMARRIED RESIDENT:

An unmarried resident is financially eligible for Medi-cal benefits if he or she has less than $2,000 in available resources. A home is an exempt resource and is not considered against the resource limit, as long as the resident states on the Medi-cal application that he or she intends to return home. Clothes, household furnishings, irrevocable burial plans, burial plots, and an automobile are examples of other exempt resources.

If an unmarried resident is financially eligible for Medi-Cal reimbursement, he or she is allowed to keep from his or her monthly income a personal allowance of $35 plus the amount of health insurance premiums paid monthly. The remainder of the monthly income is paid to the nursing facility as a monthly deductible called the “Medi-Cal share of cost.”

MARRIED RESIDENT:

If one spouse lives in a nursing facility, and the other spouse does not live in a nursing facility, the Medi-Cal program will pay some or all of the nursing facility costs as long as the couples together does not have more than $119,220 in available assets. the couple’s home will not be counted against this $119,220, as long as one spouse or a dependent relative, or both, lives in the home, or the spouse in the nursing facility states on the Medi-Cal application that he or she intends to return to the couple’s home to live.

If a spouse is eligible for Medi-Cal payment of nursing facility costs, the spouse living at home is allowed to keep a monthly income of at least his or her individual monthly income or $2,980.50, whichever is greater. Of the couple’s remaining monthly income, the spouse in the nursing facility is allowed to keep a personal allowance of $35 plus the amount of health insurance premiums paid monthly. The remaining money, if any, generally must be paid to the nursing facility as the Medi-Cal share of Cost. The Medi-Cal program will pay remaining nursing facility costs.

Under certain circumstances, an at home spouse can obtain an order from an administrative law judge that will allow the at home spouse to retain additional resources or income. Such as order can allow the couple to retain more than $119,220 in available resources, if the income that could be generated by the retained resources would not cause the total monthly income available to the at home spouse to exceed $2,980.50. Such an order also can allow the at home spouse to retain more than $2,980.50 in monthly income, if the extra income is necessary due to exceptional circumstances resulting in significant financial duress.

An at home spouse also may obtain a court order to increase the amount of income and resources that he or she is allowed to retain, or to transfer property from the spouse in the nursing facility to the at home spouse. You should contact a knowledgeable attorney for further information regarding court orders.

The paragraphs above do not apply if both spouses live in a nursing facility and neither previously has been granted Medi-Cal Eligibility. In this situation, the spouses may be able to hasten, Medi-Cal eligibility by entering into an agreement that divides their community property. The advice of a knowledgeable attorney should be obtained prior to the signing of this type of agreement.

Note: For married couples, the resource limit ($119,220 in 2015) and income limit ($2,980.50 in 2015) generally increase a slight amount on January 1 of every year.

TRANSFER OF HOME FOR BOTH A MARRIED AND AN UNMARRIED RESIDENT

A transfer of a property interest in a resident’s home will not cause ineligibility for Medi-Cal reimbursement if either of the following conditions is met:

(a) At the time of transfer, the recipient of the property interest states in writing that the resident would have been allowed to return to the home at the line of the transfer, if the resident’s medical condition allowed him or her to leave the nursing facility. this provision shall only apply if the home has been considered an exempt resource because of that resident’s intent to return home.

(b) the home is transferred to one of the following individuals:

  • The resident’s spouse.

  • The resident’s minor or disabled child.

  • A sibling of the resident who has an equity interest in the home, and who resided in the resident’s home for at least one year immediately before the resident began living in institutions.

  • A son or daughter of the resident who resided in the resident’s home at least two years before the resident began living in institutions, and who provided care to the resident that permitted the resident to remain at home longer.

This is only a brief description of some of the Medi-Cal eligibility rules; for more detailed information, you should call either contact our office, or you may contact your local county welfare office…

AS STATED ABOVE, THIS IS AN ONLY AN EXCERPT OF INFORMATION AS PROVIDED BY MEDI-CAL. YOU SHOULD CONTACT AN KNOWLEDGEABLE ATTORNEY IF YOU OR SOMEONE YOU KNOW NEEDS LONG-TERM CARE NOW, OR IN THE VERY NEAR FUTURE.

Note: Items that are in bold and highlighted above in the DHS excerpt as outlined above, are for your convenience and information only and are not highlighted on the information as provided by the DHS.