Medi-Cal for Long-Term Care
Can it help me pay for my loved one’s nursing home bills?
Medi-Cal is a California state program that will pay for long-term nursing home care for an indefinite period, as long as you qualify by being financial eligible and require medical care in a skilled nursing home or rehabilitation center.
Many people falsely believe that Medicare will pay for nursing home costs. Medicare only provides limited coverage, and the coverage only begins after three days of prior hospitalization. Once your loved one has been discharged to a nursing home, Medicare will pay for the first 20 of their stay. From days 21-100, Medicare stops full coverage, and your family member will be expected make a co-payment depending on their supplement coverage benefits. After day 100 or your family member stops making medical progress, they will be forced to pay out-of-pocket for their care. Nursing home care in the Bay Area can run about $10,000 per month. When facing expensive nursing home bills, many people will start spending down their assets by private paying for care, taking out a reverse mortgage or even trying to file bankruptcy to make ends meet; this is when applying for Medi-Cal makes sense.
Although Medi-Cal is a resource-based program, with the right legal planning most anyone can qualify for benefits. The Medi-Cal guidelines of “Exempt” and “Non-Exempt” assets can be found on the California Advocates for Nursing Home Reform website (www.canhr.org). It takes the assistance of an attorney to go beyond the Medi-Cal guidelines.
Despite Medi-Cal’s resource requirements, it is possible to qualify for benefits without spending down your assets. Successful planning techniques include gifting of assets to family members, Third Party Special Needs Trusts, and Irrevocable Trusts. For married couples, there are court orders available to increase the spousal resource allowance and direct monthly income to the spouse and away from the nursing home.
After your family member receives Medi-Cal benefits, Medi-Cal does expect to be paid back after the recipient dies. This is called “Medi-Cal recovery.” For most individuals, the family home is their greatest asset and sometimes the only thing left in their estate. As a result, Medi-Cal may put a voluntary lien on the family home if that is the only means to get reimbursed for a loved one’s expenses.
Medi-Cal has several exemptions to its recovery rules. With proper planning, Medi-Cal recovery can be avoided completely. Medi-Cal recovery planning must be completed prior to the death of Medi-Cal recipients unless they are survived by a spouse or disabled child.
Please know that it is never too late to do Medi-Cal planning. If you do not have long-term care insurance and are over age 65, then it is time to learn how Medi-Cal benefits can serve you in a long-term care situation. If your loved one is already in a nursing home, Medi-Cal planning can help end the expensive nursing home bills.
The Law Office of Lisa C. Bryant offers a no-cost consultation to discuss your Medi-Cal planning needs. Please call (408) 217-2977 to schedule your complimentary consultation.
All materials have been prepared for general information purposes only to permit you to learn more about our firm, our services, and the experience of our attorneys. The information presented is not legal advice, is not to be acted on as such, and may be subject to change without notice.
