An Introduction to Medi-Cal

Medi-Cal is California’s Medicaid program that provides free or inexpensive medical care to children and adults who meet requirements. Most Medi-Cal users will never see a bill, but families might have to pay a maximum of $39 per month. You can apply for Medi-Cal on the website for Covered California, which is the state’s health insurance marketplace; you can shop around for different healthcare plans there.

What Does Medi-Cal Cover?

Medi-Cal covers what the state of California describes as “essential health benefits.” A few examples of essential health benefits include:

  • Prescription drugs
  • Behavioral health treatments
  • Mental health and substance use disorder treatments services
  • Physical and occupational therapy services and treatments
  • Maternity and newborn care
  • Emergency medical services
  • Hospitalizations
  • Laboratory services

Using Medi-Cal to Pay For Long-Term Care

One of the most popular uses of Medi-Cal is to pay for nursing homes, assisted living, and other long-term care for seniors. Private health insurance plans often do not cover the costs of long-term care, and Medicare will provide only limited funds. Despite the fact that Medi-Cal is geared toward lower-income Californians, many individuals and families who are not considered low-income may still access the program in order to pay for long-term care. Individuals who previously qualified for Medi-Cal do not have to worry about applying again to pay for their long-term care.

For Medi-Cal to pay for someone’s long-term care, it must be deemed medically necessary. Your primary care physician can prescribe a nursing home or other long-term care facility with round-the-clock skilled nursing if it is “reasonable and necessary” to protect life, prevent a significant disability or illness, or to relieve severe pain. After applying for Medi-Cal to pay for a long-term care facility or long-term care at home, representatives will perform a Level of Consciousness (LOC) evaluation and assess other aspects of the applicant’s health and wellbeing. 

Medi-Cal and Estate Planning

Although the availability of Medi-Cal to pay for long-term care is relaxed, you still need a relatively low income to qualify. Therefore, what many Medi-Cal aspirants do is “spend down” many of their assets ahead of time to bring their levels down to acceptable thresholds. You may also transfer some of your assets, but be aware that any transfers within 60 months of applying for Medi-Cal will deem you ineligible. 

When a Medi-Cal recipient passes away, the state will make attempts to recoup their expenses paid by taking assets from the recipient’s estate. Any assets placed in trusts are shielded from these efforts, as the state can only take assets that pass through probate court. 

Conclusion

The thought of paying for long-term care gives many seniors and planners a good amount of stress. However, through meticulous planning and strategy, you can access California’s Medi-Cal program to take care of those astronomical costs. For best results, you should consider speaking with an estate-planning attorney who also is knowledgeable about Medi-Cal. Contact the team at MMZ Law today for a free consultation over the phone; call us at 909-256-6702.

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