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.
Are There Any Medi-Cal Recovery Limits?
There is no doubt that Medi-Cal recovery is a worry for many elders and their families. Fortunately, for those who have been worried about possible changes under a new president, Governor Brown signed into law a new bill called Senate Bill 833 (SB833), which has added protections for any senior estates that are subject for recovery under Medi-Cal. The new law, SB833, limits how Medi-Cal can recover from estates in several ways. Even with the good news of these changes, because the laws can be complex and confusing, we highly recommend that you consult with an elder law attorney who can help you make the right decisions if you or a family member is dealing with Medi-Cal.
Limits Under Senate Bill 833
For anyone who has been worried about possible changes in legislation, these new proposals are good news.
Here are the ways that SB833 has limited Medi-Cal recovery:
- Surviving spouses and domestic partners that are registered are protected from any claims against the estate.
- Anyone 55 years or older is only subject to recovery on home and community based services and nursing home costs.
- Recovery is limited to only the assets that are subject to probate in California.
- The amount of interest the state of California can charge on liens is limited.
- When the home is deemed to be 50% or less than the market value, then the state of California is held to waiving the claim as a substantial hardship.
- The state of California is required to provide a copy of the amount of Medi-Cal expenses that are subject to recovery to any current or former beneficiaries or their authorized representatives.
Living Trusts: The Most Important Limit
While it is fairly clear that the above listed limits are an enormous triumph for all recipients of Medi-Cal, there is a limit written in bold that helps Medi-Cal recipients and their families the most. As of January 1, 2017, only the assets of an estate that are subject to the death probate in court are recoverable by Medi-Cal. That means that any assets that are put into a living trust cannot be taken by Medi-Cal.
This important change in the law eliminates many of the complexities of Medi-Cal estate planning. Plain and simple, if there is a living trust, assets can be shielded from Medi-Cal recovery. However, something that you need to understand is that putting assets into a living trust will not automatically qualify you for Medi-Cal. In fact, the requirements for Medi-Cal eligibility today to have not changed, despite these changes of limitations of the law.
Experienced Help With Medi-Cal Laws
There is a lot to think about when it comes to Medi-Cal planning. That is why it is crucial to consult with an experienced Medi-Cal attorney who will ensure that your assets are protected while you still qualify for Medi-Cal benefits. Contact the attorneys at MMZ Law at (909) 256- 6702 to find out how you can protect your assets and have peace of mind while still utilizing your Medi-Cal benefits.