Guiding Clients Through Medi-Cal Eligibility and How Proper Estate Planning Can Help
As we age, it’s normal for health care expenses to increase due to medical conditions or the need for more in-depth or long-term care. In California, the average cost of an assisted living facility is $5,250 per month. For seniors on a fixed income, this can be difficult if not impossible to afford.
Seniors who qualify for Medi-Cal can get help paying for these and other medical care costs, but there are regulations and eligibility requirements to be aware of. Taking the time for Medi-Cal planning before you need to apply can ensure that you are able to maximize your benefits.
Create a plan for your future with the help of our Medi-Cal planning attorneys. We can talk with you about what your long-term care planning needs are and what strategies you can use to protect your assets and avoid penalties when applying for Medi-Cal. Call our office to schedule an initial consultation.
What Is Medi-Cal?
Medi-Cal is the Medicaid program for the state of California. It is designed for those who are considered low income, and there are no copays or monthly costs. It works similarly to private health insurance by paying the health care provider directly for the services. The Medi-Cal rules ensure coverage for things like:
- Doctor’s visits, including primary care providers and specialists
- Prescription medications
- Vision and dental care
- Mental health care
- Hearing aids
- Long-term care, including a skilled nursing facility or nursing home
- In-home care
- Emergency medical services
Anyone is able to complete the Medi-Cal application process, but when it comes to determining eligibility, there are specific income and asset requirements to be aware of. Medi-Cal planning involves working with an attorney to figure out the best way to protect as much of your assets as possible without impacting your eligibility.
What Are the Asset Limits to Qualify for Medi-Cal Benefits?
Because Medi-Cal benefits are reserved for low-income residents of California, the Medi-Cal application and Medi-Cal rules require that you meet certain income and asset limits. However, the Medi-Cal eligibility requirements are changing as of 2024. Previously, applicants had to have less than $130,000 worth of assets.
If there was more than one person in the household, this limit was raised by $65,000 per person. So, a married couple would be able to have a total value of assets of $195,000 or less. There was also a community spouse resource allowance, which meant that up to $148,620 or 50% of the assets could be exempted by a spouse who was not applying for Medi-Cal.
However, as of 2024, there are no longer asset limits to qualify for Medi-Cal benefits. This is a substantial change to the way this program works, but it can help seniors be able to keep their assets without having to sacrifice help with medical expenses. If you are planning to apply for Medi-Cal or have already started the process, talk to a Medi-Cal planning attorney to find out how this change may affect you.
How Does Income Affect Medi-Cal Eligibility Requirements?
The income requirements are based on the federal poverty level and vary by the number of people in the household. To qualify for Medi-Cal, a married couple would need to have less than $27,214 in annual income. The more people in your household, the larger the income that is allowed.
Keep in mind that the income requirements include the income for everyone in the household even if they aren’t applying for Medi-Cal; although, there may be some exceptions. These guidelines change frequently as the federal poverty guidelines are adjusted. If you’re not sure if you qualify for a Medi-Cal program or whether you would be better served by traditional health insurance or Covered California, a Medi-Cal attorney can help.
What Is a Medi-Cal Asset Protection Trust?
One important tool in Medi-Cal planning is a Medi-Cal Asset Protection Trust. This trust can help you qualify for Medi-Cal by protecting your assets in a trust so that they don’t count against the Medi-Cal eligibility requirements or Medi-Cal’s resource limits.
While the asset limits are going away in 2024 for non-modified adjusted gross income (MAGI) plans, there will still be limits for regular MAGI plans. These plans apply to a Medi-Cal recipient under the age of 65. Medi-Cal has a lookback period for assets, so it’s important to talk with an attorney about how and when a Medi-Cal asset protection trust may be appropriate for your situation.
What Should I Bring to My Appointment With a Medi-Cal Planning Attorney?
When you’re working with a Medi-Cal planning attorney, the first step is generally to have an initial consultation where you will learn more about what it means to be a Medi-Cal applicant and what the process looks like. This also gives the Medi-Cal recipient a chance to ask questions about their specific circumstances and needs. You will need to bring copies of your financial information with you, including bank statements, retirement account statements, and any other information related to your income or assets.
Medi-Cal planning is complex, and the earlier it is done, the better your chances are of protecting your legacy. Call MMZ Law at 909-347-7444 to speak to one of our Medi-Cal planning attorneys and find out how the recent changes to Medi-Cal may impact your future.