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1. Share of Cost – Community Spousal Resource Question: What are the community spousal resource limits for 2002 when qualifying for the Medi-Cal nursing home benefit? The 2002 community spouse resource allowances are $89,280 in assets and $2,232 in monthly income. For a married couple with one spouse in a nursing home and the other spouse at home, the spouse at home may […]...
2. How long before applying for Medi-Cal can a person transfer assets? The Medi-Cal “Look-Back” period in California is 30 months. “Transfer” means an outright gift or a “sale” made at less than “fair market value.” If a disqualifying transfer of property is made, Medi-Cal will calculate the period of ineligibility for nursing facility level of care. It will be the number of months resulting when the […]...
3. Share of Cost – Partnership policy Question: If a Partnership policy covers a patient’s stay in a private room in the nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a SOC, and the nursing facility intends to transfer them out of their private room and into a semi-private room, can the patient use their SOC […]...
4. If a person applies for Medi-Cal, can they have a principal residence in another state (outside of California) and still qualify for Medi-Cal? Yes, but the person has to distinguish between “principal residence” and “primary residence”. In other words, they can have a principal residence anywhere, as long as they eventually return to it to live. In order to qualify for Medi-Cal, a person must show that they are presently living in California with the intention to remain […]...
5. How much does a person have to pay for services while on Medi-Cal? The county looks at the applicant’s income after he or she establishes eligibility for Medi-Cal by spending down assets to no more than $89,280 for a couple with one spouse institutionalized or $2,000 for a single individual. The county looks at the income the individual receives in his or her own name and divides in […]...
6. What property/assets are allowable for Medi-Cal? The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant’s property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules. The Medi-Cal eligibility worker looks at how much an applicant and their family has […]...
7. If a Medi-Cal applicant’s spouse transfers assets, will that result in any period of ineligibility for nursing home care? Generally, California will not impose any period of ineligibility for nursing home care on the applicant if his or her spouse previously transferred assets. The exception is if the asset/resource transferred originally belonged to the applicant. In that case, a disqualification period will be imposed if the spouse received the assets from the applicant before […]...
8. Are assets my spouse inherits disregarded for eligibility purposes when I apply for Medi-Cal? For the purpose of estate recovery? In the case of an inheritance, the assets disregarded for determining eligibility are the same as those in a pre-nuptial agreement. The estate recovery program can only file claims against the assets that pass from deceased Medi-Cal beneficiaries to their surviving spouses upon death. Any assets that pass to the surviving spouse before the death […]...
9. Are the assets identified in a pre-nuptial agreement disregarded for the purpose of eligibility when an individual applies for Medi-Cal? What about estate recovery? With a prenuptial agreement, the county considers the living situation of the individual at the time of application in order to determine Medi-Cal eligibility. Let us take at look at three living situations: Example #1: Both spouses are at home. All non-exempt property over $3,000 (including assets identified in a pre-nuptial agreement) is counted in […]...
10. Can a facility transfer or discharge a resident out of the facility because of a change in the resident’s method of payment from private or long-term care insurance payment to Medi-Cal payment? Generally, no. The only exception is if the facility is not certified to accept payment from the Medi-Cal program. In that case, the facility would be allowed to transfer or discharge the resident if the resident’s stay is no longer covered by long-term care insurance and he/she is unable to continue to pay privately. However, […]...
11. Share of Cost – What property/assets are allowable for Medi-Cal? The Medi-Cal program determines eligibility for benefits on a “means” tested basis. If a Medi-Cal applicant’s property/assets are over the Medi-Cal property limit, the applicant will not be eligible for Medi-Cal unless they lower their property/assets according to the program rules. The Medi-Cal eligibility worker looks at how much an applicant and their family has […]...
12. What if the above transfer was to a family member, such as an adult child? The transfer by the applicant’s spouse must be a real gift transfer. If the adult child, for example, is only holding the assets, it probably really is a trust. In that case, the transfer could either cause a period of ineligibility or simply result in the assets continuing to be counted as available to the […]...
13. Medi-Cal Claims: A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi-Cal can result in the denial of correct claims billed by another provider. This often occurs between […]...
14. Where can I get more information on Medi-Cal Eligibility? You can find more information by downloading a copy of “Before You Buy,” found on the Partnership’s web site. This document, which provides an explanation of asset protection and Medi-Cal Eligibility rules, must be provided to consumers when long-term care presentations are made, in compliance with Partnership regulations. “Before You Buy” is updated annually with […]...
15. Can a nursing home resident give away their income, or does it need to be spent on medically necessary care? Let us say a person is in a nursing home and wants to give their grandchild $50 for their birthday. Can they do that? There is currently no transfer of income penalty in California. However, a nursing home resident’s income must be used to meet their SOC, or Medi-Cal will pay for NO services during that month. The nursing home resident is allowed only $35 for personal needs. It is fine if he/she wants to give their $35 away, […]...