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1. 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 […]...
2. 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 […]...
3. 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 keep up to $89,280 in resources (property and other assets) while the spouse in a nursing home may […]...
4. 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 […]...
5. 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 […]...
6. Share of Cost – Partnership Policy Covers Question: If a Partnership policy covers a patient’s stay in a private room in a nursing home until policy benefits are exhausted, and the patient transitions into Medi-Cal, with a Share of Cost (SOC), do they have to spend the SOC for services specifically pertinent to the nursing home? Reply: No, the patient can spend […]...
7. Share of Cost, Who pays for IHSS? Share of Cost, Who pays for IHSS?...
8. SOC, Who pays for IHSS? In-Home Supportive Services (IHSS) are financed by state, county, and federal funds. Depending on your countable income, you may have to pay for a portion of the cost of services. This is known as share of cost. If you work, you may qualify for no-cost IHSS even if you think you have to pay a […]...
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. 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 […]...
11. 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 […]...
12. 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 […]...
13. Roundup: In Oregon, New Gov. Kitzhaber Vows To Change State’s Health Care Delivery System; In Ariz., 2nd Person Denied Transplant Coverage Dies Roundup: In Oregon, New Gov. Kitzhaber Vows To Change State’s Health Care Delivery System; In Ariz., 2nd Person Denied Transplant Coverage Dies...
14. State of California Dental Insurance State of California Dental Insurance ...
15. 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 […]...