Medi-Cal is a special federal and state government program that helps seniors fund their long-term care needs, such as paying for a nursing care facility. It’s different from Medicare, which provides health insurance coverage for seniors. Medicare also covers a three-night hospital stay, and up to 100 days in a rehabilitation center, but will not pay for a senior’s daily living assistance needs.
So what happens after Medicare stops paying after the 100 days, and a senior needs to stay in a nursing care facility or get in-home care assistance? That’s typically when seniors look to see if they qualify for Medi-Cal to help fund their long-term care needs.
Unfortunately, most seniors are erroneously told they have to have little to no income to qualify for Medi-Cal. As a result, many seniors who could qualify do not apply and unnecessarily spend thousands of dollars each month paying for care — and many seniors even lose their entire life's savings paying for care! These days, most California nursing care facilities costs an average of $9,000 per month!
The problem is that many well-intentioned hospital social workers and even Medi-Cal eligibility coordinators are not familiar with all the rules for helping a senior meet the qualifications for Medi-Cal. They are familiar with the income and asset requirements that provide only low income seniors can qualify, but don’t know the exceptions to these rules that make it possible for “middle-class” seniors to also qualify.
Seniors also get misinformed from doing Google searches or talking with other seniors who were turned down, simply because they don’t know the exceptions to the Medi-Cal qualification rules. Furthermore, they also don’t realize that the rules and exceptions are different in California than in other states. As a result, “middle-class” seniors in California think they must spend all their assets down to less than $2,000 to qualify for Medi-Cal.
Here’s the truth in California regarding qualifying for Medi-Cal: Seniors almost never need to “spend down” all of their income and assets to qualify for Medi-Cal! Here’s why:
- There are many assets a senior owns that Medi-Cal won’t even count when determining if you meet their income and asset rules. For example, they won’t count your home or your IRA or other pensions plans when adding up your assets to see if you have too many to qualify.
- For those requiring skilled nursing care who are married, special spousal protection rules offer additional benefits for their spouse. This includes income protection in the form of a Minimum Monthly Maintenance Needs Allowance (“MMMNA”), which can be up to $3,090 a month in 2018, and a Community Spouse Resource Allowance (“CSRA”). In 2018, the CSRA is $123,600. However, this allowance can often be increased above $123,600 upon application, sometimes substantially. Bottom line: The CSRA is a sum a spouse is allowed to have without affecting eligibility for their “sick spouse” (in addition to other exempt assets like the home and IRA or pension).
- There are also other legal planning opportunities to make other assets exempt. Typically, an elder law attorney can help exempt other assets by setting up a special type of Medical Asset Protection Trust, which Medi-Cal won’t count as an asset.
If you are a “middle-class” senior and need help funding your daily care, call your Newport Beach, California Elder Law attorneys at the Meier Law firm at (949) 718-0420. Or just click here and give us a little information and we'll call you. We will walk you through the Medi-Cal income and asset requirements, and show you how we can help you qualify even if you still have assets and income in your name.