Medi-Cal Planning in Torrance, CA

Long term care for you or your loved one is not only a difficult decision but an expensive one that can quickly drain your family’s financial resources. The average cost of nursing homes in California for 2018 is $8,841.00. Unfortunately, heath insurance and Medicare will not pay for long-term care. That’s where Medi-Cal comes in to play. Medi-Cal is a needs-based program, subject to certain federal requirements, as well as California’s own regulations, that can be a vital lifeline for you or your loved one in later stages of life.

Even if you or a loved one is not initially eligible for Medi-Cal, we will help you determine a plan that may grant eligibility.

ARE YOU ELIGIBLE FOR MEDI-CAL?

Medi-Cal classifies property as “exempt” and “non-exempt”.  Your home, if it’s your primary residence, and your vehicle, do not count in determining eligibility, as they are “exempt” assets.

SSI and other categorically-related recipients are automatically eligible. Others, whose income would make them ineligible for public benefits, may also qualify as “medically needy” if their income and resources are within the Medi-Cal limits, (current resource limit is $2,000 for a single individual). This includes:

• Low-income persons who are 65 or over, blind or disabled may qualify for the Aged and Disabled Federal Poverty Level Program
• Low-income persons with dependent children
• Children under 21
• Pregnant women
• Medically indigent adults in skilled nursing or intermediate care or those who qualify for Medi-Cal funded home and community based waiver programs.

While eligibility primarily depends on the amount of income and resources you have, there are special rules that govern Medi-Cal eligibility. We navigate the Medi-Cal system every day, so you can rest easy as we walk you through the application process. We are here to provide you peace of mind, and we will take the time to make sure you understand how this all works.

SHARE OF COST

Individuals whose net monthly income is higher than the state payment rate may qualify for the program if they pay or agree to pay a portion of their income on monthly medical costs. This is called the share of cost. Individuals eligible with a share of cost must pay or take responsibility for a portion of their medical bills each month before they receive coverage. Medi-Cal then pays the remainder, provided the Medi-Cal program covers the services. This works much like an insurance deductible. The amount of the share of cost is equal to the difference between the “maintenance need standard” and the individual’s net non-exempt monthly income.

Since January 1, 1990 the maintenance need standard for a single elderly/disabled person in the community has been $600 monthly; the Long Term Care maintenance need level (i.e., personal needs allowance when someone is in a nursing home) remains at $35 monthly for each person.

WHAT DOES MEDI-CAL COVER?

Medi-Cal pays for health care services which meet the definition of “medically necessary.” Services include: some prescriptions (although the Medicare Part D program now covers most prescriptions), physician visits, adult day health service, some dental care, ambulance services, some home health, X-ray and laboratory costs, orthopedic devices, eyeglasses, hearing aids, some medical equipment, etc.

All covered services, or the remaining costs over the share of cost of nursing home care, will be covered if the individual meets income/resource requirements. Some services such as home health care, durable medical equipment, and some drugs require prior authorization.

Nursing home care is covered if there is prior authorization from the physician/health care provider. Residents are admitted on a doctor’s order and their stay must be “medically necessary”. Residents are allowed to keep $35 of their income as a personal needs allowance. Residents with no income may apply for the Supplemental Security Income/State Supplemental Program (SSI/ SSP), and, if eligible, they will receive a payment of $50 as a personal needs allowance.

MEDI-CAL PAYBACK

Unfortunately, qualifying for Medi-Cal is only the beginning of the process. When a Medi-Cal recipient passes away, Medi-Cal wants to get paid back. However, there are ways to protect your assets from Medi-Cal recovery and we will help you plan for that stage of the process.

We invite you to learn about our Medi-Cal services by contacting us online or by phone 310-402-2844. Based in Torrance, our lawyers serve clients throughout Southern California.