Medi-Cal Planning
Medi-Cal (known as Medicaid outside of California) provides a variety of benefits to indigent and disabled Californians. Elder law lawyers assist clients to become eligible for the long-term care benefits of Medi-Cal. This includes placement in a skilled nursing facility (SNF) and the ability to use In Home Support Services (IHSS). There are many other Medi-Cal benefits, but we do not know the eligibility requirements for the other benefits.
What is Long-Term Care
Long-term care is the care one needs when he or she can no longer handle activities of daily living (ADLs) alone. These include things like, shopping, preparing meals, dressing, bathing, toileting, eating, managing medications, transferring, etc.
Will Health Insurance and Medicare Pay for Long-Term Care
The short answer is no. The longer answer is after a 3-day hospital stay, if someone needs rehabilitation before going home, Medicare will pay for a stay in a rehab facility (often a SNF), for UP TO 100 days. The “up to” is critical to understand. If the patient is not making weekly progress (as determined by the SNF’s rehab teams), Medicare’s benefits can come to a sudden halt. This is often abrupt and with only a few days’ notice. At this point, the patient is forced to privately pay by the day (several hundred dollars per day) or they are discharged, with often nowhere safe to go. Families are left scrambling and it’s a very stressful experience.
There Are Only Three Ways To Pay for Long-Term Care
- Out of pocket
- Long-term care insurance
- Medi-Cal
What Does Long-Term Care Cost
The cost of care depends upon how much you need and where you live. Below is an average annual cost if you need 24-hour care in Los Angeles. These costs continue to increase as minimum wage and the cost of living increase.
- Private caregiver – $130,000-$240,000+ (private pay vs. using an agency)
- Assisted living – $67,000+ (average)
- Skilled nursing – $111,000+ (semi-private) or $132,000+ (private)
- Residential care home $36,000-$60,000+
While the average duration varies, men usually require 2 years of care before they pass away while women need 4-6 years. Of course, many people require this level of care for over 10 years! Most families will run out of money before their loved one passes away and that is where Medi-Cal Planning becomes invaluable.
What Is Medi-Cal Planning
Medi-Cal is always a last resort for families who cannot afford to pay the long-term care for loved ones. Medi-Cal lawyers help families qualify in advance of needing the benefits and protect the assets for future generations.
At Goldfarb & Luu There are 4 Stages to Medi-Cal Planning
Before you spend money and time with a lawyer, it’s important to understand the options for care for your loved one. We have excellent referral partners to help you with placement or in-home care to make sure you are comfortable.
The rules have drastically changed in this area and will continue to change as of January 2024. For anyone who calls us about Medi-Cal Planning before January 2024, we usually say, wait to do your planning because you may already be eligible and won’t need to pay us to help you.
Until December 31, 2023, Medi-Cal has always been assets based. You can only have limited assets in order to qualify. Currently, an applicant can’t have over $130,000 in countable assets and a spouse can’t have over $148,620 in countable assets or if both people are applicants, they can’t have over $195,000 in countable assets.
There are certain assets that have always been excluded (not countable). The most common ones are: your primary home, personal property, a car, retirement accounts (as long as you are taking your required minimum distributions (RMDs)) and term life insurance.
NOTE: If you receive SSI, the eligibility requirements are different. You may not have more than $2,000 in assets to qualify.
If your income is too high, Medi-Cal requires you to contribute to the cost of your care.
If you live in a SNF, Medi-Cal will take all your income other than $35/month. In 2023, if a Medi-Cal applicant is married, the well-spouse is allowed to keep $3,716 per month in income so as not to impoverish him/her. This number increases every year.
If you live at home and receive IHSS, Medi-Cal uses a formula to figure out your Share of Costs. For the remainder of 2023, if the applicant’s income is less than $1,564 per month, there is no Share of Costs.
Remember, IHSS is a very limited benefit. In Los Angeles County, it pays $17.25 per hour for a caregiver. This dollar amount varies depending upon the county where you live. However, paid caregivers charge a lot more than that per hour. Also, the maximum number of hours per week that you can get through IHSS is 66. Many people are given fewer hours. Often, this is not enough to safely care for someone at home.
Medi-Cal in a Nutshell
We do a lot of Medi-Cal counselling where we help families understand the rules, but traditional Medi-Cal Planning is when someone doesn’t qualify and needs help to become eligible. This is a fine ethical line for us.
Medi-Cal is intended for people who do not have a lot of resources. We help families qualify when they have insufficient resources for long-term care but a little too much to qualify. With the proper planning, the Medi-Cal recipient’s family can even avoid recovery after they are gone.
It’s very important for you to only work with a qualified elder law attorney to guide you through Medi-Cal Planning competently and ethically.
NOTE: In January 2024, Medi-Cal is drastically changing the eligibility requirements. Instead of it being an asset-based requirement, it will become an income-based requirement. We will update this section to describe the new rules.
If you receive SSI, the eligibility requirements are the same as they’ve always been and are not changing. You may not have more than $2,000 in countable assets to qualify.