Medi-Cal

Q. What is Medi-Cal?
A. Medi-Cal is California’s version of Medicaid. Medi-Cal helps pay for the medical care of public assistance recipients and certain low income people. It is administered by the Department of Health Care Services (DHCS). For the purposes of elder law, Medi-Cal is important because it funds long-term skilled nursing home care for many who could not otherwise afford it. In certain circumstances, it also helps fund in-home care. However, Medi-Cal covers many other forms of medical care for many other people.

Q. How is Medi-Cal different than other public programs?
A. California seniors have several public assistance programs available to them. Depending upon the senior’s needs, Social Security, Medicare, Veteran’s benefits, and other resources are available. Social Security offers retirement benefits, disability benefits, and supplemental security income (SSI), for example. SSI is different than the retirement benefit people are most familiar with. SSI provides a basic level of income to seniors, the blind and disabled. It is a needs-based program, and the eligibility requirements are complicated. For a questionnaire to help determine what Social Security benefits you might be eligible for, follow this link.

Unlike Medi-Cal, Medicare is a federal healthcare program providing medical benefits for seniors. Medicare includes funding for doctor visits, procedures and prescription drug programs. Medicare makes only limited payments for skilled nursing care, however, which is why Medi-Cal coverage becomes important in planning for a senior’s future nursing home care.

Q. Who qualifies for Medi-Cal?
A. Medi-Cal eligibility is determined by income and asset level, but it is a complicated formula that changes from year to year. Generally speaking, an individual applicant can only have $2,000 in non-exempt assets. A person’s residence does not count, so long as the applicant states she has an intention to return home. While it is possible to transfer some assets to speed eligibility along, it has to be done very carefully and according to strict guidelines.

Medi-Cal counts all available income when determining eligibility. Medi-Cal calculates the monthly cost of care, called the “Minimum Monthly Maintenance Needs Allowance” (“MMMNA”). The applicant is required to contribute virtually all of her income toward her care. This contribution is called “Share of Cost.” The difference between the applicant’s Share of Cost and the MMMNA is what Medi-Cal will cover.

Does the state have to be paid back when I die? It depends. In theory, Medi-Cal is entitled to be paid back for the money it spent for your benefit on skilled nursing care. However, if you do not have any assets when you die, then Medi-Cal has nothing to collect from. The main asset that is at risk for Medi-Cal “recapture” is the recipient’s residence. Medi-Cal is entitled to place a lien on the recipient’s residence after she passes so that it can get paid. There are ways to plan for this, and an attorney can be particularly useful for planning to deal with Medi-Cal recapture liens.

Q. Does Medi-Cal cover in-home care?
A. Medi-Cal can cover some in-home care in certain circumstances. The program is called In Home Social Services (“IHSS”), and has stricter eligibility requirements than Medi-Cal.

Q. Why do I need an attorney to apply for Medi-Cal?
A. You may not need an attorney to apply for Medi-Cal. When eligibility is clear, the application can be a simple process. Attorneys are useful primarily in the planning process, especially to plan appropriate transfers of assets and to deal with recapture issues. There are a number of non-attorney Medi-Cal planners out there; some are unscrupulous scam artists and more expensive than attorneys. There is a lot of bad advice out there, especially involving trusts and annuities as part of Medi-Cal planning. It can be money well spent to consult with an attorney familiar with Medi-Cal planning in order to be protected down the line.